Primary Health Care and

It’s Importance to Family Medicine

Joshua James L. Diao, MD
 Sources:

1. World Health Organization: Primary Health Care (Alma-

Ata)
2. World Health Organization: Primary Health Care (Astana)
3. Leopando, Z.E. Et. Al (2016), Primary Health Care and Its
Relevance to Family Medicine, Textbook of Family Medicine
Volume 1
4. Rakel, E. Et. All (2016) Family Physician, Textbook of
Family Medicine
Objective

To discuss the basic concepts of primary health care and

primary care and its relevance to the practice of family
medicine.
 Outline

1. Alma-Ata Declaration
2. Objectives of Primary Health Care (PHC)
3. Principles and Strategies of PHC
4. Elements of PHC
5. Astana Declaration
6. Sustainable Development Goals (Overview)
7. Family Physician and Primary Care
REALITIES OF HEALTH CARE

Health is a social phenomenon affected by multiple

factors.

Health is a fundamental human right.

There is existing social injustice and inequities in

health care
Alma-Ata Declaration

40 years ago, health experts and policy makers from 134

countries convened to attend a conference on international
primary health care.

On 12 September 1978 the Alma-Ata Declaration was

approved, with the ambitious goal of achieving
“health for all by the year 2000” .
Health for All

Based on the World Health Organization’s constitutional

definition, where Health:

“a state of physical, mental and spiritual well-being, not

merely an absence of disease or infirmity”
Alma-Ata Declaration revolutionized the world’s
interpretation of health with the core principles:

 Universal Access to care

 Equitable Healthcare
 Community participation
 Intersectoral Collaboration
 Appropriate use of resources
“Inadequate and Unequal health care is Unacceptable:
economically, socially, and politically.”
Four Objectives of Primary Health Care (PHC)

To enable people to seek better health at home, in

schools, in fields and in factories.

To enable people to prevent diseases and injuries, instead

of relying on doctors to cure illnesses that could have been
avoided.
Four Objectives of Primary Health Care (PHC)

To enable people to exercise their right and responsibility

in shaping the environment and bringing about conditions
that make it possible and easier to live a healthy life.

To enable people to exercise control in managing health and

related systems, and to ensure that the basic prerequisites
for health and access to health care are available to all.
Seven (7) PHC Principles & Strategies
 Accessibility, availability, and acceptability of health services

 Provision of high quality, basic and essential health services

 Community Participation

 Self-Reliance

 Recognition of inter-relationship between health and development

 Social mobilization

 Decentralization
Accessibility, Availability, and Acceptability of Health Services

Health services are delivered WHERE THE PEOPLE ARE, using

available and indigenous resources.
Examples:
1.Use of traditional, complementary, and alternative medicine together with
Western Medicine.

2.Promotion of scientifically validated “10 Halamang Gamot” of the Department

of Health.
Provision of High Quality, Basic and Essential Health Services

Health programs and projects are developed and implemented based

on community needs and priorities according to a minimum set of
standards.

Health services are delivered by community health workers who are

adequately trained on promotive, preventive, curative, and
rehabilitative health care.
Community Participation

Involvement of the community in all health and development activities.

Identification and training of health workers may prove to be vital,

especially during community organizing and development activities.

Awareness and consciousness-raising on health and health-related

issues can increase level of community participation.
Self-Reliance

The community itself is aware of health and health-related problems,

knows the possible courses of action to be undertaken and is capable of
resolving them.

Training of community members in leadership and management skills

including provisions for fund generation and use of local resources is also
crucial.
Recognition of Inter-Relationship between Health and Development

Health is a subsystem of a larger socio-political and economic

system

Health improvement plans must be formulated within the framework of

the nation’s socio-economic development.

Integration of PHC into national, regional, provincial, municipal and

barangay development plans.
 Elements of Primary Health Care

 Education concerning prevailing health problems.

 Methods of preventing and controlling Locally endemic
diseases.
 Provision of Essential drugs.
 Maternal and child care, including family planning and
reproductive health.
 EPI/Immunization against major infectious diseases.
 Promotion of Nutrition.
 Adequate supply of safe water and basic Sanitation.
Social Mobilization

Establish an effective networking system through:

1. Collaboration with the different existing health and non-health
organization.

2. Creating multi-sectoral and interdisciplinary linkages.

Decentralization

Leadership, support and management of budgetary resources are

given and delegated to the local leaders in the community.
ASTANA DECLARATION

Strongly affirm the commitment to the fundamental right of every

human being to the enjoyment of the highest attainable standard
of health without distinction of any kind.

Strengthening primary health care (PHC) is the most inclusive,

effective and efficient approach to enhance people’s physical and
mental health, as well as social well-being, and that PHC is a
cornerstone of a sustainable health system for universal health
coverage (UHC) and health-related Sustainable Development
Goals.
ASTANA DECLARATION

Acknowledges that in spite of remarkable progress over the

last 40 years, people in all parts of the world still have
unaddressed health needs.

Promotive, preventive, curative, rehabilitative services and

palliative care must be accessible to all.
ASTANA DECLARATION

Recognizes the increasing importance of non-communicable

diseases including mental health issues, injuries and the
health impacts of climate change.

Incorporates ‘universal health coverage’ that is at the center of

the health related Sustainable Development Goal (SDG)
Sustainable Development Goals

Are built on the Millennium Development Goals (MDGs), which

came into effect in 2000 and primarily focused on ending poverty.

The UN claim that the MDGs caused a drop in child mortality and
school dropout rates, as well as lifted 1 billion people out of extreme
poverty since 1990. They also saw a 40% decrease in AIDS/HIV
infections.

Aims to focus on 17 new goals to continue what the MDGs started.

Global Conference on Primary Health Care (ASTANA)

Governments and societies that prioritize, promote and

protect people’s health and well-being, at both population
and individual levels, through strong health systems;
Global Conference on Primary Health Care (ASTANA)

Primary health care and health services that are high

quality, safe, comprehensive, integrated, accessible, available
and affordable for everyone and everywhere, provided with
compassion, respect and dignity by health professionals who
are well-trained, skilled, motivated and committed;
Global Conference on Primary Health Care (ASTANA)

Enabling and health-conducive environments in which

individuals and communities are empowered and engaged in
maintaining and enhancing their health and well-being;

Partners and stakeholders aligned in providing effective

support to national health policies, strategies and plans.
“It is much more important to know what sort of
patient has a disease than what sort of disease a
patient has.”
SIR WILLIAM OSLER (1904)
Family Physician

Possess distinct attitudes, skills, and knowledge that qualify them to

provide continuing and comprehensive medical care, health
maintenance, and preventive services to each member of a
family regardless of gender, age, or type of problem (i.e., biologic,
behavioral, or social).

Primary Care Provider

Family Physician

Because of their background and interactions with the family, are

best qualified to serve as each patient’s advocate in all health-
related matters, including the appropriate use of consultants,
health services, and community resources.
Primary Care

Health care that is accessible, comprehensive, coordinated, and

continuing.

It is provided by physicians specifically trained for and skilled in

comprehensive first-contact and continuing care for ill persons or
those with an undiagnosed sign, symptom, or health concern (i.e.,
the “undifferentiated” patient) and is not limited by problem origin
(i.e., biologic, behavioral, or social), organ system, or gender.
Primary Care

In addition to diagnosis and treatment of acute and chronic

illnesses, primary care includes health promotion, disease
prevention, health maintenance, counseling, and patient education
in a variety of health care settings (e.g., office, inpatient, critical
care, long-term care, home care).
Primary Care

Is the backbone of the health care system and encompasses the following
functions:
1. It is first-contact care, serving as a point of entry for the patient into the
health care system.
2. It includes continuity by virtue of caring for patients in sickness and in
health over some period.
3. It is comprehensive care, drawing from all the traditional major
disciplines for its functional content.
4. It serves a coordinative function for all the health care needs of the
patient.
5. It assumes continuing responsibility for individual patient follow-up
and community health problems.
6. It is a highly personalized type of care.
Summary

Family Physicians are best qualified to serve as each patient’s

advocate in all health-related matters.

Strong primary health care systems need to be able to regularly

assess population health needs and adapt priorities and service
delivery modalities as these needs change.