PRIMARY HEALTH CARE

Health
• Health is a fundamental human right
• State responsibility for the health of its
people
• National Govt all over the world are
striving to expand and improve their
health care services
• The current situation is
– Urban oriented
– Mostly curative in nature
– Accessible to a small part of population
 Health

Health is a state of complete

physical, mental and social wellbeing
and not merely absence of disease or
infirmity
(WHO Definition of Health 1948)
 Factors affecting health
parenting
gender
styles
family
age
dynamics

geographical
employability HEALTH mobility

culture social resources

family biological
finances factors
McMurray, A. (2003) pg.12
Slide 8
 Primary Health Care
• At the international level, the Universal
Declaration of Human Rights established a
breakthrough in 1948, by stating in Article 25:
“Everyone has the right to a standard of
living adequate for the health and wellbeing of
himself and his family”
• The preamble to the WHO Constitution also
affirms that it is one of the fundamental rights
of every human being to enjoy “The highest
attainable standard of health”
 Primary Health Care
• Increasing importance given to social
justice and equity, recognition of the
crucial role of community
participation, changing ideas about
the nature of health and
development, the importance of
political will called for new
approaches to make medicine in the
service of humanity more effective.
 Primary Health Care
• Against the above background, the 30th World
health Assembly resolved in May 1977 at
Almata , that
“the main social target of governments and
WHO in the coming decades should be
The attainment by all citizens of the world by
the year 2000 of a level of health that will
permit them to lead a socially and
economically productive life”
• This culminated in the international objective
of HEALTH FOR ALL by the year 2000 as the
social goal of all governments.
 Primary Health Care
• The joint WHO – UNICEF international
conference in 1978 at Alma – Ata (USSR)
the governments of 134 countries and
many voluntary agencies called for a
revolutionary approach to health care.
• Declaring that “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”
 Primary Health Care
• Health for all means that health is to be brought
within the reach of every one in a given
community.
• It implies the removal of obstacles to health –
that is to say the elimination of
– Malnutrition
– Ignorance
– Disease
– Contaminated water supply
– Unhygienic housing etc
• It depends on continued progress in medicine
and public health.
• Alma Ata Declaration called on all
governments to formulate national
policies, strategies and plans of action to
launch and sustain primary health care as
part of a national health system.

• It is left to each country to innovate,

according to its own circumstances to
provide primary health care

• This was followed by the formulation and

adoption of the Global Strategy for Health
for all by the 34th World Health Assembly
in 1981.

• Primary Health care got off to a good start

in many countries with the theme “Health
for All by 2000 AD”
 Primary Health Care

• Primary Health Care 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.
 Concept of PHC
• PHC is for all specially the needy
Regardless of social and economic status every
individual in the nation must have access to good
health care

• The services should be acceptable to the

community and there must be active involvement
of the community

• The health services must be effective, preventive,

promotive and curative

• The services should form an integral part of the

country’s health system
• The programme must be efficient, multi- sectorial
because health does not exit in isolation
 Primary Health Care

• 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
country and community can afford
Levels of Health Care
Levels of Health Care

3 level of health care service

Levels of Health Care

3 level of health care service

• Primary care level

• Secondary care level
• Tertiary care level
Levels of Health Care
• Primary care level
– First level of contact of individual, family
and community with health system
– Most effective and close to the people
– PHC
– Clinics
– GP
Levels of Health Care

• Secondary care level

– Higher level of care
– More complex problem are dealt with
– Health centers
– Hospitals
 Levels of Health Care
• Tertiary care level
– Specialized health care
– Specific facilities
– Specialized health workers
– Teaching hospitals,
– Regional hospitals
– Central hospitals
– Specializes hospitals
Primary Health Care
PHC is essential health care made
universally accessible to individuals
and families in the community by
means acceptable to them, through
their full participation and at a cost
that the community and country can
afford
 PRINCIPLES OF
PRIMARY HEALTH CARE
PRINCIPLES OF PRIMARY HEALTH CARE

• Equity

• Community Participation

• Intersectoral Coordination

• Appropriate Technology
 Equity/Equitable Distribution
• The first key principle in primary health
care strategy is equity or equitable
distribution of health services
• Health services must be shared equally
by all people irrespective of their
ability to pay and all( rich or poor,
urban or rural) must have access to
health services
• health services are mainly in towns
Inaccessibility to majority of
population
• Social injustice
• Availability -Insurance/NHS
 Community Participation
• Overall responsibility is of the State
• The involvement of individuals,
families, and communities in promotion
of their own health and welfare is an
essential ingredient of primary health
care
• PHC coverage cannot be achieved
without the involvement of community in
planning, implementation and
maintenance of health services
• Polio. FP
 Intersectoral Coordination
• Declaration of Alma –Ata states that
PHC involves in addition to the health
sector all related sectors and aspects of
national and community development,
in particular education, agriculture,
animal husbandry, food, industry,
education, housing, public works,
communication

• To achieve cooperation planning at

country level is required to involve all
sectors
 Appropriate Technology
• Technology that is scientifically sound,
adaptable to the local needs, and
acceptable to those who apply it and
those for whom it is used and can be
maintained by the people themselves
with the resources of the community and
country can afford

• luxurious hospitals, costly equipments

Essential Component / Elements
Essential Component / Elements
1. Education concerning prevailing health
problems and the methods of identifying,
preventing and controlling them

2. Promotion of food supply and proper

nutrition, an adequate supply of safe water
and basic sanitation

3. Maternal and child health care including

family planning

4. Immunization against major infectious

diseases
Essential component / Elements

5. Prevention and control of locally

endemic diseases
6. Treatment of common diseases and
injuries

7. Promotion of mental health

8. Provision of essential drugs

The Basic Requirements for Sound
PHC (the 8 A’s and the 3 C’s)
• Appropriateness • Assessability
• Availability • Accountability
• Adequacy • Completeness
• Accessibility • Comprehensiveness
• Acceptability • Continuity
• Affordability
Millennium Development Goals

• MDG,s place health at the heart of

development and represent
commitments by governments
throughout the world to reduce
poverty and hunger and to tackle ill
health
Millennium Development Goals

• Eradicate extreme poverty and hunger

• Achieve universal primary education
• Promote gender equity
• Improve maternal health
• Reduce child mortality
• Combat HIV/AIDS, malaria, and other
communicable diseases
• Ensure environmental sustainability
• Develop global partnership for
development
 PHYSICIAN
A physician is a person who, having been
regularly admitted to a medical school,
duly recognized in the country in which it
is located, has successfully completed the
prescribed courses of studies in medicine
and has acquired the requisite
qualification to be legally licensed to
practice medicine (comprising prevention,
diagnosis, treatment and rehabilitation)
using independent judgment to promote
community and individual health
WHO 1972
 HOSPITAL
Hospital is a residential
establishment which provides short-
term and long-term medical care
consisting of observational,
diagnostic, therapeutic and
rehabilitative services for persons
suffering or suspected to be suffering
from a disease or injury and for
parturient
WHO 1963
PHC in Nigeria

• Started in 1987
• Introduced focused LGAs (Nigeria
approach)
• Later willing LGAs
• Then others joined
• EPI was used as an entry point in most
parts of the country.
PHC in Nigeria

• Country divided into 4 health zones

• Several workshops held
• 3 documents produced at LGA levels
• Most states decentralised around 1986
• Strengthening of SHT in Nigeria
• Introduction of Community Health workers
scheme
PHC in Nigeria: Features

• Health workers are still reluctant

• Community participation almost non
existent = (SH)
• Decentralised responsibility not decision
making process
• Disparity btw social & economic classes
• Governments paying lip service
Assignment

• Describe the organogram of PHC in

Nigeria
References

• Naseer Alam Tariq. Primary Health

Care. ppt.
• Abiodun Bamigboye. Primary Health
Care: Concept & Principles. Ppt.
• PaRROT. Comprehensive Primary
Health Care
• Rasha Salama. Primary Health Care