PRIMARY HEALTH CARE

What is Primary Health Care (PHC)?

Primary health care (PHC) is essential health care made

universally accessible to individuals and acceptable to them,
through full participation and at a cost the community and
country can afford. It is an approach to health beyond the
traditional health care system that focuses on health equity-
producing social policy. Primary health-care (PHC) has basic
essential elements and objectives that help to attain better
health services for all.
What is Primary Health Care (PHC)?

 Primary Health Care (PHC) is the health care that is available

to all the people at the first level of health care.
 According to World Health Organization (WHO), ‘Primary
Health Care is a basic health care and is a whole of society
approach to healthy well-being, focused on needs and
priorities of individuals, families and communities.’
 Primary Health Care (PHC) is a new approach to health care
which integrates at the community level all the factors required
for improving the health status of the population.
 Primary health care is both a philosophy of health care and
an approach to providing health services.
 It addresses the expansive determining factor of health and
ensures whole person care for health demands during the
course of the natural life.
 It is developed with the concept that the people of the country
receive at least the basic minimum health services that are
essential for their good health and care.
 What is Primary Health Care (PHC)?

 Primary health care” is an overall approach which encompasses the three

aspects of: multisectoral policy and action to address the broader determinants
of health; empowering individuals, families and communities, and meeting
people’s essential health needs throughout their lives.
 Primary care is a subset of PHC and refers to essential, first-contact care
provided in a community setting.
 Primary health care is a whole-of-society approach to health and well-being
centered on the needs and preferences of individuals, families and
communities.
 What is Primary Health Care
 (PHC)?
Primary health care is rooted in a commitment to
social justice and equity and in the recognition of the
fundamental right to the highest attainable standard
of health, as echoed in Article 25 of the Universal
Declaration on Human Rights: “Everyone has the
right to a standard of living adequate for the health
and wellbeing of himself and of his family, including
food, clothing, housing and medical care and
necessary social services […]”.
What is Primary Health Care
(PHC)?
 It addresses the broader determinants of health
and focuses on the comprehensive and
interrelated aspects of physical, mental and social
health and wellbeing. 
 It provides whole-person care for health needs
throughout the lifespan, not just for a set of
specific diseases.
 Primary health care ensures people receive
comprehensive care - ranging from promotion and
prevention to treatment, rehabilitation and
palliative care - as close as feasible to people’s
everyday environment.
WHO has developed a cohesive definition based on three
components:
1. meeting people’s health needs through comprehensive
promotive, protective, preventive, curative, rehabilitative,
and palliative care throughout the life course,
strategically prioritizing key health care services aimed at
individuals and families through primary care and the
population through public health functions as the central
elements of integrated health services;
2. systematically addressing the broader determinants of
health (including social, economic, environmental, as well
as people’s characteristics and behaviours) through
evidence-informed public policies and actions across all
sectors; and
3. empowering individuals, families, and communities to
optimize their health, as advocates for policies that
promote and protect health and well-being, as co-
developers of health and social services, and as self-
carers and care-givers to others.
Why is primary health care important?

 Primary health care is well-positioned to respond to

rapid economic, technological, and demographic
changes, all of which impact health and well-being.  A
recent analysis found that approximately half of the
gains in reducing child mortality from 1990 to 2010 were
due to factors outside the health sector (such as, water
and sanitation, education, economic growth). A primary
health care approach draws in a wide range of
stakeholders to examine and change policies to address
the social, economic, environmental and commercial
determinants of health and well-being.  Treating people
and communities as key actors in the production of their
own health and well-being is critical for understanding
and responding to the complexities of our changing
world.
 History of Primary Health Care:
 Before 1978, globally, existing health services were failing to provide quality
health care to the people.
 Different alternatives and ideas failed to establish a well-functioning health
care system.
 Considering these issues, a joint WHO-UNICEF international conference was
held in 1978 in Alma Ata (USSR), commonly known as Alma-Ata conference.
 The conference included participation from government from 134 countries
and other different agencies.
 The conference jointly called for a revolutionary approach to the health care.
 The conference declared ‘The existing gross inequality in the health status
of people particularly between developed and developing countries as well
as within countries is politically, socially and economically unacceptable’.
 Thus, the Alma-Ata conference called for acceptance of WHO goal of ‘Health
for All’ by 2000 AD.
 Furthermore, it proclaimed Primary Health Care (PHC) as a way to achieve
‘Health for All’.
 In this way, the concept of Primary Health Care (PHC) came into
existence globally in 1978 from the Alma-Ata Conference.
 Objectives of Primary Health Care (PHC):

 To increase the programs and services that affect the healthy growth and
development of children and youth.
 To boost participation of the community with government and community
sectors to improve the health of their community.
 To develop community satisfaction with the primary health care system.
 To support and advocate for healthy public policy within all sectors and
levels of government.
 To support and encourage the implementation of provincial public health
policies and direction.
 To provide reasonable and timely access to primary health care services.
 To apply the standards of accountability in professional practice.
 To establish, within available resources, primary health care teams and
networks.
 To support the provision of comprehensive, integrated, and evidence-based
primary health care services.
5 Principles of Primary Health Care (PHC):

1. Social equity
2. Nation-wide coverage/wider coverage
3. Self- reliance
4. Intersectoral coordination
5. People’s involvement (in planning and
implementation of programs)
Primary health care
consists of an
integrative group of
health care
professionals
coordinating to
provide basic health
care services to a
particular group of
people or population.

These pillars are

reinforcement for the
delivery of safe health
care.

What are the Pillars of Primary Health Care

(PHC)?
1. COMMUNITY PARTICIPATION
 Community participation is a process in which
community people are engaged and participated in
making decisions about their own health.
 It is a social approach to point out the health care
needs of the community people.
 Community participation involves participation of the
community people from identifying the health needs
of the community, planning, organizing, decision
making and implementation of health programs.
 It also ensures effective and strategic planning and
evaluation of health care services.
 In lack of community participation, the health
programs cannot run smoothly and universal
achievement by primary health care cannot be
achieved.
2. INTER-SECTORAL COORDINATION
 Inter-sectoral coordination plays a vital role in
performing different functions in attaining health
services.
 The involvement of specialized agency, private
sectors, and public sectors is important to achieve
improved health facilities.
 Intersectoral coordination will ensure different
sectors to collaborate and function interdependently
to meet the health care needs of the people.
 It also refers to delivering health care services in an
integrated way.
 Therefore, the departments like agriculture, animal
husbandry, food, industry, education, housing,
public works, communication, and other sectors
need to be involved in achieving health for all.
3. APPROPRIATE TECHNOLOGY
 Appropriate healthcare technologies are an important
strategy for improving the availability and accessibility of
healthcare services.
 It has been defined as ‘’technology that is scientifically
sound, adaptable to local needs and acceptable to those
who apply it and to whom it is applied and that can be
maintained by people themselves in keeping with the
principle of self-reliance with the resources the community
and country can afford.’’
 Appropriate technology refers to using cheaper,
scientifically valid and acceptable equipment and
techniques.
 It is also necessary to ensure that the technology is:
 Scientifically reliable and valid
 Adapted to local needs
 Acceptable to the community people
 Accessible and affordable by the local resources
4. SUPPORT MECHANISM MADE AVAILABLE
 Support Mechanism is vital to health and quality of
life. Support mechanism in primary health care is a
well-known process focused to develop the quality
of life.
 Support mechanism includes that the people are
getting personal, physical, mental, spiritual and
instrumental support to meet goals of primary
health care.
 Primary health care depends on adequate number
and distribution of trained physicians, nurses,
community health workers, allied health
professions and others working as a health team
and supported at the local and referral levels.
Why is Primary Health Care (PHC) Important?
 Primary Health Care focuses more on quality health service
and cost-effectiveness.
 Primary Health Care focuses on “Health for all”
 Primary Health Care integrates preventive, promotive, curative,
rehabilitative and palliative health care services.
 Primary Health Care encourages new connection and
community participation.
 It includes services that are readily accessible and available
to the community.
 Primary Health Care can be easily accessible by all as it
includes services that are simple and efficient with respect
to cost, techniques and organization.
 Primary Health Care promotes equity and equality.
 Primary Health Care improves safety, performance, and
accountability.
 Primary Health Care advocates on health promotion and
focuses on prevention, screening and early intervention of
health disparities.
 Primary Health Care is also perceived as an integral part of
country’s socio-economic development.
What are the Challenges for Implementation of PHC?

 Poor staffing and shortage of health personnel

 Inadequate technology and equipment
 Poor condition of infrastructure/infrastructure gap,
especially in the rural areas
 Concentrated focus on curative health services rather
than preventive and promotive health care services.
 Challenging geographic distribution
 Poor quality of health care services
 Lack of financial support in health care programs
 Lack of community participation
 Poor distribution of health workers/health workers
concentrated on the urban areas.
 Lack of intersectoral collaboration
What are the Mitigation Measures for
Ensuring Effective PHC?
 Encouraging community participation through rapport building,
effective communication and sharing objectives and benefits of
PHC.
 Developing quality assurance mechanisms through the
development of various indicators and standards.
 Development of clinical guidelines including the implementation
of Essential drugs list
 Allocating resources as per the need of the central,
provincial/state and local level.
 Develop a planning process to define objectives and set targets by
giving priority on those families and communities most at risk.
 Promoting problem-orientated research in health management
system.
 Creating pathways to give health higher priority on the agenda of
district development and collaboration of health departments to
perform its role in health activities.
 Develop guidelines and framework that specify the roles and
responsibilities of the provincial states.
Why is primary health care important?
Primary health care has been proven to be a highly effective and efficient
way to address the main causes and risks of poor health and well-being
today, as well as handling the emerging challenges that threaten health
and well-being tomorrow. It has also been shown to be a good value
investment, as there is evidence that quality primary health care reduces
total healthcare costs and improves efficiency by reducing hospital
admissions. Addressing increasingly complex health needs calls for a
multisectoral approach that integrates health-promoting and preventive
policies, solutions that are responsive to communities, and health services
that are people-centred.  Primary health care also includes the key
elements needed to improve health security and prevent health threats
such as epidemics and antimicrobial resistance, through such measures as
community engagement and education, rational prescribing, and a core set
of essential public health functions, including surveillance.  Strengthening
systems at the community and peripheral health facility level contributes to
building resilience, which is critical for withstanding shocks to the health
system.
 Why is primary health care
important?

 Stronger primary health care is essential to achieving the

health-related Sustainable Development Goals (SDGs)
and universal health coverage. It will contribute to the
attainment of other goals beyond the health goal (SDG3),
including those on poverty, hunger, education, gender
equality, clean water and sanitation, work and economic
growth, reducing inequality and climate action.
ESSENTIAL ELEMENTS OF PRIMARY HEALTH
CARE (PHC):
There are 8 elements of primary health care (PHC).

E- Education concerning prevailing health problems and the

methods of identifying,  preventing, and controlling them.

L–  Locally endemic disease prevention and control.

E– An expanded program of immunization against major
infectious diseases.
M– Maternal and child health care including family planning.
E–  Essential drugs arrangement.
N– Nutritional food supplement, an adequate supply of safe and
basic nutrition.
T– Treatment of communicable and non-communicable diseases and
the promotion of mental health.
S–  Safe water and sanitation.
Extended Elements in the 21st Century:

 Expanded options of immunizations.

 Reproductive health needs.
 Provision of essential technologies for health.
 Health promotion.
 Prevention and control of non-communicable
diseases.
 Food safety and the provision of selected food
supplements.
Principles of Primary Health Care (PHC):
Behind these elements lies a series of basic objectives that should
be formulated in national policies to launch and sustain primary
healthcare (PHC) as part of a comprehensive health system and
coordination with other sectors.

 Improvement in the level of health care of the community.

 Favorable population growth structure.
 Reduction in the prevalence of preventable, communicable, and
other diseases.
 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.
Principles of Primary Health Care (PHC):

 Equitable distribution of health care – according to this principle,

primary care and other services to meet the main health problems in
a community must be provided equally to all individuals irrespective
of their gender, age, and caste, urban/rural, and social class.
 Community participation-comprehensive healthcare relies on
adequate numbers and distribution of trained physicians, nurses,
allied health professions, community health workers, and others
working as a health team and supported at the local and referral
levels.
 Multi-sectional approach-recognition that health cannot be
improved by intervention within just the formal health sector; other
sectors are equally important in promoting the health and self-
reliance of communities.
 Use of appropriate technology- medical technology should be
provided that accessible, affordable, feasible, and culturally
acceptable to the community.
 References and For More Information:

https://www.who.int/news-room/fact-sheets/detail/primary-health-care
https://www.health.gov.nl.ca/health/publications/moving_forward_together_
apple.pdf
https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=219&se
ction=1.5.2
http://nursingexercise.com/primary-health-care-pillars/
http://www.atmph.org/article.asp?issn=1755-6783;year=2015;volume=8;issu
e=1;spage=5;epage=9;aulast=Chinawa
https://www.devex.com/news/5-challenges-in-implementing-primary-care-in
novations-and-how-to-overcome-them-85579
https://apps.who.int/medicinedocs/documents/s22232en/s22232en.pdf
https://www.health.gov.au/internet/publications/publishing.nsf/Content/NPH
C-Strategic-Framework~priorities-and-objectives
https://ccchclinic.com/low-income-clinics/importance-benefits-primary-heal
th-care/