Primary Health Care 6.
Socio-economic influences-
Optimum Level of Functioning
● The modern concept of health
refers it to the “optimum level of
functioning” (OLOF) of individuals,
families and communities which is
affected by several factors in the
ecosystem, as follows;
Factors
1. Political factors- politics have
power and authority to regulate the
environment or social climate
For example:
➔ Laws or legislative acts are often
related to promoting safety and
people empowerment.
2. Behavioral factors- a person’s level
of functioning is affected by certain
habits while their lifestyle, health
care and child rearing practices are
determined by their culture and
ethnic heritage.
3. Hereditary factors- understanding
of genetically-influenced diseases
and genetic risks
4. Health care delivery system-
primary health care is a partnership
approach to the effective provision
of essential health services that are
community-based, accessible,
acceptable, sustainable, and
affordable.
5. Environmental influences- the
menace of pollution,
communicable diseases due to
poor sanitation, poor garbage
collection, smoking, utilization of
pesticides.
families in lower income group are
the ones mostly served
Example:
➔ Unemployed, underemployed, lack
of education, lack of decent
housing
Primary Health Care (PHC)
“essential health care made universally
accessible to individuals & families in the
community by means of acceptable to them
through their full participation & at cost that
the community & country can afford at every
stage of development”
❖ Primary health care (PHC) is the
first level of contact for individuals,
the family, and the community with
the national health system and
“address the main health problems
in the community, providing health
promotion, preventive, curative, and
rehabilitative services accordingly”
History of Primary Health Care
May 1977 - The 30th World Health
Assembly adopted resolution WHA 30:43
● This resolution decided that the
main social target of governments
and of WHO should be attainment
by all the people of the world by the
year 2000 a level of health that will
permit them to lead a socially and
economically productive life.
Alma Ata Declaration, 1978
September 6-12, 1978
● “The conference strongly reaffirms
that health is a fundamental
human right”
● “The existing gross inequality in the
health status of the people
particularly between developed
and developing countries as well as
within countries is politically,
socially, and economically
unacceptable”.
● International Conference on
Primary Health Care was held this
year in Alma Ata, USSR
● The conference came up with what
is known popularly as the Alma Ata
Declaration, which represents a
global ideal, a new vision about
how to achieve world health
● The declaration stated that
primary health care is the key to
attaining the health-for-all goal.
● The global goal as stated in the
Alma Ata Declaration is Health for
all by the year 2000 through
self-reliance
● The health for all goals does not
mean however that nobody will be
sick or disabled anymore. Nor does
it mean that health care
professionals will provide care for
everybody in the country or the
world for all their existing ailments.
Underlying theme of (before / previous)
➔ Health for all by year 2000 (WHO,
1978)
➔ “Health in the hands of the people
by 2020”
Declaration of Astana
25-26 OCtober 2018 - Astana Kazakhstan
● On the 40th anniversary of the
Alma-Ata declaration, global health
leaders and stakeholders returned
to Kazakhstan to renew the
promise of primary health care as
the most effective and efficient
means to achieve universal health
coverage (WHO, 208)
● Aim to meet all people’s needs
across the life course through
comprehensive, preventive,
promotive, curative, rehabilitative,
services and palliative care.
Global health leaders commit to:
● Make bold political choices for
health across all sectors
● Build sustainable primary health
care
● Empower individuals and
communities
● Align stakeholders to support
national policies, strategies and
plans.
What is PHC (New Consensus)
● A whole of society approach to
health that aims to ensure the
highest possible level of health and
wellbeing and their equitable
distribution by focusing on people’s
needs and preferences (as
individuals, families, and
communities) as early as possible
along the continuum from health
promotion and disease prevention
to treatment, rehabilitation and
palliative care, and as close as
feasible to people’s everyday
environment.
● Primary Health Care is a strategy to
ensure that there is effective
provision of essential health
services that are community-based,
accessible, acceptable, and
sustainable
● Multiple sectors working together
to bring care closer to home with
the involvement of the community
A primary healthcare approach includes
three components:
1. Meeting people’s health needs
throughout their lives
2. Addressing the broader
determinants of health through
multisectoral policy and action
3. Empowering individuals, families,
and communities to take charge of
their own health.
PHC’s goal is anchored in the Vision of
DOH
★ Filipinos are among the healthiest
people in Southeast Asia by 2022,
and Asia by 2040
Mission
★ To strengthen the health care
system by increasing opportunities
& supporting the condition wherein
people will manage their own
health care.
Legal Basis of PHC in the Philippines
October 19, 1979
● The president of the Philippines
(Ferdinand Marcos) issued letter of
Instruction (LOI) 949 which
mandated the Ministry of Health to
adopt Primary Health Care as an
approach towards design,
development, and implementation
of programs, which focus health
development at the community
level
Universal Declaration of Human Rights,
Article 25, Section 1
● “Everyone has the right to a
standard of living adequate for the
health and well-being of himself
and of his family, including food,
clothing, housing, and medical care
and necessary social services and
the right to security in the event of
unemployment, sickness, disability,
old age, widowhood, or lack of
livelihood.”
Philippine COnstitution of 1987, Article
XIII, Section 11
● “ The state shall adopt an
integrated and comprehensive
approach to health development
which shall endeavor to make
essential goods, health and other
social services available to all the
people at affordable cost. There
shall be a priority for the needs of
the underprivileged sick, elderly,
disbled, women, and children. The
state shall endeavor to provide free
medical services to paupers.
WHO (1995)
● Governments have a responsibility
for the health of their people which
can be fulfilled only by the provision
of adequate health and social
measures.
Elements of Primary Health Care
Four Cornerstones / Pillars in Primary
Health Care
1. Active communication
participation
2. Multi Sectoral linkages
3. Use of appropriate technology
4. Support mechanism made
available
Community Participation
● A process in which people identify
the problems and needs and
assume responsibilities themselves
to plan, manage and control.
● People should take a role or
contribute, for example people
should be part of the planning
process.
Multi Sectoral Linkages
Appropriate Technology
● Method used to provide a socially
and environmentally acceptable
level of services or quality at the
least economic cost.
 ● Health technology includes tools, Examples: botika ng bayan, ligtas tigdas
drugs, methods, procedures, ang pinas
techniques; and people with
indegenous technology ❖ Community Based- delivered
where the people are
Support Mechanism
3 major sources: ❖ Sustainable-health services
should be successfully utilized,
➢ People maintained and continued

➢ Government ❖ Feasibility of use- possibility of

use at all times
➢ Private sector
❖ Effective

Key Principles ❖ Scope of technology is safe and

secure
4 A’s
● Accessibility
➢ Distance or travel time
required to get to the Types of Primary health care workers
healthcare facility or service
➢ Can be reached by the ● Various categories of health
majority of population workers make up the primary
health care team
● Affordability
➢ Inexpensive healthcare ● The type vary in different
services communities depending upon:
➢ Most health services are
covered by the government 1. Available health manpower
insurance system known as resources
Philhealth
2. Local health needs and
● Acceptability problems
➢ Compatible with the culture
and tradition with the 3. Political and financial
population feasibility.
➢ Meets the requirements and
needs in the area

● Availability
➢ Services / programs are
offered, provided on regular
basis in an organized
manner/
Two Levels of Primary Health Care
Workers
1. Grassroots of Village or Barangay
Health workers ( V/BHWs )
➔ This refers to trained
community health workers
or health auxiliary volunteer
or a traditional birth
attendant or healer
2. Intermediate level health workers
➔ General medical
practitioners or their
assistants, Public health
nurse, rural sanitary
inspectors, and midwives
may compose these groups
Basic primary health care team:
- Physician
- Public health nurse
- Midwife
Levels of Prevention
Primary Prevention
● Decrease vulnerability: reduce risk
factors. Prevent disease and
dysfunction.
● Health promotion for healthy
people
Secondary Prevention
● Halt pathological process, shorten
duration and severity of disease
● Screening for early diagnosis for
people with undetected disease or
disability.
Tertiary Prevention
● Restore a person to the highest
level of functioning within limits of
disease. Prevent further
deterioration from a fixed or
irreversible disease.
● Rehabilitation for people with fixed
irreversible disease
Example:
● Primary
➢ Quit smoking
➢ Limit alcohol intake
➢ Exercise regularly
➢ Reduce fat and increase
fiber in diet
➢ Take adequate fluids
➢ Complete immunization
● Secondary
➢ Screening
➢ Early detection
➢ Early treatment
➢ Surveillance of disease
➢ Contact tracing
● Tertiary
➢ Rehabilitative or prevention
of disability care
➢ Helping client live
productively with limitations
➢ Self-monitoring blood
glucose
➢ Physical therapy after
cerebrovascular accident
Levels of Health Care and Referral ● Complicated cases and intensive
System care requires tertiary care and all
these can be provided by the
Primary level of Care tertiary care facility.

● Is developed to the cities and the

municipalities. It is health provided
by center physicians, public health
nurses, rural health midwives,
barangay health workers, traditional
healers and others at the barangay
health stations and rural health
units.

Secondary level of 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 First level - grassroots or village workers
district hospitals and out-patient
departments of provincial hospitals Second level - intermediate

● This serves as a referral center for Third level- first line personnel who are
the primary health facilities. specialists

● Secondary facilities are capable of
performing minor surgeries and
perform some simple laboratory
examinations
The latter establish close contact with the
village, or intermediate health workers to
promote continuity of care from the hospital to
community to home.

Tertiary level of care

What is Universal Health Coverage / Care

● Is rendered by specialists in health

● All people having access to quality
facilities including medical centers
health services without suffering
as well as regional and provincial
the financial hardship associated
hospitals, and specialized hospitals
with paying for care
such as the Philippine Health
Center

● The tertiary health facility is the

referral center for the secondary
care facilities.
Universal Health Care and its Aim
● Universal health care, also referred
to as Kalusugan Pangkalahatan
(KP), is the “provision to every
Filipino of the highest possible
quality of health care that is
accessible, efficient, equitably
distributed, adequately funded,
fairly financed, and appropriately
used by an informed and
empowered public.”
The Universal Health Care Act of the
Philippines was signed last February
2019
● Health sector reform in the
Philippines has been accelerated by
the passage of Republic Act 11223,
more commonly known as the UHC
Law.

● The aquino administration puts it

as the availability and accessibility
of health service and necessities for
all filipinos

● It is a government mandate aiming

to ensure that every filipino shall
receive affordable and quality
health benefits

UHC’s Three Thrusts

To attain UHC, three strategic thrusts are
to be pursued, namely:

1. Financial risk protection through

expansion in enrollment and
benefit delivery of the national
health insurance program (NHIP)

2. Improve access to quality hospitals

and health care facilities

3. Attainment of health-related
sustainable development goals

● Financial efforts shall be provided

to allow immediate rehabilitation
and construction of critical health
facilities. In addition to that,
treatment packs for hypertension
and diabetes shall be obtained and
distributed to RHUs