for MBBS students

1. Dr. Anjali Wagh.
Prof. & HOD
Dept. of Community Medicine
D.Y.Patil Medical College, Kolhapur

2. Medical care:
personal services provided directly by physicians.
Health care :
Integrated care including preventive, promotive,
curative, rehabilitative services for individuals from
womb to tomb.
Health care includes medical care.

3. The three tier system of health careThe three tier system of health care
Tertiary level [Regional hospital,
medical college hospital]
Secondary level [community
health centre, district
hosp.]
 Primary level
[primary health
centre, sub centre]

4. Primary health care
Village level [grass root level]-
First level of contact bet n. health system and
individual
Provided by –Village health guide
Traditional birth attendant/dai
Anganwadi workers
ASHA

5. Secondary health care
The First referral level
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
Tertiary health care
Offers super-specialist care
Provided by regional/central level institution.
Provide training programs

7. EVOLUTION OF PRIMARY HEALTH
CARE
The Alma-Ata Conference
International conference on primary health care
Conducted from 6-12th September 1978 at Alma Ata
Mile stone in the history of public health
Key to the attainment of the goal of the Health for All

9. Primary health care
The “first” level of contact between the
individual and the health system.
Essential health care (PHC) is provided.
A majority of prevailing health problems can
be satisfactorily managed.
The closest to the people.
Provided by the primary health centers.

10. PRIMARY HEALTH CARE
“Primary Health Care is
essential health care made
universally accessible to
individuals & acceptable to
them, through their full
participation & at a cost the
community & country can
afford”.

11. Characteristics of PHC
COST EFFECTIVE HEALTH
CARE

13. The Basic Requirements for Sound PHC
(the 8 A’s and the 3 C’s)
Appropriateness
Availability
Adequacy
Accessibility
Acceptability
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity

14. Attributes of Primary Health care

15. Elements of Primary health care

16. Elements of Primary health care
1

17. Services in Primary
Health Care
1. Health
Education
concerning
prevailing health
problems and
the methods of
preventing and
controlling

18. 2.Promotion
of food
supply and
proper
nutrition.

19. 3. An
adequate
supply of
safe water
and basic
sanitation.

20. 4. Maternal
and child
health care,
including
family
planning.

21.  5.Immunization
against major
infectious diseases.

22. 6. Prevention and control of
locally endemic diseases.
7. Appropriate treatment of
common diseases and injuries.

23. 8. Provision
of essential
drugs

24. Principles for primary health carePrinciples for primary health care
 PHC based on the following principles

25. Equitable distribution
 ‘ Key’ principle of Primary Health Care
• Remove social injustice & services must be equally
distributed to all people of the community.
Irrespective of the cast, religion, community & ability
to pay ( rich or poor), urban or rural
Services must be accessible to all.
Needy & vulnerable group of population like
poor rural and urban slum.

26. EQUITABLE DISTRIBUTION
Access to health care - horizontal equity & vertical equity
Horizontal equity - “equal access for equal needs”
equal resources
equal access to health care
equal utilization of health services
equal health

27. EQUITABLE DISTRIBUTION
Vertical equity - unequal should be treated in proportion of
their inequality
Individuals with more need should have more treatment
The central theme of “need” therefore determines equity

28. Examples of equitable distribution in access to health care in
India:
Tripura- helicopter service to reach the remote set of tribal
hamlets
Andhra Pradesh- free bus passes to pregnant women for the
antenatal visits
Assam - Akha-ship to provide primary care services in riverine
Island through boat clinics
Tamil Nadu – concept of birth resorts is introduced in remote
and hilly areas for institutional deliveries

29. 2) Community Participation
“Promote maximum community and individual self-
reliance and participation in the planning, organization,
operation and control of primary health care, making
fullest use of local, national and other available resources;
and to this end develop through appropriate education the
ability of communities to participate”
Cost effective method.
 Placing the health of people in their hands – It is by the
people, of the people and for the people.
‘Democratization’ of health services

30. COMMUNITY PARTICIPATION
Involvement of the individuals,
families and community
Determines both collective needs and priorities
Important role in formulating a health problem, make informed
choices ,objectives with community priorities
Universal coverage cannot be achieved without the involvement
of the local community

31. Types of community participation
Active - co-operation + resources, Passive -
cooperation
Marginal – limited, transitory participation of people
e.g. organization of camp with local support
• Substantial – community plays active role in
determining priorities & helping carrying out health
activities like health education, hygiene maintenance
e.g. Panchayati Raj Institutions
• Structural – community becomes integral part of
program & major basis of health activities

32. Planning steps in community participation:
Identification and prioritization of the problems
Planning together
Implementation by community members
Evaluation by community members

33. Examples of community participation in India:
Village health guides, trained dais, ASHA
Selected by the local community and trained locally
Essential feature of health care in India

34. Bare foot doctors:
 In China, lack of availability of rural
health services was addressed from 1965 to 80
by development of bare foot doctors.
 Rural farm workers were given basic heath
training to provide combination of traditional
and western medicine.
 Regarded as model for development of
community health workers

35. Advantages of community participation
Cost effective method of providing health services
People begin to view health more objectively, they are
more likely to accept the care
Greater commitment of the people resulting in the
success of health care services
Health awareness in village people
Health workers get support for their activites
Health care services become more relevant to the
health needs of the people
Quality of health care improves

36. 3) Intersectoral co-ordination
“Involve, in addition to the health sector, all related
sectors and aspects of national and community
development
 agriculture
 animal husbandry
 food industry
 education
 housing
 public works
Communication
Voluntary organisation

37. Intersectoral co-ordination
Education
Voluntary agencies Agriculture
Municipal bodies Fisheries
Health Sector
Transport Animal husbandry
Information and broadcasting

38. Pre-requisites for Intersectoral Coordination:
Proper orientation of policies and programme
Formation of joint coordination committee at each level
Defining role and responsibilities of participatory agencies
Participatory decision making
Developing formal system of interaction, discussion and
debate
Sharing of the problems faced in implementation

39. Mechanism of co-ordination:
List out names of different sectors
Identify the NGOs and voluntary organisation
Constitute the district level co-ordination committee
Formulate specific task forces
Jointly decide the objectives and areas
Decide the role and responsibility
Development a plan

40. Difficulties facing intersectoral co-ordination:
Create conflicts of interest and disequilibrium
Power struggles
Agencies must be able to compromise and impose change on the
normal working patterns
Cultural changes may occur within organisations
Co-ordination may turn out to be more expensive in terms of
time, money and manpower

41. Irrespective of the disadvantages, intersectoral coordination is
the key principle outlined by WHO if Health for All has to be
achieved
An outstanding example of the intersectoral coordination at the
grass root level - Anganwadi as a part of ICDS programme

42. 4) Appropriate technology
Technology of Health care service provided must be
Simple,
 Scientifically sound,
 Practically adaptable,
Culturally acceptable ,
 Economically cheaper
Operationally convenient,
 Maintainable with local resources
Acceptable to users and recipients

43. 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 is maintained by the people themselves in
keeping with the principle of self reliance with the resources
the country and the community can afford”

44. Examples for the appropriate technology
Use of coloured tapes for measuring mid upper arm
circumference
Use of ORS
Tender coconut for oral hydration
Growth chart maintenance for under five children
Low cost mosquito repellent creams
Simple water purification

45. Informational technological advancements that have been
proven to ultimately enhancing the service delivery-
Health Management Information System
Telemedicine
Immunization programs,
 DOTS , Nutritional supplementation
Distribution of DDK for domiciliary midwifery services
Distribution of IFA tablets
Biogas plant for cooking, heating and lighting.
Smokeless chulhas for cooking

46. To Summarize
Primary care is an approach that:
Focuses on the person not the disease, considers all
determinants of health
Integrates care when there is more than one problem
Uses resources to narrow differences
Forms the basis for other levels of health systems
Addresses most important problems in the
community by providing preventive, curative, and
rehabilitative services
Organizes deployment of resources aiming at
promoting and maintaining health.

47. “When We talk about capacity, We absolutely must talk
about the importance of primary health care. it is the
cornerstone of building the capacity of health systems”
- dr. margaret chan
director general
Who

48. THANK YOU