The document discusses primary health care, including its conceptualization, philosophy, principles, strategies, and models. It describes the key outcomes of the 1978 Alma-Ata Conference, including its 10 declarations and 22 recommendations which established primary health care as a global health strategy focused on achieving health for all by 2000 through equitable access to comprehensive services. The document also analyzes selective and comprehensive primary health care approaches and outlines the basic components, principles, and operational aspects of primary health care delivery within national health systems.

1. Primary Health Care
Ashok Pandey
111/19/17

2. Content
Concept of Primary Health Care
Conceptualizing Primary Health Care
– Hardware
– Software
Philosophy of Primary Health Care
Health for all Strategy by 2000 AD
Aspects of Primary Health Care
Importance of Primary Care
Difference between Primary Health Care vs.
Primary Care
Linkage of Primary Health Care to a health system
11/19/17 2

3. Content……..
Declaration of Alma-Ata Conference
Ten declarations of Alma-Ata Conference (1978)
The twenty-two recommendations of the Alms Ata Conference.
The twenty-two recommendations of the Alma Ata Conference by
describing the Conference topic with Recommendations
Principles and strategies of Primary Health Care
•Basic component of Primary Health Care / 8 Essential
Component / Elements
•Levels of Health Care
•Basic Requirements for Sound Primary Health Care
•Strategies of Primary Health Care
•Principle of Primary Health Care
11/19/17 3

4. Content….
Critically analyze the Comprehensive and Selective Primary Health Care
(PHC)
•Various Approaches to Primary Health Care
•Models of primary health care
•Selective Primary Health Care with advantages and disadvantages
•Comprehensive Primary Health Care with advantages and disadvantages
Overview of operational aspects of PHC
•Operational Aspects of Primary Health Care
•Primary health care within the health system
Role of the District Public Health Office in meeting Basic Health Needs.
•Fundamental health needs
•Basic Minimum health needs
•Policies of Basic Minimum Needs
•Role of District public Health officer
•Role of District public officer in meeting basic health needs
11/19/17 4

5. Content…..
Health Care Concepts and Challenges
•Concept of health
•Concepts of health care
•Challenges health care
•Challenges health care in Nepali context
Challenges and obstacles to PHC: selective PHC, cost recovery of health
services, Structural adjustment programs and investing in health care.
• Functions of Primary Health Care
•Obstacles to the implementation of the Primary Health Care strategy
•Major assaults of Primary Health Care
•Structural adjustment programmes and user-financed health services,
introduced in the 1980s
•Criticism of SAP concern in social sector
•World Bank
11/19/17 5

6. Content……
Concept and importance of revitalization of PHC
•Background outline of revitalization of PHC
•Concept of revitalization of PHC
•Importance of revitalization of PHC
New challenges of revitalization of PHC in Nepal
Approach of health protection, community based health insurance and urban
health
•Approaches of protection Health
•Health Insurance Rules
•Models of health insurance
•Community based health insurance
•Benefits of community-based health insurance
•Urban health insurance
•Benefits of urban health insurance
Free health services and essential health care service in Nepal
•Concept of free health services
•Essential health care service in Nepal
•Essential health care service delivery in urban areas of Nepal
11/19/17 6

7. The world apart
In mid 60s
Indicators Developing Developed
countries countries
IMR 160 19
Life expectancy 45 years 72 years
GNP $170 $6,230
Health expenditure 1% 4%
711/19/17

8. 11/19/17 8

9. Specific facts
Country IMR <5MR
per 1,000 live births
Mali 233 400
Sierra Leon 219 385
Afghanistan 215 360
India 144 230
Nepal 186 279
Sweden 16 20
Netherlands 18 22
Japan 31 40
911/19/17

10. What makes difference
Child A Diarrhoea Recovers
Child B Diarrhoea Dies
Suffering from the same disease,
why some die while other recover ?
1011/19/17

11. New commitments
In 1977, the 30th World Health Assembly
The main social target of governments and
WHO should be the attainment by all people
of the world at a level of health that will permit
to lead a socially and economically productive
life by 2000.
This is what we called
HEALTH FOR ALL BY 2000
1111/19/17

12. Primary Health Care
Historical Background
Investment on health
Results
Global experiences of alternative
approaches
1211/19/17

13. What was admitted?
Health status of hundreds of millions of
people in the world today is unacceptable,
particulaly in developing countries. More
than half of the population in the world
does not have the benefit of the proper
health care
From Alma-Ata Declaration. 1978
1311/19/17

14. A new vision ...
Health is Not merely a technology
Hospitals
Doctors
Medicines
Health is also a human issue
1411/19/17

15. At the centre
Equity and
Justice
Tecnology for all to them who need it
1511/19/17

16. Conceptualizing Primary Health Care
Primary Health Care
Hardware Services
Elements
Structure
Persons
Equipment, etc.
Software Philosophy
Principles
1611/19/17

17. Philosophy and Principles
Right to live and Social justice
Relation between state and citizen
responsibility of the government
responsibility of the citizen
individually and collectively
1711/19/17

18. Paradigm shift
Liberated Health from imprisonment of
technology
Technical Societal
paradigm paradigm
1811/19/17

19. At the end of the Century
How equitable is the globe?
Countries IMR Life expectancy
USA 7.2 72 years
UK 5.7 74 years
Nepal ? ?
1911/19/17

20. Equitable planet ... ...
Countries Health Hospital beds
expenditure per 100,000 pop.
USA $ 6,000
UK $ 2,500 413
EU average $ 2,500 630
Nepal ? ?
2011/19/17

21. Discrepancies ...
... Exist even within a poor country
Life expctancy IMR
Kathmandu 71 years 40
Mugu 34 years 110
... ... ...
2111/19/17

22. Dreams ...
... Came true or shattered
What happened with the Primary Health Care
Was PHC a wrong path?
Was PHC treated wrongly ?
2211/19/17

23. Fate of PHC
McDonaldization of health care
Medicalization of health problem
2311/19/17

24. Setbacks ...
Selective primary health care
Cost sharing, cost recovery
Investing in health
2411/19/17

25. PHC beyond the national boundaries
Key players
World Bank
International Monetary Fund
Multinational Corporates
2511/19/17

26. Beyond the national boundaries
Structural Adjustment Programme
World Trade Organization
2611/19/17

27. Equation
SAP WTO
Creates gap Creates market
2711/19/17

28. Ultimately ...
Role of the state
Role of the people
What Next ?
2811/19/17

29. but
PHC is now more
than
ever
2911/19/17

30. Primary Health Care

31. Health Care
• Health is fundamental human right.
• It is the responsibility of the government.
• Current criticism – predominantly urban oriented
- mostly curative
- accessible mainly to small part of
the population

32. Levels of Health Care
primary
Secondary
Tertiary

33. Primary Health Care
• Primary – first level of contact….essential health care
PHC, HP, SHP
• Secondary – complex problems are dealt…
district hospitals, Zonal Hospital
• Tertiary – specialized level ….medical colleges,
specialized hospitals

34. District hospital
Primary health centre
Health Post
Sub Health Post

35. Primary Health Care
• In the year 1946 Sir Joseph Bhore
recommended in his report
• A PHC for every 30,000 pop & 20.000 pop in
hilly areas

36. Concept of Primary Health Care
• PHC is for all specially the needy
• Regardless of social and economic status every
individual in the nation must have access to good health
care
• The services should be acceptable to the community and
there must be active involvement of the community
• The health services must be effective, preventive,
promotive and curative
• The services should form an integral part of the country’s
health system
• The programme must be efficient, multi- sectorial
because health does not exit in isolation
11/19/17 36

37. ALMA ATA DECLARATION
‘The main goal of Governments and
World Health Organization in the
coming decades should be the
attainment by all people of the world by
the year 2000, a level of health that
would permit them to lead a socially
and economically productive life’
51ST
WHA in 1998 reaffirmed the
declaration for the 21st
century

38. Themes Leading to
Alma Ata
1. Changing theories of health &
development: shift away from GNP as
measure of development towards
recognition of the need of social
development
2. Concerns about poverty & population
control
3. Increasing reliance upon alternative
approaches to medical care model
4. Success of CHWs & associated
emphasis on community participation
5. Revival of interest in public health;
tackling causes of ill health rather
than symptoms

39. Primary Health Care
• Definition:
In 1978 the alma-Ata conference( USSR)
“Is the essential health care made universally
accessible to individuals and acceptable to them ,
through their full participation and at a cost the
community and country can afford.”

40. PRIMARY HEALTH CARE
Definition:
PHC is essential health care based on practical,
scientifically sound, and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation and at a
cost that the community and the country can
afford… It forms an integral part of the country's
health system, of which it is the central function
and the main focus, and of the overall social and
economic development of the community

41. 10 Declaration of Alma-Ata Conference
11/19/17 41

42. I
• Health
• fundamental human right
• joint action
11/19/17 42

43. II
• Existing gross inequality in the health
status of the people particularly between
developed and developing countries
11/19/17 43

44. III
• The economic and social development
• “Health for all” objective,
11/19/17 44

45. IV
• People have the right and the duty to
contribute, both individually and
collectively, to the process of planning and
implementing health-care practices.
11/19/17 45

46. V
• Governments are responsible for the
health-state of their populations
11/19/17 46

47. VI
Primary health care is considered essential
medical care ,being based on acceptable
scientific and social methods and technologies,
accessibile to individuals and families belonging
to all communities,
11/19/17 47

48. VII
• Primary health care:
11/19/17 48

49. VIII
• All governments should establish national
policies, strategies and action plans in
order to organize and support primary
health care practices.
11/19/17 49

50. IX
• Cooperate as partners,
• WHO/UNICEF
11/19/17 50

51. X
• Better and more complete use of
global resources,
• Alma-Ata also set 22
recommendations,
11/19/17 51

52. The twenty-two recommendations of the
Alms Ata Conference.
11/19/17 52

53. Basic Components of Primary
Health Care
(WIMEN & CHD)
1. Water & Sanitation,
2. Immunizations,
3. Mother & Child Care (&FP),
4. Essential Drugs,
5. Nutrition & Food
6. Curative Care,
7. Health Education,
8. Disease Control
11/19/17 53

54. COMPONENTS OF PHC
1. Education concerning prevailing health
problems & the methods of preventing &
controlling them
2. Promotion of food supply and proper
nutrition
3. An adequate supply of safe water and basic
sanitation
4. MCH including FP
5. Immunization against major infectious
diseases
6. Prevention and control of locally endemic
diseases
7. Appropriate treatment of common diseases
and injuries

55. Principles and strategies of
Primary Health Care
11/19/17 55

56. Principles of primary health care.
• Equitable distribution- urban & rural areas
• Community participation – trained SBA
• Intersectoral co-ordination- education , nutrition..etc
• Appropriate technology – ORS, growth monitoring
• Focus on prevention activities- Polio, Malaria

57. 1. Equitable distribution
• The first key principle in primary health care strategy is equity or
equitable distribution of health services
• Countries should find means to ensure every person’s access to
services.
• Something for all and most for those who need the most
• Health services must be shared equally by all people irrespective of
their ability to pay and all ( rich or poor, urban or rural) must have
access to health services
• health services are mainly in towns Inaccessibility to majority of
population
• Social injustice
• Availability -Insurance
11/19/17 57

58. 2. Community participation
• There must be a continuing effort to secure
meaningful involvement of the community in the
planning, implementation and maintenance of
health services, besides maximum reliance on
local resources such as manpower, money and
materials
• Community involvement: the involvement of
individuals in promoting their own health is
essential for the future well-being of the
community.
11/19/17 58

59. 3. Intersectoral coordination
• "primary health care involves in addition to
the health sector, all related sectors and
aspects of national and community
development, in particular agriculture,
animal husbandry, food, industry,
education, housing, public works,
communication and others sectors".
• To achieve cooperation planning at
country level is required to involve all
sectors11/19/17 59

60. 4. Appropriate technology
• "technology that is scientifically sound,
adaptable to local needs, and acceptable
to those who apply it and those for whom
it is used, and that can be maintained by
the people themselves in keeping with the
principle of self-reliance with the resources
the community and country can afford"
• Should be acceptable, cost-efficient,
cheap and available at the local level
11/19/17 60

61. 5. Focus on the prevention
activity
Acquiring knowledge, through education for health
and/or the mobilization of communities for
immunization; the role of communities in making
decisions related to the provision of resources
for medical priorities. As prevention is essential
for solving the long-term problems of the
community, though it is not always the solution
to individual problems, preventive services
should exist alongside curative services.
11/19/17 61

62. Strategies of PHC
1. Reducing excess mortality of poor marginalized
populations:
PHC must ensure access to health services for the most
disadvantaged populations, and focus on interventions
which will directly impact on the major causes of
mortality, morbidity and disability for those populations.
2. Reducing the leading risk factors to human health:
PHC, through its preventative and health promotion roles,
must address those known risk factors, which are the
major determinants of health outcomes for local
populations.
11/19/17 62

63. 3. Developing Sustainable Health Systems:
• PHC as a component of health systems must
develop in ways, which are financially
sustainable, supported by political leaders, and
supported by the populations served.
4. Developing an enabling policy and
institutional environment:
• PHC policy must be integrated with other
policy domains, and play its part in the pursuit of
wider social, economic, environmental and
development policy.
11/19/17 63

64. Models of primary health care
11/19/17 64

65. Critically analyze the Comprehensive and
Selective Primary Health Care (PHC)
11/19/17 65

66. SELECTIVE
PRIMARY HEALTH CARE
PHC implies that if one cannot afford
to offer universal coverage for even
the most basic of health care, one
could would offer treatment &
preventive strategies for the few
diseases identified as having the
greatest threat to mortality, & which
are amenable to prevention / cure at
low cost.

67. • Selective PHC was evolved from the broader concept of PHC. It is a
more cost focused approach than the traditional PHC and tries to
improve the health of a wide range of people
• An important part of selective PHC was the creation of political will
for funding opportunities.
• Selective PHC: “old wine in new bottles”
• These are the original diseases on which SPHC should focus:
• Diarrhoea
• Measles
• Malaria
• Whooping cough
• Neonatal tetanus.
• By 1988, acute respiratory infections gained weight (Warren 1988:
900).
11/19/17 67

68. Selective PHC
ADVANTAGES
1.Donor friendly
2.Elimination of
selected disease
3.Easy to plan &
implement
4.Is focused & have
more impact
5.Easy to manage &
measure output
6.Require limited
resources
7.Improve quality of
services
DISADVANTAGES
1. Disease rather than
health oriented
2. Doesn’t ensure equity
3. Top down decision
making
4. Neglect other problems
5. Leads to outbreak
6. Resources (tight) might
not be available for
urgent needs
(emergencies)
7. Less community
involvement– donor
priority

69. Comprehensive PHC
• Acknowledges other factors that contribute to poor
health including:
• social influences which look at the
– impacts of the key determinants of health which leads to the
social determinants of health
• Social justice and equity
• Community control
• Social change
• Manages factors that generate ill health
• Involves an approach to health care over a continuum
from health promotion to illness treatment
11/19/17 69

70. Comprehensive PHC
ADVANTAGES
1.Looks at total health
care
2.Involvement of
community
3.Covers all elements
of PHC
4.Ensures equitable
distribution of
resources
5.Facilitates effective
referral system
6.Government goal
DISADVANTAGES
1. More costly to
implement
2. Takes long time to
see impact
3. Long time to process
4. Lack of specialized
treatment
5. Expensive
6. Inefficient referral
system ???-- misuse

71. Overview of operational aspects
of PHC
1. Primary health care within the health system
2. Planning
3. Planning and organization of PHC in a community
4. Coverage and accessibility
5. Appropriate health technology
6. Human resource
7. Community health workers
8. Traditional medical practitioners
9. Family members
10.Referral system
11/19/17 71

72. 11. Logistics of supply
12. Physical facilities
13. National managerial process
14. Budgeting
15. Decentralization
16. Control
17. Evaluation
18. Information
19. Research
20. Financing
11/19/17 72

73. Role of District public officer
in meeting basic health needs
• Need: Circumstances without which something is lacking and
missing
• Basic Minimum health needs: requirements needs to improve the
health status of people
• On the 16th Dec 1985, His majesty the king Birendra declared the
“Basic Minimum needs” to provide basic Nepalese people.
• Policies of Basic Minimum Needs: Food grain, Clothing, Fuel
wood, Drinking water, Primary and skill oriented education,
Minimum rural transportation facilities
• Basic Minimum health needs: Child spacing, Oral rehydration,
MCH, Immunization, Nutritional services, ARTI
11/19/17 73

74. Role of District public Health
officer
• FP/MCH Services and Systems.
• NGO/CBO Partners
• Supervision
• VDC Capacity Building
• Decentralization
• Coordination and Communication
• Policy Dialogue
• Information System
• Co-ordination and supervision of all governments, non-government and
primary health services within the districts
• Preparation of periodic and annual plan
• Organisation and running of the district hospital services
• Management of all Govt. PHC services
• Organize in service training
• Conduct operational research11/19/17 74

75. Health care concept and
challenges
Health care concept
• Not only Medical care
• Render comprehensive healthcare
services.
• -Preventive, Promotive and curative
services.
• -Should be as close to the beneficiaries as
possible.
• -Irrespective of their ability to pay.11/19/17 75

76. The Challenges of changing
World
• Unequal growth, unequal outcomes
• Adapting to new health challenges
• Trends that undermine the health
systems’ response
• Changing values and rising expectations
• PHC reforms: driven by demand
11/19/17 76

77. Challenges and obstacles to
PHC:
Selective PHC,
Cost recovery of health services,
Structural adjustment programs and
Investing in health care
11/19/17 77

78. Obstacles to the implementation
of the PHC strategy
• Misinterpretation of the PHC concept
• Misconception that PHC is a 2nd
rate health
care for the poor.
• Selective PHC strategies
• Lack of political will
• Centralized planning and management
11/19/17 78

79. Selective PHC at the end of
1970s
• Focus on GOBI
• Goal: Improved survival rates fir high risk
groups (Children)
• Strategy: Technological interventions that
leave in place the inequities of the
globalization economic order
• Disease in Underdeveloped and
developed countries
11/19/17 79

80. Structural adjustment programmes and user-
financed health services, introduced in the
1980s
• Cutbacks in public spending
• Privatization of government enterprises
• Freezing of wages and freeing of prices
• Increase export of production rather than local consumption
• Reducing tariffs and regulations while creating incentives to attract
foreign capital and trade
• Reducing government deficits by charging user-fees for social
services including health
• Structural Adjustment is a term used to describe the policy changes
implemented by International monitory Fund and World Bank
11/19/17 80

81. • Conditions loans..
• Goal obtaining low interest loans reducing country
balance of payment , promote economic of country and
to pay off debt which the countries have accumulated
• SAPS are economic policies for developing countries
• Promoted by World bank and International Monitoring
fund (IMF)
• Provision of loans conditional for their adoption of such
Policies
11/19/17 81

82. SAP policies include
• Currency devaluation ,
• manage balance of payment ,
• reduction of inflation,
• wage suppression, Privatization,
• Lower tariffs on import and tighter monitory policy
increase free trade,
• Cuts in social spending , and business Deregulations
• Government also interested or reduce their role in the
economy by Privatizing state- owned industries,
including the health sector and opening up their
economy to foreign competitions
11/19/17 82

83. World Bank
• “INVESTING IN HEALTH”, but more accurate
title would be ‘TURNING HEALTH INTO AN
INVESTMENT”
• A masterpiece in disinformation to restructure
health policy to conform to the market friendly
macro-economic paradigm promoted by the
world bank.
• Health care is no longer a basic human right
• Privatization
11/19/17 83

84. Functions of PHC
• Medical care.
• MCH including family planning
• Safe water and basic sanitation
• Prevention & control of locally
endemic diseases.
• Collection & reporting of vital
statistics.
• Education about health.
• National health programmes
• Referral services
• Training of health guides, health
workers, local dais & health assistants

85. Thank you

86. Revitalization of PHC
11/19/17 86

87. 11/19/17 87

88. 11/19/17 88

89. • The Revitalization of PHC has been done in 30th
anniversary year of Alma Ata Declaration in 2008. The
central theme of Revitalization of PHC is “Health System
Strengthening” using PHC approach that can also
accommodate the needs of vertical programmes. The
position and combined advocacy of WHO's global
leadership is an extraordinary moment in WHO's history.
• To improve the health status of people and to ensure
sustainability, revitalization of the tenets of Alma Ata’s
PHC was felt by WHO.
11/19/17 89

90. Revitalizing PHC is outlined
• (1) Reaffirm high political commitment toward PHC.
• (2) Improve health equity through specific actions in the health sector as
well as other sectors
• (3) Foster more effective multisectoral collaboration
• 4) Strengthen health workforce including Community-Based Health Workers
(CBHW) and Community Health Volunteers (CHV).
• (5) Implement equitable health-care financing such as tax- based and social
health insurance and various community- based health financing.
• 6) Strengthen partnership with civil society that includes the community, the
private sector and NGOs.
• (7) Promote better transparency and accountability of the health systems
through improved leadership and governance (stewardship).
• (8) Utilize to its fullest various global health initiatives (e.g. Global Fund for
HIV/AIDS, Tuberculosis in Malaria).
11/19/17 90

91. New challenges of
revitalization of PHC in Nepal
• Countries and donors can do to save lives
and avoid disability.
• Three ills of life in the 21st century:
• The globalization of unhealthy lifestyles,
• Rapid unplanned urbanization, and
• The ageing of populations.
11/19/17 91

92. Approach of health protection
1. A systems-wide approach
2. A health system that is progressively
financed, inclusive and equitable
3. A comprehensive approach
4. A community empowerment approach
5. A health system based on the ‘Right to
Health’
6. The appropriate use of technology
11/19/17 92

93. Community based health
insurance and urban health
11/19/17 93

94. Health Insurance :(Definition)
Health insurance term is generally used to
describe a form of insurance that pays for medical
expenses
Health insurance is a type of insurance whereby
the insurer pays the medical costs of the insured, if
the insured becomes sick due to covered causes,
or due to accidents

95. INRODUCTION
WORLD:
• About 13.7 Millions of people around the world →Without the coverage
of insurance
• More than150 million people in 44 million households every year
face financial ruin as a result of large medical bills
• People becoming bankrupt/ indebt ness because of high medical
bill -15 crores/year
• About 33% of the Americans are without the coverage of insurance
• Lack of health insurance affects the health system as a whole, not
only against those who are insured

96. Advantages of health insurance:
• People pay when they are healthy and able
• Patients do not have to meet their entire health care costs, they
contribute small amount
• There is minimal expenses at the time of illness
Disadvantages of health insurance:
• It is administratively more complex
• Conceptually, difficult to explain to the people
• One needs large numbers for it to be successful

97. CLASSIFICATION OF HEALTH INSURANCE:
There are broadly three types of health insurance:
 Social health insurance
 Private health insurance
 Community health insurance

98. Community health insurance/Micro Health Insurance
• Definition: A not- for-profit health insurance, that is organized mainly for
the informal sector and is managed by the community.
Introduction:
 In India first Community health insurance was organized in 1955
 Most of them are organized by NGOs
 Today, there are more than 40 such schemes, covering 4 million people
objectives:
• To improve the access to the health care
• To subsidize the cost of medical care at primary, secondary and
tertiary levels
• To reduce exploitation from money lenders
 To protect households from high medical expenditure
• To encourage peoples participation in health services
• To make medical facilities available at grassroot level

99. Specific “organized” organized communities have been targeted.
Eg Farmers cooperatives in Yashasvini,
students in students health home etc
Patterns of Community Health Insurance:
• Type 1 provider model
• Type 2 Insurer model
• Type 3 linked model:

100. TYPES OF COMMUNITY HEALTH INSURANCE:
1) Type 1 provider model:
NGO HOSPITAL
COMMUNITY
premiu
m
Health care
Eg KLE Hospital

101. In the Provider model:
• Here the hospital organizes the health insurance and is also
provider of care
• Advantages
Cost of treatment is usually low
• Disadvantage:
Quality of care is low
Hospitals do not have much link with the community

102. • Type 2 Insurer model:
NGO HOSPITAL
COMMUNITY
HOSPITAL
Re-imbursement
Reimbursementpremium
Health care

103. In the Insurer model:
• Here NGO acts as a Insurer & organizes the insurance
• It collects premium from the community & then contacts specific
hospitals to provide care
Advantage: Scheme is tailor made to meet the requirements of the
community
Disadvantage : Insurance fund is in danger of becoming bankrupt

104. • Type 3 linked model:
INSURANCE COMPANY
NGO
COMMUNITY
HOSPITAL
Group premium Re-imbursement
Re-imbursement
premium
Health
care

105. Advantages of community health Insurance:
 Creating awareness by the community
 A community can afford to pay the premium
 Management of funds & maintenance by NGO
 The capacity within organization to manage the
programme
 Reason for instituting CHI: eg high medical costs,
financial barriers to health care etc

106. Disadvantages of CHI:
 People pay less premium
 Cost & quality not standardized
 No financial stability
 Most Schemes during membership time

107. Urban Health
11/19/17 107

108. • Around 21 % of the total urban
population lives in and many of slum
populations comprise of
-squatter populations,
-migrant colonies,
-pavement dwellers,
-families on construction sites,
-street children, etc.

109. Concentrate on Urban slums

110. Health Status of Urban Poor
• Health status and access of reproductive and child
health services of slum dwellers is poor and
comparable to the rural population.
• Slum dwellers in cities suffer from adverse health
conditions owing to insufficient services, low
awareness, and poor environment
• Public sector health delivery system in urban,
especially for poor, has so far been sporadic, far from
adequate and limited in its reach.

111. Contd..
• Factors contributing to inadequate reach of
services are
- illegality
- social exclusion of slums
-hidden slum pockets
- weak social fabric
- lacking coordination among various
stakeholders and neglected political
consciousness.

112. Free health services and essential
health care service in Nepal
Free health care service is the health service
provided by the government of Nepal free of
cost. This programme has been launched since
December 2006.
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113. At first free health care services were provided to
poor and vulnerable people seeking services
from PHCC and hospital up to 25 beds capacity.
Since January 2009,
Under the "New Nepal, Healthy Nepal" initiative of
the Government, all citizens are able to access
District Hospitals (DH) and Primary Health Care
Centers (PHCC) without having to pay for
registration: they are eligible for free outpatient,
emergency and in-patient services, as well as
drugs.
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114. In Sub-Health Posts (SHP), Health Posts (HP),
Primary Healthcare Centers (PHC) and District
Hospitals (DH), consultations are free of charge
for everybody, as well as a selection of basic
medicine.
The list of free basic medicine is comprised of 22
items in SHP, 32 in HP, 42 items in PHC and 52
items in DH
11/19/17 114

115. The 6 categories of people entitled to free care
are:
1.poor,
2.ultra poor (those whose income is insufficient to
buy food for their families for up to 6 months),
3.disabled,
4.senior citizens,
5.underserved (ethnic minorities, Dalit people),
6.Female Community Health Volunteers (FCHV).
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116. Essential Health Care Services
Essential health care services are priority
public health measures and essential
curative services that will be available to
the total population. Currently there are
20 elements and out of them 11 are
prioritized elements.

117. Elements of
Essential Health Care … contd.
• Implemented by the public sector*
• Jointly implemented by the MOHP &
Nepal Eyesight Association & alliance**
• Implemented by the ministry of housing
and transport+
• Jointly implemented by the public sector
and NGOs

118. Elements of
Essential Health Care Services
1. Reproductive health services*
2. Immunization*
3. Control of AIDS & STD*
4. Leprosy control*
5. Tuberculosis control*
6. Integrated management of childhood
illness*
7. Appropriate treatment of common diseases*

119. Elements of
Essential Health Care … contd.
8. Nutrition supplementation, enrichment,
education and rehabilitation*
9. Prevention and control of blindness**
10. Environmental sanitation and hygiene+
11. School health services
12. Vector borne disease*
13. Oral health services++
14. Prevention of deafness++

120. Elements of
Essential Health Care … contd.
15. Substance abuse including tobacco
and alcohol control++
16. Mental health services++
17. Accident prevention and rehabilitation
18. Community based rehabilitation++
19. Occupational health++
20. Emergency preparedness &
management*