PRIMARY HEALTH CARE

MAIGA AYUB HUSSEIN

M&E, ADSHM, BScN,Ms-Epid

ZZIWA SWAIBU
BEH,MPH(MUK)

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 Course objectives
By the end of this section learners will be introduced
to;-
• Healthy system in Uganda
• Levels of health care
• Definition of PHC
• Concepts of primary health care
• Components of PHC
• Pillars/ principles of PHC
• Challenges in PHC implementation
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 National health System in Uganda
 National health System in Uganda is made up of the public and the private
sectors.

 The public sector includes all Government health facilities under the Ministry
of Health (MOH), health services of the Ministries of Defence (Army),
Internal Affairs (police and prisons) and Ministry of Local Government.

 The private health delivery system consists of private health practitioners

(PHPs), private-not-for-profit (PNFPs) providers and the traditional and
complementary medicine practitioners (TCMPs).

 The MOH has four levels of administration: the national, regional, district,
and community levels

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 National health System Cont’d
 The central level includes the National Directorate of Public Health of the
Ministry of Health (which houses the NMCP), where national guidelines and
norms are promulgated

 The MOH provides leadership for the health sector and is responsible for
overseeing the delivery of curative, preventive, palliative,and rehabilitative
services to the people of Uganda

 The health services are structured into National Referral Hospitals (NRHs) and
Regional Referral Hospitals (RRHs), general hospitals, and health centres
(HC)IVs, IIIs and IIs.

 Uganda’s Health Management Information System (HMIS) remains the

primary source of malaria morbidity and mortality

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The organization of health services in Uganda

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 Levels of health care

• Primary health care

• Secondary health care
• Tertiary health care

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 Levels of health care cont’d
• Primary health care
• The “first” level of contact between the individual and the health
system.
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be satisfactorily
managed.
• Closest to the people.
• Provided by the primary health centres i.e II,III $ IV.
• It addresses many health problems in the community.
• It provides promotive, preventive, curative and rehabilitating services
accordingly.
• It’s services vary from country to country

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 Levels of health care cont’d

•Secondary health care

•More complex problems are dealt with.
•Comprises curative services
•Provided by the district hospitals
•It’s mainly concerned with health problem of individuals
•It requires trained health professionals
•It’s mainly concerned with health problem of individuals
•The 1st referral level

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 Levels of health care cont’d
• Tertiary health care
• Offers super-specialist care
• Provide training programs
• It’s hospital based health care
• It deals with individual
medicine
• It’s composed of bed side
nurses
• It requires trained health
professionals
• It’s mainly concerned with
health problem of individuals
• It provides mainly curative
services
• Drugs are costly and not
evenly distributed
• It’s mainly concerned with
health problem of individuals
• It provides mainly curative
services
• Provided by regional and
national hospitals
• Accessibility is too costly or
not for all, it’s for urban and
rich people
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 PRIMARY HEALTH CARE
• Primary health care was born in September in 1978 at
Alma-Ata in Russia former USSR. This was a world health
organization review of the progress and challenges of faced
by health care world wide.
• It was a time when the 2nd world war in 1945 had
depreciated health services.
• The conference took place on the 6th-12th September 1978
and 134 countries that attended the conference realized that
no country had enough health resources for its population.
• The ministry of health and other government Ministries had
to compete for the scarce resources with other sectors fore-
example; agriculture, transport and defence

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 PHC cont’d
• This called for the need to change from
curative medicine to preventive health care.
• More than 90% of the disease burden are
preventable, so the new approach was branded
or baptized primary health care. Therefore,
P.H.C became the declaration of the Alma-ata
conference.

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 What is P.H.C( Alma-Ata declaration)
• Primary health care is the essential health care based on
practical, scientifically sound, socially acceptable methods and
technology made universally accessible to individuals,
families and communities through their full participation and
at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of
self-reliance and self-determination (WHO, The Alma- Ata
Declaration, 1978)
• It is the first level of contact of the individual, the family and
community with the national health system bringing health
care as close as possible to where people live and work, and
constitutes the first element of a continuing health care
process.
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 Concepts of PHC
• Essential health care;- health care that meets local
needs of the community with their full participation
• Practical, scientifically sound methods and
technology;- able to solve health problems using
locally available resources and technology which exist in
the community
• Socially acceptance methods;- the health care
should not conflict with norms and culture of a community
that the recieves the health services

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 Goal of PHC
• The ultimate goal of primary healthcare is the
attainment of better health services for all

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 Concepts of PHC cont’d
• Accessibility;- the services to promote health in a
community should be within easy reach of
individuals/families in that community
• Full community participation and involvement;-
the community should be actively in the needs
assessment, monitoring, implementation and evaluation for
services to be socially acceptable and sustainable
• Affordability ;- the cost of a health care service and its
maitainance should be affordable both by the community
and the country

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 Concepts of PHC cont’d
• Self reliance;- strategies for PHC implementation
should aim at encouraging communities to be
independent, confident and trusting them selves from
being passive recipients of services.
• Self determination;- the community should be able to
decide on matters concerning their own health and
development
• Integration;- all sectors should be actively involved in
promotion of PHC

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Characteristics of PHC cont.

• Majority of prevailing health problems can be

satisfactorily managed.
• Closest to the people.
• Provided by the primary health centres i.e II,III $ IV.
• It addresses many health problems in the
community.
• It provides promotive, preventive, curative and
rehabilitating services accordingly.
• It’s services vary from country to country
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Characteristics of PHC include:
• Community participation
• Health workers collaborating in inter-
disciplinary teams
• Proactive Prevention Focus
• Accessibility
• Localized set of choices
• Sustainability
• Multi-sector alignment and involvement
• Self-reliance & determination
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 ELEMENTS / COMPONENTS OF PRIMARY
HEALTH CARE

1. Education [Health Education]

2. Locally Endemic diseases [Prevention of Locally endemic
diseases e.g. Malaria, Diarrhea, T.B ]
3. Expanded programme on immunization
4. Maternal and child Health care / family planning
5. Essential drug supply
6. Nutrition and adequate food supply
7. Treatment of common illness and prevention of minor
injuries
8. Sanitation and safe water supply
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 ELEMENTS cont’d

• While the above elements originated at the Alma-Ata

conference, the member state were made to add as more
as the situation would require in their countries.
Uganda added the following:-
1. Oral and dental health care
2. Mental health care
3. Eradication of Guinea Worms
4. Primary Eye Care
5. Community based rehabilitation services [CBR] and disability
prevention
6. HIV and STI prevention

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 Principles of PHC
• PHC rests upon three principles i.e. community
participation, intersectoral collaboration and equity.
• However , emerging from the prescription of the Alma
Ata conference there was liberty accorded to national
health systems to modify these principles according to
their own health needs. E.g. Uganda adopted
community participation, appropriate technology,
political commitment and intersectoral collaboration.
Since 1982 the country has been implementing PHC
activities along these four principles.

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Principles of PHC cont’d

Full community participation

Full community participation and involvement enhances a sense of
ownership and fosters sustainability.
Inter-sectoral collaboration.
There is need to co-ordinate and co-operate with others sectors for the
success of P.H.C e.g. politicians, religious leaders, educationists and
agriculturalists should combine effort.
Political commitment and support.
The politicians and civil leaders including traditional leaders should
not be left when implementing PHC activities.
Appropriate technology.
The methods and techniques used to deliver P.H.C must be
scientifically sound and socially acceptable. It should be evident based
(It has ever worked somewhere) and not to contradict the cultural issues
of a given community 22
 The Basic Requirements for Sound PHC
(the 8 A’s and the 3 C’s)/attributes of PHC
• Appropriateness • Assessability
• Availability • Accountability
• Adequacy • Completeness
• Accessibility • Comprehensiveness
• Acceptability • Continuity
• Affordability

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 Appropriateness
• Whether the service is needed at all in
relation to essential human needs, priorities
and policies.
• The service has to be properly selected and
carried out by trained personnel in the proper
way.

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 Adequacy
• The service proportionate to requirement.
• Sufficient volume of care to meet the need
and demand of a community

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 Affordability
• The cost should be within the means and
resources of the individual and the country.

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 Accessibility

• Reachable, convenient services

• Geographic, economic, cultural accessibility

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 Acceptability

• Acceptability of care depends on a variety of

factors, including satisfactory communication
between health care providers and the
patients, whether the patients trust this care,
and whether the patients believe in the
confidentiality and privacy of information
shared with the providers.

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 Availability

• Availability of medical care means that care

can be obtained whenever people need it.

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 Assessability

• Assessebility means that medical care can be

readily evaluated.

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 Accountability

• Accountability implies the feasibility of regular

review of financial records by certified public
accountants

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 Completeness

• Completeness of care requires adequate

attention to all aspects of a medical problem,
including prevention, early detection,
diagnosis, treatment, follow up measures, and
rehabilitation.

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 Comprehensiveness

• Comprehensiveness of care means that care is

provided for all types of health problems.

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 Continuity

• Continuity of care requires that the

management of a patient’s care over time be
coordinated among providers.

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 Strategies of PHC
• The following are the strategies of PHC
• Use of local resources
• Use of Appropriate Technology.
• Community Participation.
• Information dissemination
• Mobilization of Political Will
• Inter-Sectoral Collaboration
• Provision of accessible health services
• Reorientation of other health providers is needed
• Emphasize disease prevention and health promotion
• etc
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 Challenges faced in implementation of PHC in
the community
• Lack of full community of
participation
• Lack of inter sectoral
collaboration
• Inappropriate technology
• Poor referral system
• poor relationship with
community members
• Failure to co-ordinate and
involve community health
workers
• Inadequate staffing e.g.
doctors, nurses and support
staff
• Lack of a clear national policy
for program development
• poor infrastructural
development
• Lack of motivation /incentives
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 Challenges cont’d
• Poor culture practices, community members
norms, customs, beliefs • Natural calamities like
and food taboos floods, drought,
• Poor attitude of local earthquake, heavy
leaders and community winds
members • Civil unrest
• Inadequate funding • Language barrier
• Some communities a • Corruption and
too embezzlement
rigid/conservativeness • Lack of political support
• Poverty among
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 References
• World Health Organization. Declaration of Alma-Ata. Adopted at the International
Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978
• Starfield, Barbara. "Politics, primary healthcare and health." J Epidemiol
Community Health 2011;65:653–655 doi:10.1136/jech.2009.102780
• Secretariat, WHO.
"International Conference on Primary Health Care, Alma-Ata: twenty-fifth anniver
sary"
(PDF). Report by the Secretariat. WHO. Retrieved 28 March 2011.
• "Health topics: Primary health care". World Health Organisation. Retrieved 28
March 2011.
• Braveman, Paula; E. Tarimo (1994).
Screening in Primary Health Care: Setting Priorities With Limited Resources.
World Health Organization. p. 14. ISBN 9241544732. Retrieved 4 November 2012.
• World Health Organization. World Health Report 2005, Chapter 5: Choosing
Interventions to Reduce Specific Risks. Geneva, WHO Press.

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Thanks

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