MODULE 1

Chapter 2: What is Primary Health Care (PHC) and why?

Theme Concept of Primary Health Care
Objectives - By the end of the chapter, you should be able to:
Explain the major concept of Primary Health Care
Differentiate the differences between comprehensive and selective Primary Health Care
Understand how Primary Health Care is put into practice

CONTENT
Concepts of Primary Health Care (PHC)
Many people, even health professionals, confuse Primary Health Care with a number of other
concepts. First of all, Primary Health Care is not Primary Medical Care (or primary care), nor is
it primary nursing. These terms should not be used interchangeably. The two documents that
laid down the foundation for PHC were the Alma-Ata Declaration and the Ottawa Charter. We
shall discuss these documents in-depth in the coming module.
In recent decades, it was found that traditional Western medicine fails to address health issues in
developing countries, as well as chronic conditions in developed countries. It was due to the fact
that some of these diseases are related to socioeconomic factors such as poverty or affluent
lifestyles. These provided a background to the conference hosted jointly by the World Health
Organization (WHO) and the United Nations Childrens Fund (UNICEF) at Alma Ata, the USSR,
in 1978. The conference expressed the need for urgent action by all governments, all health and
development workers, and the world community to protect and promote health of all the people
of the world.
PHC was described by participants of the WHO Primary Health Care conference at Alma Ata
1978 as:
Essential health care based on practical, scientifically sound and socially acceptable
methods of technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and country can
afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination. It is the first level of contact with individuals, the family and the community
with the national health systems bringing health care as close as possible to where people
live and work, and constitutes the first element of a continuing health care process.
WHO-UNICEF 1978, Primary Health Care, Alma-Ata, USSR, WHO, Geneva p.3
PHC is, in fact, more than the above statement. It includes the prevention of disease and the
promotion of health. It also states that care should be available, affordable, accessible and
acceptable to the individual and the community. It emphasizes three levels of prevention: at
the primary (prevention of disease), secondary (early detection) and tertiary level (rehabilitative
and maintenance stage). Moreover, it addresses three levels of care: the primary level of care
(General practitioner), the secondary level of care (local non-specialist hospital) and the tertiary
level of care (teaching and specialist hospitals). Macdonald (1992) stated that PHC is part of the
search for a new model of health care which incorporates the advantages of modern medicine but
which seeks to include a wider vision of health and health care into its system.

The WHO introduced the idea of considering health as a global issue. In order to promote the
health of all people in the world, nations in the developing world are encourage to share the
expertise of the developed nations, emphasizing non-exploitative healthcare among nations.
The philosophies that underpin PHC are (please refer to internet materials). It combines the
best ideas in technical medicine. It is culturally appropriate and an inexpensive means of
maintaining health and tackling diseases.

Below are some Hong Kong examples to guide you through some of the major PHC
concepts.
Universally accessible health care services In Hong Kong, every citizen is able to access
to basic health care services. These include government out-patient clinics, accident and
emergency departments, hospital services, maternal and child health services and free
immunization for children.
Cultural appropriateness of health services where the local needs should be at the heart
of health services Traditional Chinese Medicine (TCM) has been gaining recognition by
the government in recent years. University degrees in TCM are being offered to practicing
TCM practitioners and high school graduates
Improve the economic condition and policy change Health is directly related to the
socio-economic situation of a country. Government strategies include revision of the tax
base, reduce unemployment rate, retraining of unemployed staff, and working with the
Chinese mainland authorities to combat the problem of drug abuse and communicable
disease such as SARS.
Reorientation of all health services towards the health needs of communities The
government tries to prioritize health care resources by putting more emphasis on health
promotion and TCM research. The health promotion campaign, Healthy Living towards the
21st century is considered a new paradigm that focuses on participation and selfdetermination in this regard.
Prevention There were various prevention strategies being disseminated through mass
media during the SARS outbreak. For example, home cleansing with diluted Bleach, various
means to maintain good body immune system and to increase symptom awareness. Other
strategies include class suspension in schools and mandatory isolation of the SARS patients
and families of highly infectious housing estate.
Health education Education programmes are being organized by the Department of Health,
the Hospital Authority (Information World in the headquarters of the Hospital Authority) and
non-governmental organizations concerning prevailing health problems and methods of
preventing and controlling them.

Comprehensive Primary Health Care vs. Selective Primary Health Care

Comprehensive PHC involves the collaboration of other sectors with peoples participation to
search for solutions for better health, along with governments commitment towards greater
equity in health care. Whereas, a selective version of PHC can be seen as a microscopic medical
view of PHC.

In Hong Kong and around the world, many health organizations claim to provide Primary Health
Care services to the public. However, most of the services are medically oriented and focus on
disease prevention. Workers are not directly involved in working with people in their social,
economic and political environment to build a context that promotes their health. Services are
targeted at those who are at risk for specific diseases that are amendable in short term. For
example, mass vaccination against influenza and measles during the epidemic, and disease
screening for SARS in university during the outbreak.
For comprehensive PHC during the SARS epidemic, the government not only to provide
adequate resource to the hospitals for disease cure, other strategies included working the WHO
for disease control, collaborating with the Guangdong authorities to work on the virus, complete
suspension of schools, temperature checks for all air travelers, allocate funding for the new virus
research, improve environmental and restaurant hygiene, and financial and social support to the
SARS victims and families. Comprehensive PHC is the health care system that contributes to
the health and social well-being of the society.

How Primary Health Care is able to put into practice?

Primary Health Care includes at least the following:

Health Education
Promotion of a quality food supply and proper nutrition
An adequate supply of safe water and basic sanitation
Maternal and child health care
Family planning
Immunization against the major infectious diseases
Prevention and control of locally endemic diseases
Appropriate treatment of common diseases and injuries
Provision of essential drugs

PHC calls for a new kind of doctor, a new kind of health worker and a new kind of health
professional. Personnel are trained socially and technically to work as a health team to
respond to the expressed health needs of the community.
In addition to the health sector, it involves 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 for coordinated efforts.
Government commitment to formulate national policies, strategies and plans of action to
launch and sustain primary health care for all people.

WHO-UNICEF 1978, Primary Health Care, Alma-Ata, USSR, WHO, Geneva p.4