Concept of Primary Health care

DR MALIMU -MUHAS/KIU

Learning objectives:

At the end of the session the participants will be able to:1. Define what is primary health care (PHC)2. Describe the Elements, principles and strategy of PHC3. Outline the factors that contributed to evolvement of PHC4. Describe the indicators for evaluating PHC

Find out the current status of PHC in Tanzania6. .Describe the linkage between PHC and HFA 2020

Definition of PHC

“Is essential care that is based on scientifically sound and

socially acceptable methods and technology that is made

universally accessible to individuals and families in the

community through their full participation and at a cost they can

afford at every stage of development and spirit of self reliance”.

Differentiate

Primary Health Care

Primary Medical Care

Context- Primary health care Elements1. Education on prevailing health problems and methods of

preventing and controlling them2. Provision of food supplies and promotion of proper nutrition3. Adequate supply of safe water and provision of basic

sanitation4. Maternal and child health care, including family planning5. Immunization against the major infections diseases6. Prevention and control of locally endemic and epidemic

diseases7. Appropriate treatment of common disease and injuries8. Provision of essential drugs and supplies

Tanzania add:9. Provision of Mental Health10. Provision of Oral Health

Factors that contributed to evolvement of PHC

in Tanzania

1. Policy of socialism and Self reliance, emphasizes rural development; equity in distribution of basic human needs (BHN)

2. Pattern of diseases are preventable

3. Increase in health infrastructures not synchronous with population increase

:. PHC for every village instead of a dispensary for each village

Factors which contributed to evolvement of PHC at

At Global level

1. Failure of the trickle down theory of economic development

2. Maurice King's ideology of accessibility of facilities

3. Success of barefoot doctors in China, Cuba, and Tanzania

4. Pressure from Donors

5. Population growth not synchronizing with increase in basic services

Strategies for implementation of PHC1. Training and use community members as health

workers2. Community participation in planning and

implementing health programmes3. Inter-sectoral coordination, particularly between

agriculture, education, housing, sanitation and water supplies

4. Collaboration between health organizations, particularly governmental and NGO , traditional and private practitioners.

5. Decentralization of MOH planning and the strengthening of district health system

Milestones of PHC in Tanzania 1967- Started with Arusha Declaration

emphasizing rural development and distribution of basic human Needs (BHN)

1972 – Villagization & Decentralization policy

1974- Mtu ni Afya Campaign 1977- Universal Primary education

(UPE)

Milestones of PHC in Tanzania 1974 & 1977 MCH and T.B and Leprosy

programs started country wide Private Practice banned in Tanzania 1978- Alma Ata Declaration of PHC 1980 – Long-term Health policy established 1983 – Formulation of Guidelines for

implementation of PHC 1992-New PHC strategy 1993- Health Sector Reform and Cost

sharing

Principles underlying PHC

1. Equity2. Community involvement3. Focus on prevention4. Appropriate technology5. Multi-sectoral approach

INDICATORS FOR EVALUATING PHC

HEALTH POLICY INDICATORS (1)

SOCIAL AND ECONOMIC INDICATORS(2)

INDICATOR OF PROVISION OF HEALTH CARE (3.) INDICATOR OF COVERAGE (4) HEALTH STATUS INDICATORS(5)

Nutritional status

HEALTH POLICY INDICATORS (1)

1. Political commitment 2. Allocation of Resources3. Degree of Equity in distribution of Resources4. Level of community Involvement5. Establishment of suitable managerial & National Strategy for HFA6. Political Manifestations of International Political commitment to HFA, 2020.

SOCIAL AND ECONOMIC INDICATORS(2)

1. Rate of population increase2. Gross National product (GNP) and Gross Domestic Product (GDP)3. Income distribution4. Work availability5. Adult literacy rate6. Adequacy of housing expressed as the No. of people per room

7. Per capita energy availability.

INDICATORS FOR EVALUATING PHC

INDICATOR OF PROVISION OF HEALTH CARE (3.)

1. Availability2. Physical accessibility3 Economic and cultural accessibility4 Utilization of services5 Indicators of assessing quality of care

INDICATOR OF COVERAGE (4)1. Level of "healthy literacy"2. Availability of safe water in the home or within short distance3. Adequate sanitary facilities in the home or immediate vicinity4. Access of mothers and children to local health care5. Birth attendance by trained staff6. Percentage of immunized children7. Availability of essential drugs throughout the year8. Accessibility of Referral Institutions9. Ratio of population to different kinds of health worker in PHC and referral levels.

HEALTH STATUS INDICATORS(5)1. % Newborns with Birth weight <2500g2. % Children with Weight/Age according to norms3. Indicators of psychosocial development in children 4. Infant Mortality Rate5. Child mortality rate6. Under five year mortality Rate7. Life expectancy at a given age8. Maternal mortality rates9. Disease specific mortality rates10. Disease specific morbidity Rates11. Disability Rates12. Indicators of social & mental pathology (suicide, drug addiction, juvenile delinquency, alcohol, smoking)

What is the Current status of PHC Indicators in Tanzania 2010?

Ref; DHS/2010 and other MOHSW documents.

Status of PHC Nutritional status1. % Newborns with BWT <2500g …..2. % Children underweight (Wt/Age) <2SDs …..

% Children (stunted) (ht/Age <2SDs ….. % Children (wasted) wt/ht <2SDs ……Mortality3. Infant Mortality Rate …/1000 live births5. Child mortality rate6. Underfive year mortality Rate ……/1000 7. Life expectancy at birth …… years8. Maternal mortality rate ……./100000 live births

Current Status of PHC Basic Education1. % of women with completed Primary education ……..

% of men with completed Primary education ……..% of girls 6-12 years attending school ……..%of boys 6-12 years attending school ……..% of women who are 15-49 who are literate ………..

Child Health% mothers who received TT during pregnancy ………% Children 12-23 with measles vaccination ………% of Children 12-23 fully vaccinated ……..

Recent Status of PHC Women’s health

% of births with medical prenatal care ………% of births with prenatal care in 1st trimester ……..% of births with medical assistance at delivery ……..% of births in a health facility ……..% of births at high risk ………Contraceptive prevalence rate(any method) ………

Child Health% children with diarrhea who received ORS ……….% Children with ARI seen by a medical person ……….

What is the linkage between PHC and Health for All 2020?

Began in 1977 when WHA passed resolution No. 30.43 of HFA by 2000

Endorsed at the Alma Ata Conference of 1978 that PHC will be the strategy for attainment of HFA 2000,

In 1995 WHO reviewed HFA achievements and passed Resolution No. 48.16 for renewed policy of HFA 2020

What is Health for All 2020? HFA is a social goal Health is a human right Emphasizes equity in health Health is part and parcel of socio-economic

development Individuals, families and communities must

take a leading role in changing their life style and behavior so as to be in a good state of health ultimately contribute towards Socioeconomic development

EPIDEMOLOGY

The END

Thank you

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