Community Health Nursing

Unit 4Primary Health Care

Learning out comes • To discuss the ALMA ATA DECLARATION• To describe the goals and targets of health

for All• To enumerate the Themes Leading to

Alma Ata• To define primary health care• To discuss the objectives of PHC

• To enlist the COMPONENTS OF PHC• To discuss the Obstacles to the

Implementation of PHC Strategy • To identify Levels of Care • To discuss the Primary health care• To identify the PRINCIPLES OF PHC

Learning out comes

ALMA ATA DECLARATION

‘The main goal of Governments and World

Health Organization in the coming decades was

be the attainment by all people of the world by

the year 2000, a level of health that would

permit them to lead a socially and economically

productive life’

GOALS AND TARGETS OF health for All

An increase in life expectancy and in the quality of life for all

Improved quality in health between and within countries

Access for all to sustainable health systems and services

An initial set of targets will guide the implementation of the HFA policy and define priorities for action for the first two decades of the 21st century

Themes Leading to Alma Ata

1. Changing theories of health & development: shift away from GNP as measure of development towards recognition of the need of social development

2. Concerns about poverty & population control 3. Increasing reliance upon alternative approaches

to medical care model4. Success of CHWs & associated emphasis on

community participation5. of interest in public health; tackling causes of ill

health rather than symptoms

PRIMARY HEALTH CARE

PHC is 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 community and the country can afford…

Early detection and treatment of illnesses

Objectives of primary health care

Prevention of health hazards

Rehabilitation

Prevention of illnesses and

accidents

Disability limitation

Primary Health Care

Preventive services Curative services

General services Care of vulnerable groups

Outpatient clinic (referral)

Laboratory services

Dispensary

First aid and emergency services

Health education

Monitoring of environment

Prev.&control of endemic diseases

Health office services

Maternal &child health s.

School health services

Geriatric health services

Occupational health services

Levels of Care

• Primary health care• Secondary health care• Tertiary health care

Con…..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.• The closest to the people.• Provided by the primary health centers.

Cont….

Secondary health care • More complex problems are dealt with.• Comprises curative services• Provided by the district hospitals• The 1st referral level

Tertiary health care• Offers super-specialist care• Provided by regional/central level institution.• Provide training programs

LEVEL OF PHC

1-HOME LEVEL :• Refer to the basic unit in any community : House hold Family member e.g.: mother or head of

house Person from neighborhood • Home visiting community worker

2-Communal level :-

• Activities at this level concern the health of whole community (village. town .group of village s)

• Common facilities or voluntary effort of community member

3-Health system

• First health facility level :- refer to the first level where trained health professional and facilities are available .

• First referral level :-there is two type of :Clinical referral system which include s the

supervision of performances at lower level

The second is administrative referral system usually the district health office this level involved planning .management and support of activities related to health education ,information and disease control

PRINCIPLES OF PHC1. Health Prevention & Promotion

2. Equity

3. Appropriate Technology

4. Community Participation

5. Intersectoral Coordination

6. Decentralization*

Equity

“Countries developed national health policies stating equity as one of the objectives ….

…. it meant a reallocation of limited resources, which led to taking away resources from the already over-funded services serving the urban

The equity policy objective was therefore not fully implemented”

Community participation

“although community participation has been argued as the core of PHC policies, it has largely remained problematic, calling for more review and definition …

…Village health worker programmes in many countries have disintegrated”

And then there were the TBAs ….

Appropriate technology

• Generic drugs• Basic radiological units• Donkey, bicycle, motorcycle ambulances (eRanger

ambulance)

“this challenge continues to grow especially as globalisation takes root and the health profession’s education, training and practice continues to be driven by the medical model instead of the health model”

Health sector reforms

• Rationalisation of MoH• Decentralisation of planning, management

and implementation of health services• Introduction of new financing mechanisms• Recognition of the role of the private sector,

NGOs, and others

Health sector reforms

“these initiatives were aimed to achieve greater access to services, improved efficiencies in resource utilisation … and improved quality of health services.

Yet there has been no improvement in health systems performance. In fact evidence available shows that in many countries the health status of the people has worsened”

COMPONENTS OF PHC1. Education concerning prevailing health problems & the

methods of preventing & controlling them

2. Promotion of food supply and proper nutrition

3. An adequate supply of safe water and basic sanitation

4. MCH including FP

5. Immunization against major infectious diseases

6. Prevention and control of locally endemic diseases

7. Appropriate treatment of common diseases and injuries

8. Provision of essential drugs

9. mental health.

8 Elements of Primary health care

Health education

Safe water

supply, basic

sanitation

-Food supply - Proper

nutrition

Comprehensive maternal and child health

care

Immunization of children

Provision of

essential drugs

Treatment of

common diseases

Prevention and control of endemic

diseases

Health promotion& prevention of health hazardsEarly detection and treatment of illnesses

Objectives of PHC:

Obstacles to the Implementation of PHC Strategy 1. Misinterpretation of the PHC Concept

2. Misconception that PHC is a 2nd rate health care for the poor

3. Selective PHC Strategies

4. Resistance to Change

5. Lack of political will

6. Centralized Planning & Management Infrastructure

SELECTIVE PRIMARY HEALTH CARE

PHC implies that if one cannot afford to offer universal coverage for even the most basic of health care, one could would offer treatment & preventive strategies for the few diseases identified as having the greatest threat to mortality, & which are amenable to prevention / cure at low cost.

Comprehensive PHC

ADVANTAGES1.Looks at total health

care2.Involvement of

community3.Covers all elements of

PHC4.Ensures equitable

distribution of resources5.Facilitates effective

referral system

6.Government goal

DISADVANTAGES1.More costly to

implement2.Takes long time to

see impact3.Long time to process4.Lack of specialized

treatment5.Expensive6. Inefficient referral

system ???-- misuse

Selective PHCADVANTAGES

1.Donor friendly2.Elimination of

selected disease3.Easy to plan &

implement 4.Is focused & have

more impact5.Easy to manage &

measure output6.Require limited

resources7.Improve quality of

services

DISADVANTAGES1. Disease rather than

health oriented2. Doesn’t ensure equity3. Top down decision

making4. Neglect other problems5. Leads to outbreak 6. Resources (tight) might

not be available for urgent needs (emergencies)

7. Less community involvement– donor priority

PHC: FROM ALMA- ATA TO 21st CENTURY

1. PHC as an approach has provided impetus and energy to progress towards HFA

2. Some progress has been made in ensuring access to the original eight PHC elements

3. PHC remains valid as the point of entry into a comprehensive health care system

4. Intersect oral action for health has not been fully achieved

5. Reorientation of health services and personnel to PHC principles remains elusive

6. Community participation takes time and dedication by all

PHC in the 21st Century:Policy Objectives to Reinforce the PHC Approach

1. Make health central to development and enhance prospects for intersect oral action

2. Combat poverty as a reflection of PHCs concern for social justice

3. Promote equity in access to health care4. Build partnerships to include families,

communities and their organizations5. Reorient health systems towards

promotion of health and prevention of disease

Acceptable

PHC: provision of essential health care which is:

Accessible to all individuals

Multi

-Sectorial

Equitable Distribution

Appropriate technology

Socially

Community Participation

Principles of Primary health care

Economically

Scientifically

Primary Health Care ReformMedical model Primary Health Care

Illness Health

Cure Prevention, care, cure

Treatment Health promotion

Episodic care Continuous care

Specific problems Comprehensive care

Individual practitioners Teams of practitioners

Health sector alone Intersectoral collaboration

Professional dominance Community participation

Passive reception Joint responsibility

MDGS

1. Eradicate extreme poverty and hunger2. Achieve universal primary education 3. Promote gender equality4. Improve maternal health5. Combat HIV/AIDs, malaria, and other

communicable diseases.6. Ensure environmental sustainability.7. Global partnership for development.

Role of CHN in primary health care

• In 1974 WHO executive board recommended way in which nursing could have critical impact on the urgent health problems throughout the world.

Recommendations are:-

• Reformulation of basic and post basic nursing education to prepare all nurses for CHN.

• Support of nursing in the national developmental plans.

• CHN to work in schools, and all kinds of setting.