Primary health

care

Reporters:
Monda, Ma.Karla Fatima

Orlayen, Edlene
Learning Objectives
■Define primary health care
■Discuss what are the values enshrined in both Alma-Ata

and Astana Declaration documents on Primary Health Care

Upon completion of this chapter, the
reader will be able To the ff.
■Describe Primary Health Care as a strategy in helping
populations achieve health in their hands.

■Enumerate the different services in Primary Health Care

■Explain pillar/cornerstone of Primary Health Care.

■Compare and contrast primary care and primary health care

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• Elucidate how appropriate technology will benefit the health population groups and communities.
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Concepts of Primary
Health Care
Primary Care vs. Primary Health Care

The clamor for equitable health care Systems from our

understanding that health is a human right and as such is
everybody’s responsibility. This paved the way for the concepts
of health in the hands of the people.
Primary Care
is the first level of healthcare delivery in which a generalist like a
physician or a nurse renders medical and nursing services for
individuals and population groups. It can be a government-

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owned clinic but more often than not is privately owned.
Some of the services offered in these facilities include medical
consultation, first-aid, urgent care, immunization, wound care,
simple laboratory counseling, and normal deliveries for mothers
in labor.
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 Primary Health Care
is an overall approach to providing people access to basic healthcare and ultimately improve the health of communities.

It calls for collective efforts among all stakeholders in society and gives a premium to people's empowerment in health;

that is allowing them to improve health thru their own offers.

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 Historical background and Nature of PHC
It was in 1977 when the United Nations (UN) thru the World Health Organization
launched “Health for all by the Year 2000” as a global agenda to be pursued to fully
realized the dream of attaining the full potential of people around the world in both social
and economic terms.

The adoption of PHC as a key strategy to achieve the global agenda that ensued
as stated in the Alma-Ata Declaration. This declaration adopted by members
states of the UN in September 1978 aims to implement worldwide system reform
focusing on accessibility of healthcare for population groups.

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In our country, PHC was implemented thru the Letter of Instruction 949(1979) from
then-President Marcos who underscored the need to promote health development in
rural areas and to integrate health in all government activities.
 ■Primary Health Care

is essential healthcare based 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
community and country can afford to maintain at every stage of the
development in the spirit of self-reliance and self-determination (WHO 2008).

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It forms an integral part both of the country's health system, of which it is the
central function and main focus, and of the overall social and economic
development of the community
 It advocates for a healthcare system characterized by 5 A's
namely:
• Accessible healthcare is the
first step in making PHC a
reality.
• Available healthcare
refers to ensuring that
essential services are
• Affordable healthcare avail of technology for
a reasonable price.
• Acceptable healthcare speaks of the need for
contextualized health services.
• Accessible healthcare connotes the use of
technology-based on expressed needs of the
people that are not only scientifically proven

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provided to people in
communities across all effective but at the same time safe .
strata of society.
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 Core Values of PHC Essential Health Services in PHC
Health Education
Social Justice
Immunization
Equity
Respect for Human Dignity and Essential medicines/drugs
Human Rights Mother and child health services
Solidarity Endemic disease control and management
Self-reliance Nutrition
Treatment of simple conditions

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Sanitation and access to safe water supply

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From Alma – Ata to Astana: Leaving no one
behind the quest for health
According to WHO, the social determinants of health are
conditions in which people are born, grow, live work, and age.
These circumstances are shaped by the distribution of money,
power, and resources at global, national, and local levels. To
address the perennial problem of injustice in health in outcomes,
member states of the United Nations introduced Primary Health
Care in 1978 during the international conference held in Alma-Ata,
Kazakhstan. It offers a holistic approach for achieving inclusive
development by prioritizing healthcare that puts people first on the
agenda.

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Forty years from the inception of PHC in 1978, world health
leaders coverage once again last October 2018 at this time at
Astana Kazakhstan to affirm the declaration of Alma-Ata that
health is a fundamental right of all people and all should be
afforded equitable healthcare access.
Leaders present during this global conference specified that "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" (WHO, 2018)

Key Points of Astana Declaration:

■Health is a key element to achieving global, peace, security, and development.
■All people should enjoy the highest level of wellness without any distinction and
access to promotive, preventive, curative, rehabilitative, and palliative healthcare
should be provided at all.

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■Persistent inequalities in health among all countries especially among the poor is
socially, politically, and ethically unacceptable.
■The fight against the
relentless increase in the
number of people dying from
non communicable disease
should be continued and
intensified by expanding
tobacco control and
promoting of healthy
lifestyles

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 Multisectoral action and
engagement of all
stakeholders in health will be
pursued to make significant
strides in achieving health
reforms across all nations and
mainstreaming health in all
government policies.
Strengthen implementation
of PHC to avoid
fragmentation and to ensure
a resilient, gender sensitive,
people centered healthcare
delivery in all countries.
Rally all governments of the
world and other
organizations to work
together for full
implementation of universal
health coverage.
Empower communities
through capacity-building
activities and promote
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health literacy among all
population groups beyond
borders
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Elements of Primary Health Care

Three main elements define PHC:
01 03

PRIMARY CARE AND 02

EMPOWERED
ESSENTIAL PUBLIC
MULTISECTORAL PEOPLE AND
HEALTH FUNCTIONS
POLICY AND COMMUNITIES
AS THE CORE OF
ACTION
INTEGRATED
SERVICES.

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Public health is a multidisciplinary science that revolves
around preventive disease, prolonging life, and promoting
the health and efficiency of the population thru the
collective efforts of all stakeholders. It operates
employing the core functions of assessment, policy, and
assurance.
Birthing centers and lying-in clinics are integrated as part
of rural health units in provinces of the country.
This is mandated thru the Department of Health's (DOH)
administrative order 2008-2009 that focuses on safe
motherhood.

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Multisectoral policy entails functional coordination between public
and private agencies in making health for all possible. Salunke
(2017) states that "Multisectoral approach (MSA) refers to
deliberate collaboration among various stakeholder groups (e.g.,
government, civil society, and private sector) and sectors (e.g.,
health, environment, and economy) to jointly achieve a policy
outcome. By engaging multiple sectors, partners can leverage
knowledge, expertise, reach, and resources, benefiting from their
combined and varied strengths as they work toward the shared
goal of producing better health outcomes". To illustrate we look
again at the Department of Health's AO 2008-2009. It aims to
rapidly reduce maternal mortality across the country.

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Inherent to the concept of multisectoral approach (MSA)
is fostering inter and intrasectoral.
Intersectoral pertains to coordinated actions between
two or more agencies from a different sector. Example of
this is the fight against zoonosis-diseases that are
transmitted from animals to humans.
Intrasectoral refers to activities within the same sector
like referrals among health professionals from primary to
secondary care. The purpose of this is to ensure not only
continuity of care but provision of competent care. Such
is the purpose of the two-way referral system in the

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country. in the end, it will benefit the people by ensuring
safe and quality care deserved by all.
Empowered people and communities are pivotal to the success of
PHC since it envision health in the hands of the people.
Obviously, it puts emphasis on health more than a right but a
responsibility. Thus, health professionals should assist
individuals, families, and groups to realize that health is a
personal and social responsibility. Fostering partnerships and
giving people a sense of initiative can be achieved through health
education and literacy.
The local government code of the Philippines (RA 7160)
emphasizes participatory governance and shared leadership with
the people.

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 Determinants of 1. Knowledge and Capacity
Success for PHC Building
Information is an essential element
of self-sufficiency. Communities
The Astana Declaration
(WHO, 2018a) outlined should actively participate in every
four critical factors for stage of planning and developing
achieving health for all health programs and services.
by all:

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2. Human Resources
for Health
Community health needs are varied
and require not only holistic care but
a multidisciplinary approach. Hence,
the need for skill mix to address
health needs of the people is crucial
to the efficient implementation of
primary health care. Manpower is the
most important resource in

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healthcare PHC relies heavily on
human resources that include nurses,
midwives, physicians and other
health professionals.
According to Dayrit (2018), majority of health
professionals are in hospitals, and in terms of
distribution, they are mostly concentrated in urbanized
areas.
Further, Dayrit (2018) mentioned that "the hospital-
centric distribution of doctors and nurses in health
institutions is reflective of a model of care that diverges
from the ideal set-up of the first point of contact at the
primary care level. Mobilizing doctors who are
providing services in their own private clinics as the
first point of contact in service delivery care network
offers a solution to the challenge of shifting away from

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hospital-focused services. Expanding the nurse
practitioner programme also offers solution".
 3. Financing
PCH aims to strengthen the healthcare delivery system by providing people access to
essential health services that wil ultimately advance the well-being of individuals,
families, and the population in general.
The Philippines has a mixed healthcare system composed of public and private
organizations. The DOH (2018) reported that " More than half of health expenditures
remained to be funded by out-of-pocket (OOP) payments despite increased resources
for health in recent years. While the huge budgetary infusion translated to higher
PhilHealth coverage and led to the design of pro-poor schemes such as the No
Balance Billing (NBB) policy, social health insurance remained inadequate in
protecting Filipinos from the financial burden of healthcare".
Thus, reforms in the health system are crucial to cover all Filipinos and this begins
with legislation.
To generate more funding for health, the national government thru congress
formulated sin taxes last 2013 which include RA 10351. This law increased the excise
taxes for both tobacco and alcohol to generate revenue for health care financing.
RA 10963 also known as TRAIN law or the tax reform for inclusion and acceleration of
2018.
4. To ensure that people from all walks of life enjoy
the highest possible level of wellness, access to
Technology available services and technology must be provided.
Technology is defined in a general context as the
application of science for the benefit of
communities.
WHO(2018b) defines it as the "application of
organized knowledge and skills in the form of
devices, medicines, vaccines, procedures, and
systems developed to solve a health problem and
improve quality of lives."
CRITERIA FOR APPROPRIATE
HEALTH TECHNOLOGY
The World Health Organization as cited by
Goodyear (2009) defines appropriate health
technology as methods, procedures, techniques,
and equipment that are: scientifically valid,
adapted to local needs, acceptable to users and
recipients, and maintainable with local resources.
Goodyear (2009) states that health technology
should be characterized by the following:
Effective
Safe Affordable
it delivers the intended
it assures users that no the cost of technology will
benefit or purpose of the
harm will result from the not be a burden for both
technology as proven
use of the technology or individual consumers and
through scientific processes.
to the least, it minimizes organizations like the
risk of harm government to guarantee
its accessibility
 Sustainable
Acceptable
the technology is of
utility to the population use of technology is in
and can be maintained, harmony with community
supplied to all, and norms and culture. It
repaired as needed by should also spring from
users. expressed need of the
people employing bottom
up approach.
 Essential drugs/ medicines
An important element in the effective delivery of health service is the provision
of medicines to treat endemic conditions affecting people in the community.
Drugs that are considered essential are not only regarded as life saving but can
be used for all population groups. Examples include the provision of
paracetamol and amoxicillin in primary care facilities to address common
problems like fever, headache, and infections.
 -seeks “to promote, require, and ensure the
production of an adequate supply, distribution, use,
and acceptance of drugs and medicines identified by
the generics names.” This law was written to ensure a
RA 6675 sufficient supply of medicines in the country at the
lowest possible cost.
Generic Act of -"sought to ensure adequate supply, distribution, use,
1998 and acceptance of drugs and medicines identified by
their generic names. It was supported by EO 49,
s.1993, which directed the mandatory use of the

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Philippine National Drug Formulary (PNDF) as the
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basis for the procurement of drug products by the

government".
 ENTITLED "AN ACT PROVIDING
PROTECTION TO CONSUMERS BY
RA 7581 STABILIZING THE PRICES OF BASIC
NECESSITIES AND PRIME
Price Act COMMODITIES AND BY PRESCRIBING
MEASURES AGAINST UNDUE PRICE
INCREASES DURING EMERGENCY

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SITUATIONS AND LIKE OCCASIONS"
AND FOR OTHER PURPOSES.
 is intended to achieve universally
accessible and cheaper and

RA 9502 quality medicines by pursuing an

effective competition policy in the
Cheaper Medicines pharmaceutical sector. The
Act of 2008 President subsequently issued an
executive order requiring
maximum retail prices for a

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number of drugs.
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Traditional and Alternative Health Care
Two general schools of thought
in medicine:
Eastern and Western
Both are anchored on a well-established
body of knowledge: the former scientific
while the latter is traditional.
Primary Health Care advocates for the
provision of health services for all. To
achieve this requires that both modern
and traditional knowledge go hand in
hand in improving people's health
(WHO,2013)
In the Philippines, traditional and complementary medicine
has been institutionalized through RA 8423. This law created
the Philippine Institute of Traditional Alternative Health Care
or PITAHC which has the broad mandate of initiating
activities to advocate, develop, and promote the use of
indigenous healthcare practices in the country. This agency
works under the DOH and closely coordinates with the DOST
for undertaking researches to widen the evidence base for
this approach by establishing its safety and efficacy. The
WHO (2019) defines traditional medicine as "the sum total of
the knowledge, skill, and practices based on the theories,
beliefs, and experiences indigenous to different cultures,
whether explicable or not, used in the maintenance of health
as well as in the prevention, diagnosis, improvement or
treatment of physical and mental illness".
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Herbal Medicines
This refers to the use of plants or derivatives from plants for the treatment of specific
conditions.
in the Philippines, herbal medicines are considered one of the most popular
modalities of complementary medicine. They are commonly sold in the local market
as foods supplements and are regulated by the Food and Drugs Administration (FDA).

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 Summary
• Primary Health Care is a total approach in achieving health for all, by all. It is
regarded as a strategy, goal, and philosophy. It also refers to the provision of
essential healthcare to people regardless of age, sex, creed, or religion.
• Healthcare should be characterized by 5 A's namely: accessible, available,
affordable, acceptable, and appropriate. Elements of PHC include: provision of
primary care, multi-sectoral collaboration, and empower people and
communities.
• Health is not only a right but a responsibility. Self-reliance in health is a major
goal of PHC. Active community participation is crucial to the success of the
primary health care.

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• Appropriate health technology includes medicines, vaccines and supplies that
will help promote and maintain the health of the general population.
• Equitable financing for healthcare and deployment of human resources for
health are key determinants in success of PHC implementation in all countries.
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