COMMUNITY HEALTH NURSING 1 LECTURE

1ST SEMESTER S.Y. 2023-2024

WEEK 4
C. PRIMARY HEALTH CARE (PHC)
LEARNING OBJECTIVES
1. Define Primary Health Care
2. Outline the historical background of PHC
3. Enumerate the key principles of PHC
4. Enumerate the 5 As of PHC
5. Differentiate between the multisectoral, intersectoral linkages
6. Relate the application of the PHC key principles in the implementation of public
health programs

A. Primary Health Care (PHC)

1. Brief History
2. Legal Basis
3. Definition
4. Goals
5. Elements
6. Principles and Strategies

1. Brief History:
The core strategy is the effective provision of essential health services.
PHC was declared during the First International Conference on Primary Health Care held in
Alma Ata, USSR on September 6-12 1978 by WHO and UNICEF. Together they expressed the
need for concerted efforts by all governments and health and development workers for the
protection and promotion of health of all the people.

2.Legal Basis of PHC in the Philippines

Letter of instruction (LOI) 949 signed by Pres. Marcos on October 19, 1979. Making the
Philippines the first country in Asia to embark on meeting the challenge of PHC.
It must be noted that even prior to LOI 949, which provided impetus to the then Ministry of
Health, there were several health workers, nongovernmental organizations (NGOs) and church
organizations offering community-based health programs In the rural areas of Visayas and
Mindanao, applying the spirit of PHC even before it was formally adopted by the government.

The Alma ATA Declaration on Primary Health Care emerged from this conference. The Alma Ata
conference made the following declarations:
1. Health is a basic fundamental right
2. There exists global burden of health inequalities among populations

PREPARED BY: MARILYN M. SANTOS PhD.M,MAN.,RN. 2023 pg. 1

3. Economic and social development is of basic importance for the full attainment of health for
all
4. Governments have a responsibility for the health of their people.

-Basic to the PHC declaration is the common view that health “is a state of complete, physical,
mental, and social well-being , and not merely the absence of disease or infirmary “
-Viewing health from holistic perspective, beyond just physical and mental maladies, the WHO
has put equal emphasis on the social dimensions of health, that wellness can be achieved by
considering different factors that interdependently influence the health of the population, such
as the environment, education, social services and politics/ leadership.

-A healthy population has the capability to contribute more to its development. By emphasizing
the people’s right to health, the government is driven to increase investment on health care.
The WHO recommends governments to allocate 5% of the gross national product (GNP) to
health services from 2005 t 2007 was only 3.3 % of the GNP

5 A’s (4As)
a. Accessible- The WHO guideline states that for these health care facilities to be considered
accessible, they must be within 30 minutes from the communities. BHSs are facilities intended
to provide accessible health services at the community level.
b. Attainable
c. Affordable- is not only in consideration of the individual or family’s capacity to pay for basic
health services.

Particularly for public health services, it is also a matter of whether the community or
government can afford these services. One of the factors the WHO considers in determining
affordability of health care is the out of pocket expenses for health care.

This is the actual cost to the family for health services lea any coverage of insurance. In the
Philippines, the government health insurance is covered through Phil health. There are other
health insurance policies offered by private companies or health management organization.
d. Acceptable- means that the health care offered in in consonance with the prevailing culture
and traditions of the population.
e. Availability- is a question of whether the basic health services require by the people are
offered in the health care facilities or id provided on a regular and organized manner.

-PHC as a service delivery policy of the DOH permeates all strategies and thrusts of government
health programs from the national to the local and community levels
--PHC is a complete turn-about from disease-oriented, curative, hospital based, and urban
centered health care to preventive, people centered, and community-based health care.

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3.The WHO defined PHC:
-Essential health care made universally accessible to individuals and families in the community
by means acceptable to them, through their full participation and at a cost that the community
and country can afford at every stage of development.

-According to Alma Ata Declaration, PHC “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 to maintain at every stage of their development in the spirit of self-reliance and self-
determination”

Main Objectives:
1. Promotion of healthy lifestyles,
2. Prevention of diseases
3. Therapy for existing conditions

President Marcos signed the LOI 949 that has an underlying theme” Health in the Hands of the
People by 2020”
4.GOALS
Health for All by the year 2000
Health for all means an acceptable level of health for all the people of the world through
community and individual self-reliance and self determination
This policy agenda of “health for all by the year 2000” technically was a global strategy
employed for achieving their main objectives.

5. 5 key elements
The WHO has identified 5 key elements to achieving the goal “health for all”
1. Reducing exclusion and social disparities in health (universal coverage)
2. Organizing health services around people’s needs and expectations (health service reforms)
3. Integrating health into all sectors (public policy reforms)
4, Pursuing collaborative models of policy dialogue (leadership reforms)
5. Increasing stakeholder participation

The Alma Ata Declaration listed 8 essential health services using the ACRONYM (ELEMENTS)
E-education for all
L Locally endemic disease control
E expanded Program for immunization
M maternal and child health including responsible parenthood
E essential drugs
N nutrition
T treatment of communicable and non-communicable diseases

PREPARED BY: MARILYN M. SANTOS PhD.M,MAN.,RN. 2023 pg. 3

S safe water and sanitation

6. Principles of PHC AND STRATEGIES

1. Accessibility, affordability, acceptability and availability
2. Support mechanism
3. Multisectoral approach
4. Community participation
5. Equitable distribution of health resources
6. Appropriate technology

Health programs according to the 4As

1. Botika ng Bayan and the Botika ng barangay
2. Ligtas sa Tigdas ang Pinas” mass measles immunization campaign. Children aged 9 months to
below 8 years old. The two were vaccinated against measles and rubella

3 major entities
1. People themselves
2. The government
3. Private sector like NGOs and socio-civic and faith groups.

Multisectoral approach

As health and disease are outcomes of multiple interrelated factors, PHC requires
communication, cooperation and collaboration within and among various sectors.
A. Intrasectoral Linkages
B. Intersectoral linkages

1. Intrasectoral linkages
It refers to communication, cooperation and collaboration within the health sector: among the
members of the health team and among health agencies.
This is exemplified by team approach utilized by the personnel of a health center in dealing with
health conditions and problems.
The two-way referral system, is necessary so that clients get the needed and desired care.
The two-way referral system ensures competent care, maximum use of availability of resources
and continuity of care

2.Intersectoral linkages
-One of the major criticisms against the traditional perspective in development is that the tools
for analysis and strategies used are primarily economic in orientation.

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-The idea that the population Is sick because they are poor implies that illness or health is a
result of economic gains or the lack thereof.

-Intersectoral linkages encompasses that communication, cooperation and collaboration

between the health sector and other sectors of society like education, public works, agriculture,
and local government officials.

-Example Rabies prevention and control program. It requires collaborative effort among the
Department of Health (DOH), DA, DepEd and LGUs. The DOH provides immunization or victims
of animal bites. The DA provides outreach rabies immunization for dogs, while Dep ED and the
LGUs are in charge of information campaign in schools and communities.

-One of the major criticisms against the traditional perspective in development is that the tools
for analysis and strategies used are primarily economic in orientation. It encompass the
communication, cooperation and collaboration between the health sector and other sectors of
society like education, public works, agriculture and local government officials.

Community Participation
A key to understanding the concept of PHC puts emphasis on how it is defined: that health is
achieved through self-reliance and self-determination and that individuals, families and
communities are not considered as recipients of care but active participants in achieving their
health goals.

-Community participation is an educational and empowering process in which people in

partnership with those who are able to assist them, identify the problems and the needs and
increasingly assume responsibilities themselves to plan, manage, control and assess the
collective actions that are proved necessary.

Equitable distribution of health resources

2 programs
1. Doctor to the Barrios (DTTB) is the deployment of doctors to municipalities tat are without
doctors.
DTTB volunteers are fielded to manage the RHU or health centers in unserved, economically
depressed fifth or 6th class municipalities for 2 years.
2. Registered Nurses Health Enhancement and Local Service (RN HEALS)

-It is a training and deployment programs for unemployed nurses. They are volunteers are
deployed to unserved, economically depressed municipalities for 1 year to address the
inadequate nursing workforce in rural communities and health facilities.

D. LEVELS OF PREVENTION

PREPARED BY: MARILYN M. SANTOS PhD.M,MAN.,RN. 2023 pg. 5

LEARNING OBJECTIVES:
1. Classify the three levels of prevention
2. Compare the Universal health care law to the present health situation in the
Philippines
3. Differentiating the 8 things the citizen to expect for the health care
4. Relate the strategic thrusts of Universal Health Care to the current health situation
and the goal and objectives of Universal Health Care

-Medical Care focuses on disease management

-Cure public health efforts focus on health promotion and disease prevention

3 levels of prevention
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention

PRIMARY PREVENTION
Relates to activities directed to preventing a problem before it occurs for susceptible
individuals.

2 Elements
1. General health promotion
2. Specific protection
Example: Promotion of good nutrition, provision of adequate shelter and encouraging regular
exercise

Specific protection efforts

-Reduce or eliminate risk factors and include such measures as immunization, and water
purification
Primary level disease Prevention
-directed towards individuals who are at Risk of developing a disease or those who are in the
pre-pathogenic stage; deals with the removal of risk factors of specific protection of individuals
against these risk factors
Example; immunization, food supplementation, and malaria chemoprophylaxis.

SECONDARY PREVENTION
-Refers to early detection and prompt intervention during the period of early disease
pathogenesis.
-It was implemented after a problem has just begun but before signs and symptoms appear and
target those populations who have risk factors

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Example: Mammography, Blood pressure screening, newborn screening and mass sputum
examination for pulmonary tuberculosis
Secondary prevention is also directed toward prompt intervention to prevent worsening
conditions of the affected population.
-This includes measures during the early stage of disease to prevent complications.
-Teaching how to Oresol to her child suffering from diarrhea to prevent dehydration and
administering vitamin A capsules to children with measles are examples.

TERTIARY PREVENTION
-Targets population that have experienced disease or injury and focuses on limitation of
disability and rehabilitation.
-Aims of tertiary prevention are to reduce the effects of disease and injury and to restore
individuals to their optimal level of functioning.
Examples: Teaching how to perform insulin injection techniques and disease management to a
patient with diabetes, referring a patient with spinal injury for occupational and physical
therapy and leading a support group for cancer patients who have undergone cancer treatment
such as surgery, chemotherapy and radiation therapy.

PREPARED BY: MARILYN M. SANTOS PhD.M,MAN.,RN. 2023 pg. 7