COLLEGE OF MEDICINE AND ALLIED

HEALTH SCIENCES

Department of Community Health

Primary Health Care

Alhaji Dr Momodu sesay

 Background
Why PHC ?
• Health is a fundamental human right
• 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”
• “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
• Services were Urban focused and mostly curative in nature
• Health was accessible to a small part of the population
• Against the above background, the 30th World health Assembly
resolved in May 1977 at Alm-ata , 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”
• International objective of HEALTH FOR ALL by the year 2000 as the
social goal of all governments was adopted.

• 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.
• Read Alma-ata Declaration on 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
• 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.
 What is 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 to maintain at every stage of their
development in the spirit of self-reliance and self-determination’’ (WHO)
• It forms an integral part both of the country’s health system and of the
overall social and economic development of the community

• It is the first level of contact of individuals, 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.
New concept of PHC
• "PHC is a whole-of-society approach to health that aims at ensuring
the highest possible level of health and well-being and their equitable
distribution by focusing on people’s needs and as early as possible
along the continuum from health promotion and disease prevention
to treatment, rehabilitation and palliative care, and as close as
feasible to people’s everyday environment." (WHO and UNICEF. A
vision for primary health care in the 21st century: Towards UHC and
the SDGs).ASTANA Declaration
• Primary health care ensures people receive quality comprehensive
care - ranging from promotion and prevention to treatment,
rehabilitation and palliative care - as close as feasible to people’s
everyday environment
Concept of Primary health care
• PHC is for all especially the needy regardless of social and economic
status and 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 exist in isolation
 Goals and principles

• The ultimate goal of primary healthcare is the attainment of better health

services for all.
• Five key elements to achieving PHC goal (WHO):
I. reducing exclusion and social disparities in health (universal coverage
reforms);
II. organizing health services around people's needs and expectations
(service delivery reforms);
III. integrating health into all sectors (public policy reforms);
IV. pursuing collaborative models of policy dialogue (leadership reforms);
and
V. increasing stakeholder participation.
The Basic Principles of Primary Health Care

7 main principles of Primary Health care derived from the Alma Ata
Declaration.
• Equitable and accessible Distribution: Health services should be more
equally accessible to the whole population including rural communities
and urban slums.
• Community Involvement: The community should effectively participate in
planning, decision-making, implementation, monitoring and supervision of
activities related to the provision of health care delivery services.
• Focus on Prevention and Control: Health promotion through Health
Education and Disease Prevention and Control through community
programmes as well as curative services should be encouraged.
• Appropriate Technology: The methods and materials used should be
acceptable to the community, relevant to the major health problems and
within the economic resources of the country.
Principles Contd……….
• Multi-Sectoral Approach: Health care is part of development. It
includes nutrition, water supplies, sanitation, education and other line
ministries that contribute to the general rise in the standard of living
of communities.
• Sustainability: Sustainability is basic to improvement. It is the means
by which we accumulate benefits and thus improve ourselves.

• Constant Monitoring: All programmes should constantly monitor and

supervise their workers to maintain and improve the level of their
positive effects on the community
 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
Objectives contd……
• 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.
Components /elements of Primary Health care
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
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
9. Community based rehabilitation
10. Oral health
11. Mental health
The Importance of Primary Health Care (PHC)
• 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.
Importance of PHC contd…….
• 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.
Equality means each individual or group of people is given the same resources
or opportunities.
Equity recognizes that each person has different circumstances and allocates
the
exact resources and opportunities needed to reach an equal outcome.
• 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.
Characteristics of PHC
• Patient/family centredness, self-reliance and participation.

• Community engagement and participation.

• Health workers collaborating in inter-disciplinary teams.

• Proactive Prevention Focus.

• Integration and coordination of services.

• Accessibility.

• Better Management of Chronic Conditions

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 eg PHUs, Clinics, GP
• Secondary care level
Higher level of care.More complex problem are dealt with eg District
Hospitals
• Tertiary care level
Specialized health care with Specific facilities, and Specialized health
workers eg Teaching hosp, Regional hospitals
Selective Primary Health Care versus comprehensive Primary Health
care

• Idea of Selective Primary Health Care was introduced as a strategy to

complement comprehensive PHC in 1979 at a conference organized by ,
the Rockefeller Foundation in Italy.
• “Selective Primary Health Care, is an Interim Strategy for Disease Control in
Developing Countries”.
• This new framework advocated for a more economically feasible approach
to PHC by only targeting specific areas of health, and choosing the most
effective treatment plan in terms of cost and effectiveness.
 Comprehensive Vs Selective PHC
Comprehensive PHC
• Addresses health of individuals more
holistically,(preventive and curative
health care, and promotes health
infrastructure development and
community involvement,
• Provide more sustainable
improvement of health in the whole
community.
• More costly and results not readily
seen
Selective PHC
• Selective PHC focuses on prevention
or treatment of the few diseases that
cause the most mortality and
morbidity and for which there are
effective interventions
• The advantages of selective PHC
include: a rational, cost-effective way
to prioritize disease problems; narrow
scope, making it affordable for
developing countries; and readily
detectable results in the short term
GOBI as an example of SPHC
GOBI :
• Growth monitoring
• Oral rehydration,
• Breastfeeding,
• Immunization
Focus of GOBI
• GOBI is a strategy consisting of four low-cost, high impact, knowledge
mediated measures
• introduced as key to halving child mortality by James P. Grant at UNICEF
in 1983.
• Family planning (birth spacing),Female education, Food supplementation:
for example, iron and folic acid fortification / supplementation to prevent
deficiencies in pregnant women were later added to become: GOBI-FFF.
• These strategies focus on reducing high rates of infant and child
mortality.
• The targets and effects of selective PHC are specific and measurable.
Further reading
• Global Conference on Primary Health Care: From Alma-Ata towards
universal health coverage and the Sustainable Development Goals
Astana, Kazakhstan, 25 and 26 October 2018.WHO

• Ouagadougou Declaration on Primary Health Care and Health Systems

in Africa:: Achieving Better Health for Africa in the New Millenniu.
WHO regional office for Africa 2008