Primary Health Care: An approach to delivery of health care “Health for all by Year 2000”

services  Declared during First International

Conference on Primary Health Care
Current Health Situation that Explain the Rationale of PHC
 Held in Alma Ata, USSR
1. Magnitude of Health Problems  Happened on September 6-12, 1978
2. Inadequate and Unequal distribution of Health  Organized by the World Health Organization
Resources
3. Increasing Cost of Medical Care LETTER OF INSTRUCTION 949
4. Isolation of Health Care Activities from Other Philippines
Developmental Activities HEALTH IN THE HANDS OF PEOPLE BY 2020
Definition of PHC Ferdinand Marcos
 Essential health care made universally accessible to October 19, 1979
individuals and families in the community by means 1. Despite the failure to realize the goal of
acceptable to them, through their full participation Health for All by 2000, the altruistic
and a cost that the community and country can endeavor has bear fruit as it has produced
afford at any stage of development. progress in the lives of people from the
VISION communities it has influenced.
 Health for all Filipinos and Health in the hands of the
people by year 2020. CONCEPTS
MISSION
 To strengthen the health care system by increasing
opportunities and supporting the conditions wherein
people will manage their own health care.
OBJECTIVES
1. Improvement in the level of health of the
Community.
2. Favorable population growth and structure.
ELEMENTS OF PHC
3. Reduction in morbidity and mortality rates
1. Education on Health
especially among infants and children.
2. Control of Communicable Diseases/
4. Reduction in the prevalence of preventable,
Locally endemic disease control
communicable and other diseases.
3. Immunization/ Expanded Program on
5. Extension of essential health services with priority
Immunization
given to underserved sectors.
4. Maternal and Child Health and Family
6. Improvement in basic sanitation.
Planning
7. Development of the capability of the community
5. Provision of Essential Drugs
aimed at self-reliance.
6. Adequate Food and Proper Nutrition
8. Maximization of the contribution of all sectors other
7. Provision of Medical Care and Emergency
than health to the social and economic development
Treatment
of the community.
8. Treatment of Locally Endemic Diseases
9. Safe Water & Environmental Sanitation

GENERAL PRINCIPLES OF PHC

1. Recognition of the interrelationships
between health and development
2. Essential health services must be
accessible, available, acceptable and
affordable.
2. focus on promotion of health and
prevention of disease.
3. Genuine people’s participation is essential.
a) self-reliance
b) social mobilization
c) decentralization or devolution
HISTORY
 4. Partnership between the community and Intermediate level health workers.
health agencies in the provision of quality,
- General medical practitioners or their assistants
basic and essential health services.
- Public health nurse
- Rural sanitary inspectors
- Midwives

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

STRATEGIES
 Reorientation and reorganization of national 1. Primary Level of Care - health care provided on the
health care system with the establishment of first contact between the community members and
functional support mechanism. the health care providers.
 Effective preparation and enabling process for 2. Secondary Level of Care – is usually given in
health action at all levels. privately owned or government operated facilities
 Mobilization of the people to know their wherein the facilities are capable of performing
communities and identifying their basic health minor surgeries and simple laboratory examinations.
needs. 3. Tertiary Level of Care – is rendered by specialized
 Development and utilization of appropriate health facilities wherein capable of managing
technology focusing on local indigenous complicated cases and intensive care can be
resources available in and acceptable to the provided.
community.
 Organization of communities arising from their
expressed needs which they have decided to
address.
 Increase opportunities for community
participation in local level planning,
management, monitoring and evaluation
within the context of regional and national
objectives.
 Development of intra-sectoral linkages with
other government and private agencies.
 Emphasizing partnership so that the health
workers and the community leaders/members
view each other as partners.

FOUR PILLARS/ CORNERSTONES IN PHC

1. Active community participation

2. Intra and inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

TYPES OF WORKERS

 Physicians OUTLOOK IN THE 21ST CENTURY

 Medical Technologists CURRENT CONCERNS OF PHC REFORMS
 Nurses
 Midwives  Transformation and regulation of existing health
 Traditional healers systems, aiming for universal access and social
 Community health workers health protection.
 Dealing with the health of everyone in the
LEVELS OF WORKERS community.
 A comprehensive response to people’s expectations
Village or Barangay health workers.
and needs, spanning the range of risks and illnesses.
- Trained community health workers  Promotion of healthier lifestyles and mitigation of
- Health auxiliary volunteer the health effects of social and environmental
- Traditional birth attendant or healer hazard.
 Teams of health workers facilitating access to and
appropriate use of technology and medicines.
DEMOGRAPHY
 Institutionalized participation of civil society in
policy dialogue and accountability mechanisms.
 Pluralistic health systems operating in a globalized
context.
 Guiding the growth of resources for health towards
universal coverage.
 Global solidarity and joint learning.
 Primary care as coordinator of a comprehensive
response at all levels.
 PHC is NOT cheap: it requires considerable
investment, but it provides better value for money
than its alternatives
 First, health is BOTH part of the problem and part of
the solution to world population change.
 The unprecedented growth of human populations in
the 20th century was due demographically to the
very rapid decline of mortality in relation to fertility,
especially in developing countries.
 Universal access to affordable, high-quality
reproductive and child health services —
contraception, control of sexually transmitted
diseases including HIV/AIDS, maternal and child
health —offers the most effective and humane
approach to attaining good health, enabling couples
to achieve smaller desired family sizes and
 108,246,271: Population of Philippines (2019 est.) –
accelerating the world's demographic and health
1.4% of world population
transitions to stability and quality.
 There were approximately 36.9 million people
 America's health in the 21st century must wrestle
successfully with equity between the young and the
aged and among social and ethnic groups.
 The aging of America's population will have
enormous social implications for family structure
and care taking of the elderly, economic implications
for health care costs.
 America's health in the 21st century is already
inextricably linked to world population and health.
We are becoming part of a "global health village"
because of health interdependence and the
transnationalization of disease.
 Most health problems are commonly shared, and
many health risks clearly have transnational
properties. The imperative for international worldwide living with HIV/AIDS in 2017
cooperation will intensify. o Of these, 1.8 million were children
 New directions for health into the 21st century have (<15 years old)
been released that could save millions of lives and o An estimated 1.8 million individuals worldwide
have a major impact on global well-being and became newly infected with HIV in 2017 – about
poverty reduction within a decade. 5,000 new infections per day. This includes 180,000
 The main aim of organizations such as The World children (<15 years). Most of these children live in
Health Organization (WHO) is to increase health life sub-Saharan Africa and were infected by their HIV-
expectancy for all while ensuring a better deal for positive mothers during pregnancy, childbirth or
the world's poorest people. breastfeeding.
o In 1993, the World Health Organization (WHO) are estimated to occur in sub-Saharan Africa, mostly
declared tuberculosis (TB) to be a global health among children under five years old. Although Africa
emergency. Today, TB remains one of the world's is hardest hit, it is estimated that more than one-
major causes of illness and death. About one-third third of clinical malaria cases occur in Asia and 3%
of the world's population, carry the TB bacilli, occur in the Americas.
although most never develop active TB disease. o Young children and pregnant women are at the
o Global access to TB treatment is improving but highest risk of malaria infection and mortality.
remains low and the emergence of drug-resistant Many children experience initial malaria infection
TB, particularly in settings where many TB patients during their first two years of life, when they have
are also infected with HIV, poses a serious threat to not yet developed sufficient immunity, making these
TB control, and confirms the need to strengthen early years particularly dangerous.
prevention and treatment efforts. o Malaria accounted for one in 10 deaths among
o In 2006, out of an estimated 9.2 million new TB children in developing countries in 2002. Pregnancy
cases worldwide, 4.1 million were diagnosed by causes women to have reduced immunity to malaria,
laboratory testing, 710,000 were among people making them more susceptible to malaria infection
living with HIV and there were 500,000 cases of and increasing their risk of illness, severe anemia
multi-drug resistant TB (MDR-TB). and death. Approximately 60% of all cases of malaria
o Of the estimated 1.7 million people who died of TB occur among the poorest 20% of the world's
in 2006, 14% were co-infected with HIV. population.
o In 2017, 10 million people fell ill with TB, and 1.6 HEALTH BEHAVIOR AND LIFESTYLE
million died from the disease (including 0.3 million  Lifestyle - a consistent integrated way of life that is
among people with HIV).
– TB is a leading killer of HIV-positive people.
o In 2017, an estimated 1 million children became ill
with TB and 230 000 children died of TB (including
children with HIV associated TB).
o The U.N. Millennium Development Goals include
targets to halve the 1990 TB prevalence and death
rates by 2015.
o Most TB cases occur in Southeast Asia and Africa.
One-third of the number of new TB cases occurs in
Southeast Asia, but the estimated incidence per
capita is highest in Africa. In addition, Africa has the
highest number of estimated deaths due to TB and
the highest mortality per capita, with HIV leading to
typified through one’s behavior, attitudes and
rapid increases in TB incidence in the region.
possessions
o TB is the sixth leading cause of death in the
 Health Protective Behavior
country, which has the ninth highest number of TB
- any activity people perform to maintain or promote
cases worldwide, according to the World Health
health
Organization. 250,000 Filipinos are positive for TB.
- most common are eating sensibly, getting enough
The disease kills 75 people in the Philippines daily,
sleep, keeping emergency numbers near the phone
according to the Department of Health.
- differences exist among the health practices by
o Malaria, one of the world's most common and
gender, occupation and age
serious tropical diseases, causes at least one million
- health behaviors are not strongly interdependent
deaths every year -the majority of which occur in
the most resource-poor countries
HEALTH STATUS AND BEHAVIOR
o More than half of the world's population is at risk of
A. Follows the various stages in the progress of
acquiring malaria, and the proportion increases each disease
year because of deteriorating health systems, 1. Health behavior has a preventive function.
growing drug and insecticide resistance, climate 2. Illness behavior
change, natural disasters and armed conflict. a. internal self-check
o At least 300 million acute cases of malaria occur b. plan of action
worldwide each year, resulting in more than one c. describe your symptoms to others
million deaths annually - more than 80% of which d. seek treatment and support
3. Factors within the individual
4. Interpersonal factors 60 Health status and
behavior
B. Health behaviors depend on motivational
factors.
C. Healthy and unhealthy behavior are acquired
through experience and observation.
D. Eventually, behaviors become habitual.

Three Levels of Prevention

A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
What determines individual health-related
behavior?
A. Heredity or genetics
B. Learning

The Stages of Change Model

A. Precontemplation – not considering change
B. Contemplation - aware of a potential problem
exists and are seriously considering changing to a
healthier behavior but they are not ready to commit
to this action
C. Preparation - ready to try out the behavior; may
have tried in the past but failed to reach their goal
D. Action - Successful negotiation of the behavior;
usually lasts about six months; trial and error period
E. Maintenance - working to keep the behavior in
place; self - management mechanism is in place

LEVELS OF HEALTH CARE

1. Promotive
2. Preventive
3. Curative
4. Rehabilitative