Professional Documents
Culture Documents
PHC and Community Strategy
PHC and Community Strategy
PHC and Community Strategy
COMMUNITY STRATEGY.
By MUOKI.
Historical background of PHC.
In 1997 the world health assembly with Kenya alongside other
member states of WHO endorsed the worldwide social
objective of attainment of health for all ppl by the yr 2000
over a lever of health that will permit the to lead a society of
economically productive life.
PHC was endorsed by the countries that attended a world
conference that was in Alma-Ata and they came up with a
goal a of health for all by the yr 2000 and beyond.
However many countries in the developing countries could
not attain this due to lack of resources, so they needed to
adopt a strategy that allowed them to use the available
resources to reach everybody.
Cont.…………
No developing country has enough money to run all the health
services, hospitals are expensive to construct and mostly dealt with
more curative services for the sick and little on preventive services.
The strategy of primary health care was adopted by the Kenyan
government to provide H.C to its population majority 80% being in
rural areas.
The PHC forms an integral part both of the countries health system
of which it is the central function and the main focus of the overall
social and economic development of the community.
PHC is the fist level of the contact of individual family and
community with the national health system, bringing H.C as close
as possible to where ppl live and work.
Definition of PHC.
Is essential health care based on particular scientifically sound
and socially acceptable methods and technology made
anniversary accessible to individual and family in the
community trough there full participation at the cost
affordable by the community and country to maintain at every
stage of development in the spirit of self reliance and self
determination.
Emphasis of PHC.
1. It is the first contact of health care or primary
medical care.
2. Heath services for all so as it is intended to
reach each individual esp those in need.
3. It involves individual family and community.
X-tics of PHC.
1. Universally accessible to the individual and family in the
community.
If refers to the continuity of care which shd be within reach to
satisfy the health needs of all ppl and the methods are
acceptable to the m within there cultures and norms.
3. affordable.
Services are provided at a cost that the community can afford.
Cont.……….
4. Promote full participation.
Made available to them thro’ there full participation meaning that
NB: PHC strategy ENCOURAGES self care and self Mnx in the
health and social life. Ppl shd be educated and empowered to use
there own knowledge, attitude and skill in activities that improve
health for themselves their families and the community.
Components of PHC
Ideas about the implementation of health care for all and it is usually
identified using 5As.
A- accessibility. Meaning that the services are geographically,
financially, culturally within easy reach to the whole community.
A- acceptability. The quality of health services offered are appropriate,
adequate and able to satisfy the health needs of ppl and are provided by
methods which are within the social cultures and norms.
A-affordability. The services are provided at a cost that the community
can afford.
A- availability. The health services are easily available to the community
and help them assume responsibility in promoting their health.
A- appropriate technology. The methods, technology and resources are
within the community.
Principles of primary health care.
1.Equitable distribution.
The manpower and health services are equitably distributed
project.
Cont.….
4. Appropriate technology.
Methods used shd be socially acceptable locally available and
scientifically sound.
5. Multi sectorial approach.
Involves other sectors since health cannot be alone. E.eg
Skin dzz.
Worm infestation.
Common accidents.
Eye conditions.
on the same.
f. SAFE WATER SUPPLY AND PROPER
SANITATION.
These are available to the Kenyan population.
Many water borne dzz can be prevented by having clean
water and proper refuse disposal.
CHW together with HW shd educate community on
construction of latrines, safe water and how to make it safe.
g. MENTAL HEALTH.
H is a state of complete physical, psychological, spiritual and
social well being and not merely absence of dzz or deformity.
Mental H. services shd be viewed as integral part of other
health services that are needed to achive the complete H of
individual, family and community.
HC shd be able to look at mental health as a part of the PHC
element.
Promote good mental H services thro’ H education to family
and community to create awareness, provide H services to all
H institutions to detect rx and refferal systems to mental dzz,
seek H as soon as abnormal bahaviour is observed and educate
community to avoid substance abuse.
h. DENTAL HEALTH.
Dental dzz are wide spread in the community and can be
prevented.
Most dental dzz are due to poor lifestyle like eating sugary
foods.
Educate the community to have regular dental check up.
Most ppl see dentist when the teeth are aching. HW shd
provide regular H services thro’ outreach and mobile clinics.
Use of local tooth picks shd be encouraged .
Avoid harmful traditional habits like tooth extraction.
Eat indigenous foods and avoid sugars.
Gov’t to train dentists to provide Services.
i. COMMUNITY BASED
REHABILITATION.
It is required to give special attention to Mnx and prevention
of disabilities that might be raising from congenital
malformations, accidents and from some imunizable dzz.
Dzz can come from some incommunicable dzz like DM,
HTN.
These ppl shd be supported coz disability is not inability.
Gov’t shd provide schools and centers to train these ppl to be
self reliant.
They can do jobs that suit there disability.
Encourage the community to accept them.
k. STI, HIV/AIDS AND TB.
Aim is to control and prevent the infection, treat conditions when
they occur, reduce new infections and reduce stigma associated
with HIV/AIDS.
Gov’t shd train more HW on the same. Work with private sector
e.g. NGOs.
HW to give H. education to the community.
There shd be drug adherence and stigma reduction.
Organized H activity day e.g. HIV and TB days.
H. education to the community on behavior change, use of
condoms, accepting family members affected, home based care,
rx of STIs, empowering women who are venerable to HIV by
improving there H. education, regal status and economic status.
HEALTH SERVICES IN KENYA BEFORE
IMPLEMENTATION OF PHC.
SINCE KENYA GOT independence in 1963 the gov’t has shown
commitment towards H provision that is quality via manifesto.
Major milestones achieves are as follows:
• 1965 gov’t free medical treatment thro KANU.
• 1967 national FP program started.
• 1970 central gov’t took over running of health services from local
council.
• 1971-72 gov’t of Kenya and WHO formulated formation of a
rural training centers ( rural demonstration center for training like
kalulumo, chulaimbo, mbale, maragwa, mosoriot and tiwi.
• 1981 community based H. care was set within the integrated rural
H and FP program.
POLICIES THAT AIDED
IMPLEMENTATION OF PHC.
Development of the PHC has made it necessary to continuous review
of the H system.
The following are the policies that aided in the implementation of PHC.
o District focus for rural dev’t- introduced by the gov’t in 1985. the aim
was to decentralize decision making in the rural Ares then the district to
be the center for organizing, coordinating, planning, implementation
and evaluation the H. programs.
o Increased coverage and accessibility of H. services in rural area. It was
realized that rural H. infrastructure was behind so the gov’t made effort
to direct finance to rural areas for the dev’t of H services.
o Consolidating urban rural promote and curative services.
Complimentary approach in the allocation of resources and proper mnx
of various H components.
CONT……….
HW are trained on preventive and primitive methods and
encouraged to include H education of a routine component of
their activity.
o Intersectoral collaboration- H is too important to be
like boiling and 3 pot systems. Teach them on the protection of water
resources.
Use of latrines, personal hygiene, proper waste disposal and harvesting
of rain water.
CONT………
4. Maternal child health.
Encourage good traditional practices like prolonged BF. The
Responsibilities include:
activities.
Community participation.
Community awareness.
Community involvement.
Community participation is the process in which the community
Primary hospitals.
Ptmtc.
the community.
teams and team building.
Team is a group of 2 or more ppl with some interest towards
achieving a certain goal. Teamwork is the foundation of success.
Stages of team development.
Forming- it is orientation and acquaintance.
Storming- individuals personalize
Norming- conflict development during storming are resolved
and on the team unit.
Performing- team members focus on problem solving and
accomplish there task.
Addowning(finish) members prepaid for dispesement. Every
individual is alone.
TYPES OF TEAMS.
Formal teams- created by organization as port of organizational
structure. Like DHMT.
Vertical team- formal team composed of manager and his
subordinates. There is chain of command.
Horizontal team- a formal team compose of employees of the
same level with different expertise like nurse and Cos.
Committee teams- are team that deal with tasks that occurs
regular.
Special purpose teams- created outside organizations to
undertake special programmes.
Self directed team- consists of 5-20 members, rotate on their
role and supervise by there leaders.
Evaluation and monitoring.
Monitoring is a continuous process of following unplanned
activities to identify any deviation and address them
immediately for purpose of attaining the goal.
importance of monitoring.
To follow up progress.
To analyze r/ship btn output and input.
Ascertain that method and strategy used are appropriate.
Enable project personnel to plan effectively.
Motivate community and staff involved.
Indicators of monitoring.
Population profile.
Births and deaths.
Household visited.
Dzz incidence.
Use of services like ANC and immunization.
Availability of latrines.
Rx of water points.
Use of ITNs.
Evaluation.
It is a scientific based analysis of information about a
program.
The purpose is to determine if the intended goal has been
affectively achieved.
Evaluation is time bond meaning it takes place at certain
point.
It enables one to identify successful strategy.
Modify and discontinue interventions that donor yield results.
Share findings with other stake holders.
Provide donors with evidence of the result of the investment
and demonstrate accountability.
Importance of evaluation.
Check for effectiveness teach and method used.
Establish bond making for determining achievements and
appropriate interventions.
tools used.
Reports, daily results, checklists, daily register, focused group
discussion, observation using the 5 senses.
referral system.
It is a interlinked network of services provider and facility that
provide a continuous of care for acute and chronic illness.
There are 4 levels of H referral network.
Community. -secondary
Primary -tertiary.
CONT……..
The house hood care givers CHW and CHEWs be trained to
recognize illness and gauge its severity and in order to provide
referral in time.
objectives of referral.
Improve the asses of client to H services.
Reduce the time it takes to get to the next level.
Avoid unnecessary delays.
To achieve theses activities the following shd be done:
Formal referral arrangement.
Proper communication and availability of transport.
Essential elements for referral
system.
Service availability- availability of services at next winch are
accessible and affordable to the community.
Coordination of referral activity- CHW shd coordinate referral
activity in community and provide feedback.
r/ship- the referral 3 facilities shd take the lead in establishing and
maintaining records.
Communication and transport- they are crucial for effective referrals
identifying the cheapest means of transport and community
members can assist .
Feedback mechanism- a good feed back system shd be established
to help track referrals.
Monitoring and evaluation- referral system shd be included in the
monitoring and evaluation to ensure continuous referral.
Steps in referral process.
It shd be done thro’ dialogue btn services provider and the client.
Assessment need- discuss with the client to identify their immediate need.
Determine attentives- discuss what the client shd do to reach the next level.
Identify option- discuss with both the client and the care giver to come up
with other opinions.
Appraise the options- select doable option or appropriate.
Commit to action- discuss consequences taking and not taking the agreed
action.
Develop a plan of action- map out what is to be done and feel out the referral
document.
Take action- more on the option as planned and follow up.
Asses the action and provide feed back thro’ regular meetings and inform the
care givers.
Emergency support system.
There is money set aside for emergency response both in
central gov’t and county gov’t.
This money is used up in case of disaster or outbreak.
Community shd be encouraged to have emergency kit.