ByByDR: NAJEEB MEMON DR: NAJEEB MEMON MPH,DFHCMPH,DFHC

Asst: ProfessorAsst: Professor

F.C.M & P.H.SF.C.M & P.H.S LUMHS, Jamshoro, SindLUMHS, Jamshoro, Sind PAKISTANPAKISTAN

e mail mnajeeb80@gmail.come mail mnajeeb80@gmail.com

Levels of CareLevels of Care

Primary health carePrimary health care

Secondary health careSecondary health care

Tertiary health careTertiary health care

Primary Health CarePrimary Health Care Anew approach to health care Came in to existence in Anew approach to health care Came in to existence in 19781978 following an international conference following an international conference at at Alma-Ata (USSR)Alma-Ata (USSR)

This known asThis known as ““Primary Health Care”Primary Health Care”

It has all the hallmarks of a Primary health care It has all the hallmarks of a Primary health care delivery, first proposed by delivery, first proposed by “Bhore Committee “Bhore Committee in 1946,in 1946,

& now espoused world-wide by international & now espoused world-wide by international agencies & national Govt:agencies & national Govt:

Global strategyGlobal strategy for for ““Health for AllHealth for All”” 34 34thth World World Health assembly in 1981.Health assembly in 1981.

Bhore CommitteeBhore Committee

Primary Health carePrimary Health care

Before Alma-Ata, “Primary Health care” synonymousBefore Alma-Ata, “Primary Health care” synonymous““Basic Health services”Basic Health services”““First Contact Care”First Contact Care”““Easily Accessible Care”Easily Accessible Care”““Services provided by generalists”Services provided by generalists” etc.etc.

Alma-Ata, international conferenceAlma-Ata, international conference defined “PHC” as defined “PHC” as follows:follows:

PRIMARY HEALTH CAREPRIMARY HEALTH CARE“ “ It is an It is an essential health careessential health care made universally made universally

accessible to accessible to

through their full participation & at a cost the through their full participation & at a cost the community & country can affordcommunity & country can afford””. .

individualsindividuals & acceptable to them & acceptable to them

essential health careessential health care

individualsindividuals

PRIMARY HEALTH CARE ( WHO)PRIMARY HEALTH CARE ( WHO)

IS IS UNIVERSALLY ACCESSIBLEUNIVERSALLY ACCESSIBLE HEALTH CARE HEALTH CARE

THAT IS THAT IS SOCIALLY ACCEPTABLESOCIALLY ACCEPTABLE, ,

AFFORDABLEAFFORDABLE AND AND

REQUIRES INDIVIDUALS TO BE REQUIRES INDIVIDUALS TO BE MORE SELF-MORE SELF-RELIANTRELIANT

WITH THEIR WITH THEIR HEALTH CARE NEEDSHEALTH CARE NEEDS..

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.

Secondary health care More complex problems are dealt with.

Comprises curative services

Provided by the district hospitalsThe 1st referral level

Tertiary health careOffers super-specialist care

Provided by regional/central level institution.

Provide training programs

Levels of Levels of CareCare

LUM Hospital

Concepts of PHCConcepts of PHC

For all ( especially for needy )For all ( especially for needy )

AcceptableAcceptable Community Community

Active involvementActive involvement

BASIC ELEMENTSBASIC ELEMENTS OFOF ““PRIMARY HEALTH CARE”PRIMARY HEALTH CARE”

Health education Health education ( Health problems- preventing & controlling)( Health problems- preventing & controlling)

Identifying & controlling prevailing health problems.Identifying & controlling prevailing health problems.

Promotion of Food supply and proper Promotion of Food supply and proper nutrition.nutrition.

Provision of safe water and basic sanitation.Provision of safe water and basic sanitation.

Maternal & child health care,Maternal & child health care,

including family planning.including family planning.

BASIC ELEMENTSBASIC ELEMENTS (cont:) (cont:)

ImmunizationImmunization

Prevention and control of locally endemic Prevention and control of locally endemic diseasedisease

Appropriate treatment of common diseases and Appropriate treatment of common diseases and injuriesinjuries

Promotion of mental healthPromotion of mental health

Provision of essential drugsProvision of essential drugs

PrinciplesPrinciples

Equitable Distribution

PHC must be given to PHC must be given to all individuals in equal all individuals in equal amount in community amount in community irrespective of their irrespective of their gender, age, caste, gender, age, caste, color, urban, rural and color, urban, rural and social class.social class.

Community Participation

Involvements of Individuals, families & communities in promotion of their own health & welfare is an essential ingredient of PHC

Intersectorial coordination

Alma-Ata states that PHC involves in addition to the health sector, all related sectors & aspects of national & community development, in particular agriculture ,food, industry, education, housing , public works, communication & other sectors.

Appropriate Technology

Technology i,e scientifically sound, adapted to local needs & acceptable to those who apply it & those for whom it is used.

PHC in PakistanPHC in Pakistan

Health facilities are offered through severalHealth facilities are offered through several BHUBHU RHCRHC

Serves 5000 – 10 000 population

5 – 10 BHUs linked to one RHC

Services provided at BHUs included

-MCH services

-Child care

-Immunization

-Diarrheal control

-Malaria control

-Mental Health

-School Health services

BHU

RHC

Each has 25 beds

Laboratory

Provision for minor surgery

Ambulance

Each RHC ( linked to) Taluka Hospital

Taluka Hospital ( linked to) District Head quarter’s Hospital

Whole system is designed as integrated Rural Health Complex

Selective Primary Health CareSelective Primary Health Care

Is a policy of selective interventions to deal with Is a policy of selective interventions to deal with the the most serious public health problemsmost serious public health problems, ,

rather than comprehensive PHC which is rather than comprehensive PHC which is considered considered too costly too costly && requires a large no: of requires a large no: of trained persons.trained persons.

UNICEF’s Proposed Selective UNICEF’s Proposed Selective ApproachApproach

Growth monitoringGrowth monitoring ORSORS Breast feedingBreast feeding ImmunizationImmunization Family planningFamily planning Female educationFemale education

ComprehensivenessComprehensiveness

Comprehensiveness of care means that Comprehensiveness of care means that care is care is provided for all types of health problemsprovided for all types of health problems..

THE FUNCTIONS OF PRIMARY HEALTH CARETHE FUNCTIONS OF PRIMARY HEALTH CARE

1. To provide continuous and comprehensive care1. To provide continuous and comprehensive care

2. To refer to specialists and/or hospital services2. To refer to specialists and/or hospital services

3. To co-ordinate health services for the patient3. To co-ordinate health services for the patient

4. To guide the patient within the network of social 4. To guide the patient within the network of social welfare and public health serviceswelfare and public health services

5. To provide the best possible health and social 5. To provide the best possible health and social services in the light of economic considerations.services in the light of economic considerations.