Primary Health Care: An approach to delivery of health care services Current Health Situation that Explain the Rationale of PHC 1 2 3 4 Magnitude of Health Problems Inadequate and Unequal distribution of Health Resources Increasing Cost of Medical Care Isolation of Health Care Activities from Other Developmental Activities Definition of PHC VISION Essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and a cost that the community and country can afford at any stage of development. Health for all Filipinos and Health in the hands of the people by year 2020, MISSION ‘To strengthen the health care system by inereasing ‘opportunities and supporting the conditions wherein people will manage their own health care. ‘OBJECTIVES 1 Improvement in the level of health of the Community. Favorable population growth and structure. Reduction in morbidity and mortality rates especially among infants and children. Reduction in the prevalence of preventable, communicable and other diseases. Extension of essential health services with priority given to underserved sectors. Improvement in basic sanitation. Development of the capability of the community aimed at self-reliance. Maximization of the contribution ofall sectors other than health to the social and economic development of the community. HISTORY “Health for all by Year 2000” ‘© Declared during First International Conference on Primary Health Care ‘+ Held in Alma Ata, USSR ‘+ Happened on September 6-12, 1978 ‘© Organized by the World Health Organization LETTER OF INSTRUCTION 949 Philippines HEALTH IN THE HANDS OF PEOPLE BY 2020 Ferdinand Marcos October 19, 1979 Despite the failure to realize the goal of Health for All by 2000, the altruistic ‘endeavor has bear fruit as it has produced ‘progress in the lives of people from the ‘communities it has influenced. CONCEPTS ELEMENTS OF PHC 1. Education on Health 2. Control of Communicable Diseases/ Locally endemic disease control 3. Immunization/ Expanded Program on Immunization 4, Maternal and Child Health and Family Planning 5. Provision of Essential Drugs 6. Adequate Food and Proper Nutrition 7. Provision of Medical Care and Emergency Treatment 8 Treatment of Locally Endemic Diseases 9. Safe Water & Environmental Sanitation GENERAL PRINCIPLES OF PHC 1. Recognition ofthe interrelationships between health and development 2. Essential health services must be accessible, available, acceptable and affordable, 2. focus on promotion of health and prevention of disease 3. Genuine people's participation is essential a) selfreliance ') social mobilization ) decentralization or devolution 4. Partnership between the community and health agencies in the provision of quality, basic and essential health services.STRATEGIES ‘* Reorientation and reorganization of national health care system with the establishment of functional support mechanism. ‘+ Effective preparation and enabling process for health action at all levels. ‘+ Mobilization of the people to know their communities and Identifying their basic health needs. ‘+ Development and utilization of appropriate ‘technology focusing on local indigenous resources available in and acceptable to the community, ‘© Organization of communities arising from their expressed needs which they have decided to address ‘+ Increase opportunities for community participation in local level planning, management, monitoring and evaluation within the context of regional and national objectives, ‘+ Development of intra-sectoral linkages with other government and private agencies. ‘+ Emphasizing partnership so that the health workers and the community leaders/members view each other as partners. FOUR PILLARS/ CORNERSTONES IN PHC 1. Active community participation 2. Intra and inter-sectoral linkages 3. Use of appropriate technology 4. Support mechanism made available ‘TYPES OF WORKERS. + Physicians ‘+ Medical Technologists © Nurses = Midwives +Traditional healers = Community health workers LEVELS OF WORKERS Village or Barangay health workers. = Trained community health workers - Health auxiliary volunteer - Traditional birth attendant or healer Intermediate level health workers. = General medical practitioners or their assistants ~ Publichealth nurse = Rural sanitary inspectors - Midwives LEVELS OF HEALTH CARE AND REFERRAL SYSTEM. 1 Primary Level of Care - health care provided on the first contact between the community members and the health care providers. Secondary Level of Care — is usually given in privately owned or government operated facilities wherein the facilties are capable of performing minor surgeries and simple laboratory examin Tertiary Level of Care - is rendered by specialized health facilities wherein capable of managing complicated cases and intensive care can be provided. HEALTH AND DEVELOPMENT @ HEALTH, DEVELOPMENT AND POVERTY Echo ition ace ty ih epee in cate acts OUTLOOK IN THE 21°" CENTURY ‘CURRENT CONCERNS OF PHC REFORMS Transformation and regulation of existing health systems, aiming for universal access and social health protection. Dealing with the health of everyone in the community, ‘A comprehensive response to people's expectations ‘and needs, spanning the range of risks and illnesses. Promotion of healthier lifestyles and mite the health effects of social and environmental n of, hazard Teams of health workers facilitating access to and appropriate use of technology and medicines. Institutionalized participation of civil society in policy dialogue and accountability mechanisms. Pluralistic health systems operating in a globalized context.Guiding the growth of resources for health towards universal coverage. Global solidarity and joint learning Primary care as coordinator of a comprehensive response at al levels. PHC is NOT cheap: it requires considerable investment, but it provides better value for money ‘than its alternatives First, health is BOTH part of the problem and part of the solution to world population change. ‘The unprecedented growth of human populations in the 20th century was due demographically to the very rapid decline of mortality in relation to fertility, especially in developing countries Universal access to affordable, high-quality reproductive and child health services — contraception, control of sexually transmitted diseases including HIV/AIDS, maternal and child health —offers the most effective and humane approach to attaining good health, enabling couples to achieve smaller desired family sizes and accelerating the world's demographic and health transitions to stability and quality. ‘America's health in the 21st century must wrestle successfully with equity between the young and the aged and among social and ethnic groups. ‘The aging of America's population will have enormous social implications for family structure and care taking of the elderly, economic implications for health care costs. ‘America's health in the 21st century is already inextricably linked to world population and health. ‘We are becoming part of a “global health village” because of health interdependence and the transnationalization of disease. Most health problems are commonly shared, and many health risks clearly have transnational properties. The imperative for international cooperation will intensify New directions for health into the 21st century have been released that could save millions of lives and have a major impact on global well-being and poverty reduction within a decade. ‘The main aim of organizations such as The World Health Organization (WHO) isto increase health life expectancy for all while ensuring a better deal for the world's poorest people, DEMOGRAPHY Global Health Statistics ‘world population (June 2019) 7,577,130,400 = 6,602,224,175: world population (2007) 2011 - 7 billion 14,424,343: People living with TB +33,200,000: Poople living with HIV/AIDS 408,388,706: Malaria Cases Most populous countries * China 1,346,000,000 + India 4,241,000,000 + United States 312,000,000 * Indonesia 238,000,000 + Brazil 197,000,000 + Pakistan 177,000,000 + Nigeria 162,000,000 + Bangladesh 11,000,000 + Russia 143,000,000 + Japan 128,000,000 2050 (projection) + India 4,692,000,000 + China 1,313,000,000 + Nigeria 433,000,000 + United States 423,000,000 + Pakistan 314,000,000 + Indonesia 309,000,000 + Bangladesh 226,000,000 + Brazil 223,000,000 + Ethiopia 174,000,000 + Philippi 150,000,000 108,246,271: Population of Philippines (2019 est.) ~ 1.4% of world population There were approximately 36.9 million people ‘worldwide living with HIV/AIDS in 2017 © Ofthese, 1.8 million were children {<15 years old) ‘An estimated 1.8 million individuals worldwide became newly infected with HIV in 2017 ~ about 5,000 new infections per day. This includes 180,000 children (<15 years). Most of these children live in sub-Saharan Africa and were infected by their HIV- positive mothers during pregnancy, childbirth or breastfeeding In 1993, the World Health Organization (WHO) declared tuberculosis (TB) to be a global health ‘emergency. Today, TB remains one of the world's major causes of illness and death. About one-third of.the world’s population, carry the TB bacilli, although ‘most never develop active TB disease. Global access to TB treatment is improving but remains low and the emergence of drug-resistant TB, particularly in settings where many TB patients are also infected with HIV, poses a serious threat to TB control, and confirms the need to strengthen prevention and treatment efforts. In 2006, out of an estimated 9.2 million new TB cases worldwide, 4.1 million were diagnosed by laboratory testing, 710,000 were among people living with HIV and there were 500,000 cases of multi-drug resistant 8 (MOR-TB). Of the estimated 1.7 milion people who died of TB in 2006, 14% were co-infected with HIV. In 2017, 10 million people fel il with TB, and 1.6 million died from the disease (including 0.3 million ‘among people with HIV). = 7B isa leading killer of HIV-positive people. In 2017, an estimated 1 million children became ill with TB and 230 000 children died of TB (including, children with HIV associated TB). The UN. Millennium Development Goals include targets to halve the 1990 TB prevalence and death. rates by 2015, Most TB cases occur in Southeast Asia and Africa. ‘One-third of the number of new T8 cases occurs in Southeast Asia, but the estimated incidence per capita is highest in Africa. In addition, Africa has the highest number of estimated deaths due to TB and the highest mortality per capita, with HIV leading to rapid increases in TB incidence in the region. ‘Bis the sixth leading cause of death in the country, which has the ninth highest number of TB cases worldwide, according to the World Health Organization. 250,000 Filipinos are positive for TB. ‘The disease kills 75 people in the Philippines daily, according to the Department of Health Malaria, one of the world's most common and serious tropical diseases, causes at least one million deaths ‘every year -the majority of which occur in the most resource-poor countries More than half of the world's population is at risk of. acquiring malaria, and the proportion increases each year because of deteriorating health systems, growing drug and insecticide resistance, climate change, natural disasters and armed conflict. ‘At least 300 million acute cases of malaria occur worldwide each year, resulting in more than one million deaths annually - more than 80% of which are estimated to occur in sub-Saharan Africa, mostly among children under five years old. Although Africa is hardest hit, itis estimated that more than one-third cf clinical malaria cases occur in Asia and 3% occur in, the Americas. Young children and pregnant women are at the highest risk of malaria infection and mortality. Many children experience initial malaria infection during. their first two years of life, when they have not yet developed sufficient immunity, making these early years particularly dangerous. Malaria accounted for one in 10 deaths among children in developing countries in 2002. Pregnancy ‘causes women to have reduced immunity to malaria, making them more susceptible to malaria infection and increasing their risk of illness, severe anemia and death. Approximately 60% of all cases of malaria ‘occur among the poorest 20% of the world's population, Health Statistics Life Expectancy: Year MALE FEMALE. 2002-2005 64 70 2005-1010 66 71 2010-2015 67 Both sexe: At age 60: 7 HEALTH BEHAVIOR AND LIFESTYLE Lifestyle ~ a consistent integrated way of life that is typified through one’s behavior, attitudes and possessions Health Protective Behavior any activity people perform to maintain or promote health most common are eating sensibly, getting enough sleep, keeping emergency numbers near the phone differences exist among the health practices by gender, occupation and age health behaviors are not strongly interdependent HEALTH STATUS AND BEHAVIOR ‘A. Follows the various stages in the progress of 1. Health behavior has a preventive function. 2.llness behavior a. internal self-check b. plan of action ©. describe your symptoms to others d, seek treatment and support 3, Factors within the individual 4, Interpersonal factors 60 Health status and behaviorB. Health behaviors depend on motivational factors. . Healthy and unhealthy behavior are acquired through experience and observation. D. Eventually, behaviors become habitual ‘Three Levels of Prevention A Primary prevention 8. Secondary prevention C. Tertiary prevention What determines individual health-related behavior? A. Heredity or geneties B. Learning ‘The Stages of Change Model ‘A. Precantemplation — not considering change B. Contemplation - aware of a potential problem exists and are seriously considering changing to a healthier behavior but they are not ready to commit, to this action C. Preparation - ready to try out the behavior; may have tried in the past but failed to reach their goal D. Action - Successful negotiation of the behavior, usually lasts about six months; trial and error period E, Maintenance - working to keep the behavior in place; self - management mechanism isin place LEVELS OF HEALTH CARE 1. Promotive 2. Preventive 3. Curative 4. Rehabilitative