Lesson 5:

PRIMARY
HEALTH CARE
Overview:
Primary Health Care is the 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 that the community and country can afford to
maintain at every stage of their development in the spirit of SELF RELIANCE and self - determination
(Alma Ata).
 An approach to health development which is carried through a set of activities and
whose ultimate aim is continuous improvement and maintenance of the health status of
the community (DOH).
 The collection impact of the community health nurses in PHC concept embraces the
provision of basic essential services – promotive, preventive, curative and rehabilitative
– for the total population at the local community level (Thompson).
 As an approach, requires the community health nurse to be competent in a number of
responsibilities including promoting self reliance in health care among individuals and
families, collaborating with development sectors in promoting health and preventing
diseases and disability and extending health care coverage to all segment of the
population especially vulnerable groups. (Rodollo)

Learning Objectives:

1. Define primary health care (PHC)

2. Outline the historical background of PHC
3. Enumerate the key principle of PHC

At the start of the lesson, you are to take Pre Assessment test to see how much background
information and knowledge you have.

This lesson is self – instructional. You can read, analyze concepts and ideas presented and
relied on them. The Activities and Self – Check Questions will help you assess how you
progress as you go through this Lesson.

Your answer to the Self – Check Questions and Activities may be self – evaluated by your
facilitator if you so desire. These will be part of your formative evaluation. Do not write your
answer in the lesson. Your answer should be written in a separate notebook.
The Answer Key to the Self – Check Questions and Activities are found at the end of this
lesson. The Post Assessment Test will be given in a separate booklet upon completion of the
lesson. It will serve as the summative evaluation of your performance.

Remember, you are to work on this lesson independently. I shall not be around to supervise
you as you go through each lesson. It is expected that you will make the most of this lesson
and grow professionally in your desire to become a competent Nurse, determined to make a
difference.

Pre – Assessment Test

Multiple Choice: Directions: Read the sentence carefully. Choose the best answer. Write the
letter of your answer on your notebook.

1. What is the focus of secondary health care?

a. Early malnutrition c. early diagnosis and treatment
b. Early signs and symptoms d. early detection
2. The first international conference of PHC was held in Alma Ata last:
a. February 23 – 24, 1978 c. October 29, 1979
b. September 6 – 12, 1978 d. September 12, 1979
3. All of the following compose the intermediate level health workers except:
a. Barangay health worker c. Public health nurse
b. Midwives d. rural health inspectors
4. When a traditional birth attendant (TBA) and midwife attends to home delivery, the care
provided for is classified as:
a. Primary level of care c. tertiary level of care
b. Secondary level of care d. fold healing practice
5. A traditional plant used to lower the uric acid:
a. Pancit – pancitan c. bayabas
b. Lagundi d. sambong
6. Used to relieve muscle and joint pain
a. Lagundi c. Yerba Buena
b. Akapulko d. sambong
7. It is a aromatic herb which is used to treat rheumatism and arthritis?
a. Yerba Buena c. cormina retusa
b. Lagundi d. Ulasimang bato
8. It is seeds are taken 2 hours after supper to expel round worms in asariasis:
a. Akapulko c. bayabas
b. Niyug – niyugan d. bawang
9. It is effective for asthma, cough and dysentery:
a. Yerba Buena c. Lagundi
b. Sambong d. tsaang Gubat
10. All of the following are true of the health services provided by private sectors except:
a. Health services are pain
b. Maybe provided by nonprofit organizations
 c. Generally provided free to the public
d. Largely market oriented

Definition of Primary Health Care

- According to the 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 to a cost that the community and country can afford to maintain at every stage of
their development in the spirit of self – reliance and self – determination.
 May 1977 -30th World Health Assembly decided that the
main health target of the government and WHO is the
attainment of a level of health that would permit them to
lead a socially and economically productive life by the
year 2000.

September 6-12, 1978 – First International Conference on

PHC in Alma Ata, Russia (USSR) The Alma Ata Declaration
stated that PHC was the key to attain the “health for all”
goal

October 19, 1979 – Letter of Instruction (LOI) 949, the

legal basis of PHC was signed by Pres. Ferdinand E.
Marcos, which adopted PHC as an approach towards the
design, development and implementation of programs
focusing on health development at community level

Rationale for Adopting Primary Health Care

 Magnitude of Health Problems

 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities

Goal of Primary Health Care

 HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by
the year 2020.
 An improved state of health and quality of life for all people attained through SELF RELIANCE

Key Strategy to Achieve the GoaL

  Partnership with and Empowerment of the people – permeate as the core strategy in the
effective provision of essential health services that are community based, accessible, acceptable,
and sustainable, at a cost, which the community and the government can afford

Objectives
 To develop and maximize people potential and self-reliance of the community for the
improvement of their own health.

 To maximize the contributions of other sectors of health

 To maximize the extension of effective health care services

https://www.youtube.com/watch?v=a3UhtiAwbog

Objectives of Primary Health Care

 Improvement in the level of health care of the community
 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and other disease.
 Reduction in morbidity and mortality rates especially among infants and children
 Extension of essential health services with priority given to the underserved sectors.
 Improvement in Basic Sanitation
 Development of the capability of the community aimed at self- reliance.
 Maximizing the contribution of the other sectors for the social and economic development of the
community
 Mission
To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their
own health care.
Goal : Health For All by the Year 2020
Theme: Health for All and Health in the
Hands of the People by the year 2020
Key Strategy to Achieve Goal: Partnership
with empowerment of the People

Types of Primary Health Care Workers

1. Barangay Health Workers – trained community health workers or health auxiliary volunteers or
traditional birth attendants or healers.
2. Intermediate level health workers- include the Public Health Nurse, Rural Sanitary Inspector and
midwives
3. Health Personnel of First Line Hospitals
Basic concepts

a. Health is related to social structures. Health problems are brought about by economic,
political and cultural problems and vice versa.
b. Health and development are interrelated.
c. People’s participation is essential.
d. Community organizing is the core in PHC.
e. Use of appropriate technology

Principles of Primary Health Care

1. 4 A’s = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health

services.
• The health services should be present where the supposed recipients are. They
should make use of the available resources within the community, wherein the focus
would be more on health promotion and prevention of illness.
2. Community Participation
• heart and soul of PHC
 People are the center, object and subject of development
3. Barriers of Community Involvement
 Lack of motivation
 Attitude
 Resistance to change
 Dependence on the part of community people
 Lack of managerial skills
4. Self-reliance
 Through community participation and cohesiveness of people’s organization they
can generate support for health care through social mobilization, networking and
mobilization of local resources. Leadership and management skills should be
develop among these people. Existence of sustained health care facilities
managed by the people is some of the major indicators that the community is
leading to self - reliance.
5. Partnership between the community and the health agencies in the provision of quality
of life.
 • Providing linkages between the government and the nongovernment
organization and people’s organization
6. Recognition of interrelationship between the health and development
• Health - Is not merely the absence of disease. Neither is it only a state of
physical and mental well-being. Health being a social phenomenon recognizes the
interplay of political, socio-cultural and economic factors as its determinant. Good Health
therefore, is manifested by the progressive improvements in the living conditions and
quality of life enjoyed by the community residents (PCF,)
 Development- is the quest for an improved quality of life for all. Development is
multidimensional. It has political, social, cultural, institutional and environmental
dimensions (Gonzales 1994). Therefore, it is measured by the ability of people to
satisfy their basic needs.
7. Social Mobilization - It enhances people participation or governance, support system
provided by the Government, networking and developing secondary leaders
8. Decentralization - This ensures empowerment and that empowerment can only be
facilitated if the administrative structure provides local level political structures with
more substantive responsibilities for development initiators. This also facilities proper
allocation of budgetary resources

Elements of Primary
Health Care

1. Education for
Health

Is one of the
potent
methodologies for
information
dissemination. It
promotes the
partnership of both
the family
members and
health workers in
the promotion of
health as well as
prevention of
illness
2. Locally Endemic Disease Control
• The control of endemic disease focuses on the prevention of its occurrence to
reduce morbidity rate. Example Malaria Control and Schistosomiasis Control
3. Expanded Program on Immunization
• This program exists to control the occurrence of preventable illnesses especially
of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus,
 diphtheria and other preventable disease are given for free by the government and
ongoing program of the DOH
4. Maternal and Child Health and Family Planning
• The mother and child are the most delicate members of the community. So the
protection of the mother and child to illness and other risks would ensure good health
for the community. The goal of Family Planning includes spacing of children and
responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
• Environmental Sanitation is defined as the study of all factors in the man’s
environment, which exercise or may exercise deleterious effect on his well-being and
survival. Water is a basic need for life and one factor in man’s environment. Water is
necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is
necessary for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
• One basic need of the family is food. And if food is properly prepared then one
may be assured healthy family. There are many food resources found in the
communities but because of faulty preparation and lack of knowledge regarding proper
food planning, Malnutrition is one of the problems that we have in the country.
7. Treatment of Communicable Diseases and Common Illness
• The diseases spread through direct contact pose a great risk to those who can
be infected. Tuberculosis is one of the communicable diseases continuously occupies the
top ten causes of death. Most communicable diseases are also preventable. The
Government focuses on the prevention, control and treatment of these illnesses.
8. Supply of Essential Drugs
• This focuses on the information campaign on the utilization and acquisition of
drugs.
• In response to this campaign, the GENERIC ACT of the Philippines is enacted. It
includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine

Learning Activity:

1. Make a Drug Study about Cotrimoxazole, Paracetamol,

Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine
2. List down all the Herbal Plants approved by DOH and their
actions
 Lesson 6:
LEVEL OF
PREVENTION

Overview:

Prevention is the action aimed at eradicating, eliminating or minimizing the impact of disease
and disability, or if none of these are feasible, retarding the progress of the disease and
disability.

3 Level of Health Care

1. Prevention of illness or promotion of health

2. Curative
3. Rehabilitative

Levels of Health Care and Referral System

1. Primary Level of Care
  Devolved to the cities and municipalities. It is health care provided by center
physicians, public health nurses, rural health midwives, BHWs, traditional healers
and others at BHS and RHU
 rural health units
 sub centers
 chest clinics
 Malaria Eradication Units
 schistosomiasis control units operated by the DOH
 Puericulture centers operated by League of Puericulture centers
 tuberculosis clinics and hospitals of the Philippine Tuberculosis Society
 private clinics, clinics operated by the Philippine Medicare Care
Commission
 Health facilities operated by voluntary religious and civic groups

2. Secondary Level of Care

 Secondary care is given by physicians with basic health training. This is usually
given in health facilities either privately owned or government operated such as
infirmaries, municipal and district hospitals and OPD of provincial hospitals.

3. Tertiary Level of Care

 Tertiary care is rendered by specialists in health facilities including medical
centers as well as regional and provincial hospitals such as Philippine Health
Center. The tertiary health facility is the referral center for the secondary care
facilities.

According To Increasing Complexity of the Services Provided

Type Services Type Example
Primary Health Promotion, Preventive care, Health Promotion Information
continuing care for common health and Illness Dissemination
problems, attention to psychological Prevention
and social care referral
Secondary Surgery, Medical services by Diagnosis and Screening
specialists Treatment
Tertiary Advanced specialized, diagnostic, Rehabilitation PT/OT
therapeutic, and rehabilitative care

HEALTH PROMOTION

https://www.youtube.com/watch?
v=TlGe80Mi85U&t=44s
Three Level of Prevention
1. Primary Prevention – relates to activities directed at preventing a problem before it
occurs by altering susceptibility on reducing exposure for susceptible individuals.
Goal: Health Promotion
specific protection e.g immunization
 quite smoking
 avoid/limit alcohol intake
 exercise regularly
 eat well balanced diet
 reduce fat and increase fiber in diet
 take adequate fluids
 avoid exposure to sunlight
 maintain ideal body weight
 complete immunization program
 wear hazard devices in work site
2. Secondary Prevention – refers to early direction and prompt intervention during the
period of early disease pathogenesis.
 is implemented after a problem has began but before signs and symptoms
appear and targets those population who have risk factors.
Goal: early diagnosis detection/screening
prompt treatment to limit disability
 have annual physical check – up
 regular pap’s test for women
 month BSE for women who are 20 years old and above
 sputum exam for tuberculosis
 annual stool guide test and rectal examination for client over age 50 years.

3. Tertiary Prevention – to support the client’s achievement of successful adaptation to

known risks, optimal reconstitution and/or establishment of high level wellness.
Goal: restoration and rehabilitation
 self - monitoring of blood glucose among diabetics
 physical therapy after CVA
 Participate in Cardiac rehabilitation after MI
 Attend Self – management education for diabetes
 undergo speech therapy after laryngectomy

Learning Activities:

1. Make a Teaching Plan on the topics above as part of

Health Promotion in the Community.
 Post - Test Assessment
Multiple Choice: Directions: Read the sentence carefully. Choose the best
answer. Write the letter of your answer on your notebook.

1. What is the focus of secondary health care?

a. Early malnutrition c. early diagnosis and treatment
b. Early signs and symptoms d. early detection
2.The first international conference of PHC was held in Alma Ata last:
a. February 23 – 24, 1978 c. October 29, 1979
b. September 6 – 12, 1978 d. September 12, 1979
3. All of the following compose the intermediate level health workers except:
a. Barangay health worker c. Public health nurse
b. Midwives d. rural health inspectors
4. When a traditional birth attendant (TBA) and midwife attends to home delivery, the
care provided for is classified as:
a. Primary level of care c. tertiary level of care
b. Secondary level of care d. fold healing practice
5. A traditional plant used to lower the uric acid:
a. Pancit – pancitan c. bayabas
b. Lagundi d. sambong
6. Used to relieve muscle and joint pain
a. Lagundi c. Yerba Buena
b. Akapulko d. sambong
7. It is a aromatic herb which is used to treat rheumatism and arthritis?
a. Yerba Buena c. cormina retusa
b. Lagundi d. Ulasimang bato
8. It is seeds are taken 2 hours after supper to expel round worms in asariasis:
a. Akapulko c. bayabas
b. Niyug – niyugan d. bawang
9. It is effective for asthma, cough and dysentery:
a. Yerba Buena c. Lagundi
b. Sambong d. tsaang Gubat
10. All of the following are true of the health services provided by private sectors
except:
a. Health services are pain
b. Maybe provided by nonprofit organizations
c. Generally provided free to the public
d. Largely market oriented

Self - Assessment

Before you end this lesson, evaluate your current competency by answering the
checklist that follows. Put a check (/) mark to best describe your current level of
mastery of each list of competence.
 Competency I can do I can do this but I I am learning I can not
this very need to learn more how to do this do this
well and improve (Apprentice) yet
(Expert) (Practitioner) (Novice)
Define Primary Health Care
State the Rationale for
adopting PHC
Discuss the types of Primary
Health Care Workers
Discuss the Principles of
Primary Health Care
State the Components of
Primary Health Care
Enumerate the Elements of
Primary Health Care
Enumerate the 10 Medicinal
Plants approved by DOH
Discuss the Levels of health
care and Referral System
Discuss the 3 levels of
Prevention

Resources:
1. Zenaida U. Famorca, Mary A. Nies, Melanie McEwen 2018, Nursing Care of the
Community. C&E Publishing, Inc. Quezon City Philippines
2. Frances Prescilla L. Cuevas, Jean P. Reyala, Rosalinda Cruz – Earnshaw, Sheila Bonito,
Jean M. Sitioco, Lorenza C. Serafica, 2007, Public Health Nursing
3. https://www.youtube.com/watch?v=a3UhtiAwbog
4. https://www.youtube.com/watch?v=TlGe80Mi85U&t=44s