2. WHO-UNICEF held international conference
in 1978 at Alma-Ata (USSR),the
governments of 134 countries and many
voluntary agencies called for a
revolutionary approach to health care.
The Alma-Ata conference called for
acceptance of the WHO goal for Health for
All(HFA) by the year 2000 and proclaimed
primary health care as a way to achieving
Health for all.
3. PHC (cont.)
The Alma-Ata Conference defined PHC as
follows:-
"Primary health care 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 the community & country can afford to
maintain at every stage of their development in the
spirit of self determination".
4. Definition
• PHC is an essential health care that is a
socially appropriate, universally
accessible, scientifically sound first level
care provided by a suitably trained
workforce supported by integrated referral
systems and in a way that gives priority to
those most in need, maximises community
and individual self-reliance and
participation and involves collaboration
with other sectors.
5. DEFINITION OF PHC (WHO)
• Primary Health Care is essential health
care made accessible at a cost a country
and community can afford, with methods
that are practical, scientifically sound and
socially acceptable.
•
*Reference: Alma Ata Declaration, WHO, Geneva, 1978
6. Elements of PHC
• Education concerning prevailing health
problems and the methods of preventing and
controlling them
• Promotion of food supply and proper nutrition
• Monitoring an adequate supply of safe water
and basic sanitation
• Maternal and child health care, including family
planning
• Immunization against the major infectious
diseases
7. Elements of PHC (cont.)
• Prevention and control of locally endemic
diseases
• Appropriate treatment of common diseases and
injuries
• Basic laboratory services and provision of
essential drugs.
• Training of health guides, health workers and
health assistants.
• Referral services
8. Elements of PHC (cont.)
• Mental health
• Physical handicaps
• Health and social care of the elderly
9. PRINCIPLES OF PRIMARY
HEALTH CARE
• EQUITABLE DISTRIBUTION
• COMMUNITY PARTICIPATION
• INTERSECTORAL COORDINATION
• APROPRIATE TECHNOLOGY
• DECENTRALISATION
10. WHO 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. 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.
12. FOUR SETS OF PHC REFORMS
• Needed for an effective response to the health challenges of today’s
world
• UNIVERSAL COVERAGE REFORMS: systems contribute to health
equity, social justice.
• SERVICE DELIVERY REFORMS: health services as primary care, i.e.
around people’s needs and expectations.
• PUBLIC POLICY REFORMS: reforms that secure healthier communities,
by integrating public health actions with primary care and by pursuing
healthy public policies across sectors
• LEADERSHIP REFORMS:Reforms that replace disproportionate reliance
on command and control on one hand, and laid faire disengagement of
the state on the other, by the inclusive, participatory, negotiation-based
leadership required by the complexity of contemporary health systems
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. Appropriateness
• Whether the service is needed at all in
relation to essential human needs,
priorities and policies.
• The service has to be properly selected
and carried out by trained personnel in
the proper way.
15. Adequacy
• The service proportionate to
requirement.
• Sufficient volume of care to meet the need
and demand of a community
16. Affordability
• The cost should be within the means
and resources of the individual and the
country.
18. Acceptability
• Acceptability of care depends on a variety
of factors, including satisfactory
communication between health care
providers and the patients, whether the
patients trust this care, and whether the
patients believe in the confidentiality and
privacy of information shared with the
providers.
22. Completeness
• Completeness of care requires adequate
attention to all aspects of a medical
problem, including prevention, early
detection, diagnosis, treatment, follow up
measures, and rehabilitation.
24. Continuity
• Continuity of care requires that the
management of a patient’s care over time
be coordinated among providers.
25. Evaluation of HFA : 1979-2006
• Reasons for slow progress:
– Insufficient political commitment
– Failure to achieve equity in acess to all PHC
components
– The continuing low status of women
– Slow socio- economic development
– Difficulty in achieving inter sectoral action for
Health
– Unbalanced distribution of resources
26. Reasons for slow progress
(contd.)
• Widespread inequity of health promotion efforts
• Weak health information systems and lack of
baseline data
• Pollution, poor food safety, and lack of water supply
and sanitation
• Rapid demographic and epidemiological changes
• Inappropriate use and allocation of resources for
high cost technology
• Natural and man made disasters
27. 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
28. 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
29. EXTENDED ELEMENTS OF PHC
• Expanded options of immunization
• Reproductive health needs
• Provision of essential technologies for
health
• Prevention and control of non
communicable diseases
• Food safety and provision of selected
food supplements.
