COMMUNITY MEDICINE

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Primary Health Care(PHC)

In 1978 the World health Organization(WHO) and the United Nations International Children‘s
Emergency Fund(UNICEF) held a conference on primary health care.

The main outcome of conference was the Declaration of Alma Ata which has the following
fundamental principles of primary health care:
1-Equity

2-Community participation

3-Use of socially accepted technology

4-Health promotion and disease prevention

5-Involvement of all government departments

6-Political action

7-Cooperation between countries

8-Redirection of funding to health

9-World peace

This challenged the world nations to embrace the principles as way of overcoming health
inequality.

Primary health care approach is defined as:

Is essential health care based on practical, scientifically accessible to individuals and families in
the community through their full participation and at a cost the community and country can
afford to maintain at every stage of their development in the spirit of self-reliance and self-
determination.

Primary health care(PHC) is the organization of full range of health care, from home to hospital,
with prevention as equally important as cure. PHC should be universally available, person
centered and supported by healthy public policies.

Primary health care is not primary care alone; it is primary, secondary and tertiary care.
Primary health care is different in each community depending upon:

-Needs of residents,

-Availability of health care providers,

-The communities geographic location,

-Proximity to other health care services in the area.

The basic requirements for sound PHC:

• Essential
• Availability
• Adequacy
• Accessibility
• Appropriateness
• Affordability
• Assessability
• Accountability
• Completeness
• Comprehensiveness
• Continuity

Essential:

Means that these services or activities are needed and important for improving the health status
of the community & so the community cannot go without it. eg: immunization

Availability:

❖ Availability of medical care means that care can be obtained whenever people need it.
❖ We must make sure that all areas have health services coverage.
❖ This means that enough health facilities should be available so that every member of
community can reach them when needed.

Adequacy:

❖ The services proportionate to requirement.

❖ Sufficient volume of care reach them when needed.

Accessibility:

❖ Reachable
❖ Convenient services
 ❖ Geographic accessibility
❖ Economic accessibility
❖ Culture accessibility.

Acceptability:

Depend on a variety of factors include:

❖ Satisfactory communication between health care providers and patients,

❖ Whether the patients trust this care and whether the patient believe in the confidentiality
and privacy of information shared with the providers.

Through health education, people will understand the benefits of the services.

Appropriateness:

❖ Whether the services needed at all in relation to essential human needs, priorities.
❖ The services has to be properly selected and carried out by trained personnel in proper
way.
❖ Health staff should give most of their time & interest to the common disease which
cause most ill-health and death in the population rather than concentrating on few people
with rare & interesting diseases.

Affordability:

The cost should be within the means & resources of individual and country.

Assessability:

Means that medical care can be readily evaluated.

Accountability:

Implies the feasibility of regular review of financial records by certified public accountants.

Completeness:

Completeness of care requires adequate attention to all aspects of medical problem, include:

❖ Prevention
❖ Early detection
❖ Diagnosis
❖ Treatment
❖ Follow up measures and
❖ Rehabilitation.
Comprehensiveness:

means that care is provided for all types of health problem.

Continuity:

Required that management of a patient s care over time be coordination among providers.

Primary health care benefits:

1-PHC focus on keeping people healthy & addressing illness early so as to increase probability
of cure.

2-PHC is client focused.

3-services are matched to community needs,

4-targeted services will have a positive impact on the utilization of health and social services.

5-healthy communities with healthy people contribute to a vibrant & stable economy.

The main elements of a primary health care program

1-Health education

2-Promotion of adequate nutrition

3-Immunization against common infectious diseases

4-Maternal and child health care(MCH) including family planning

5-Ensuring accessibility to safe and adequate water supply and basic sanitation

6-Control of locally endemic diseases

7-Treatment of common diseases and injuries

8-Provision of essential drugs.

Other elements can be added according to health needs of the community such as promotion of
mental health, school health services and oral health services.

We can see from above that PHC services are not only promotive and preventive, but
curative and rehabilitative.