Session 2:
Introduction of Primary
Health Care
Learning Tasks
•By the end of this session students are expected to be able
to:
Define primary health care
List principles of primary health care
Mention components of primary health care
Explain WHO strategies of primary health care
Explain the basic requirements for sound primary health
care
List rights and responsibilities of all participants in PHC
Definition of Primary Health Care
The 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 country can afford to maintain at every
stage of their development in the spirit of self-reliance
and self determination.
It forms an integral part both of the country’s health system, of
which it is the central function and main focus, and of the
overall social and economic development of the community.
It is the first level of contact of individuals, the family, and the
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.
Determinants of Health
Internal:
o Biological and cognitive
o Genetics, race, sex and age (diabetes, breast cancer are genetic in nature;
diarrhea more common in children)
o Psychological and spiritual
o Life stress causes mental disorders, hypertension, heart attack, diabetes, gastric
ulcer
External:
o Environmental
o Socio-economic conditions
o Welfare services
o Food and nutrition
o Education
o Occupation
o Culture
The principles of primary health care are:
i. Equity
ii. Accessible
iii. Acceptable
iv. Affordable
v. Appropriate Technology
vi. Community Participation
vii. Intersectoral Coordination
viii. Decentralization
ix. Health Prevention and Promotion
Government through Primary Health Care emphasizes on:
Community involvement and ownership through active
participation in identification of problem areas, planning,
implementation, monitoring and evaluation of health care
services;
Multisectoral collaboration by establishment of Committees
involving other sectors such as Water, Agriculture, Education
and Ministries such as Community Development, Gender and
Children.
EQUALITY Vs EQUITY
Equity and accessibility to health care by ensuring that
every individual has the right to health care, and equitable
distribution of health resources in the country;
Empowerment through decentralization of health services
to regions and districts and communities to ensure
effective coordination, implementation, supervision and
provision of quality health care to the community;
Providing promotive, preventive, curative and
rehabilitative interventions to all individuals and families
with their active participation;
Components of Primary Health Care
The following are components of primary health care
i. Health education
ii. Food supply and nutrition
iii. Safe drinking water and sanitation
iv. Maternal and child health, family planning
v. Expanded programme in Immunization (EPI)
vi. Prevention and control of endemic diseases
vii. Appropriate treatment and prevention of common
diseases, injuries and accidents
viii. Provision of essential drugs
Global Targets on Primary Health Care
All people in every country will have ready access at least to essential health care and to
first-level referral facilities
All people will be actively involved in caring for themselves and their families, as far as they
can, in community action for health
Communities throughout the world will share government’s responsibility for the health care
of their members
All governments will assume the overall responsibility for the health of their people
Safe drinking water and sanitation will be available to all people
All people will be adequately nourished/fed
All children will be immunizes against the major diseases of childhood
Communicable diseases in the developing countries will be of no greater public health
significance in the year 2000 than they were in the developed countries in the year 1980
All possible ways will be applied to prevent and control non-communicable diseases and
promote mental health through influencing the life styles and controlling the physical and
psychological environment
Essential drugs will be available to all
WHO Strategies of Primary Health Care
Reducing excess mortality of poor marginalized
populations: Primary Health Care, must ensure access to
health services for the most disadvantaged populations, and
focus on interventions which will directly impact on the major
causes of mortality, morbidity and disability for those
populations.
Reducing the leading risk factors to human health: Primary
Health Care, through its preventative and health promotion
roles, must address those known risk factors, which are the
major determinants of health outcomes for local populations.
Developing Sustainable Health Systems: Primary Health
Care as a component of health systems must develop in
ways, which are financially sustainable, supported by
political leaders, and supported by the populations served.
Developing an enabling policy and institutional
environment: Primary Health Care policy must be
integrated with other policy domains, and play its part in
the pursuit of wider social, economic, environmental and
development policy.
•
Basic Requirements for Sound Primary Health Care
Appropriateness:
o Whether the service is needed at all in relation to essential human
needs, priorities and policies.
o The service has to be properly selected and carried out by trained
personnel in the proper way.
Availability:
o Availability of medical care means that care can be obtained
whenever people need it.
Adequacy:
o The service proportionate to requirement.
o Sufficient volume of care to meet the need and demand of a
community
Accessibility:
o Reachable, convenient services
o Geographic, economic, cultural accessibility
Acceptability:
o Acceptability of care depends on a variety of factors,
including satisfactory communication between health care
providers and the patients, whether the patients trust this
care, and whether the patients believe in the confidentiality
and privacy of information shared with the providers.
Affordability:
o The cost should be within the means and resources of the individual
and the country.
Assessability:
o Assessability means that medical care can be readily evaluated.
Accountability:
o Accountability implies the feasibility of regular review of financial
records by certified public accountants.
Completeness:
o Completeness of care requires adequate attention to all aspects of a
medical problem, including prevention, early detection, diagnosis,
treatment, follow up measures, and rehabilitation.
Comprehensiveness:
o Comprehensiveness of care means that care is provided for
all types of health problems.
Continuity:
o Continuity of care requires that the management of a
patient’s care over time be coordinated among providers.
•
Rights and Responsibility of all participants
in PHC
Individual
i. Personal hygiene
ii. Healthy lifestyles
iii. Vaccination and preventing diseases
iv. Medical examination/ treatment
v. Healthy environment
vi. Safe water, sanitation
vii. Family planning and population management
Community
i. Utilizing health facilities
ii. Supporting and strengthening health centres
iii. Activist for health promotion and protection
iv. Community health workers training
v. Improving sanitation and environment
vi. Food safety, adequate water
vii. Promoting family planning, breastfeeding, healthy
lifestyles
viii. Restricting causative factors of ill health like poverty
Government
i. Policies and plans
ii. Resources
iii. Accessibility
iv. Awareness – building
v. Human resources development
vi. Monitoring/ support
vii. Outbreak control
viii. Exchanging of experiences
International
i. Human resources development
ii. Capacity building
iii. Technical corporation among developing countries
iv. South-to-south corporation
v. Information sharing
vi. Technical support
vii. Building partnerships
viii. Financial support
Obstacles of implementation of PHC strategy
Misinterpretation of the PHC Concept
Misconception that PHC is a 2nd rate health care for the poor
Selective PHC Strategies
Resistance to Change
Lack of political will
Centralized Planning and Management Infrastructure
