PRIMARY HEALTH CARE

1. PRIMARY HEALTH CARE By DrNaseerAlam Tariq

2. Health • Health is a fundamental human right • State responsibility for the health of its people • National Govt all over the world are striving to expand and improve their health care services • The current situation is • Urban oriented • Mostly curative in nature • Accessible to a small part of population

3. Health Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity (WHO Definition of Health 1948)

4. Primary Health Care • At the international level, the Universal Declaration of Human Rights established a breakthrough in 1948, by stating in Article 25: “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and his family” • The preamble to the WHO Constitution also affirms that it is one of the fundamental rights of every human being to enjoy “The highest attainable standard of health”

5. Primary Health Care • Increasing importance given to social justice and equity, recognition of the crucial role of community participation, changing ideas about the nature of health and development, the importance of political will called for new approaches to make medicine in the service of humanity more effective.

6. Primary Health Care • Against the above background, the 30th World health Assembly resolved in May 1977 at Almata , that “the main social target of governments and WHO in the coming decades should be The attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” • This culminated in the international objective of HEALTH FOR ALL by the year 2000 as the social goal of all governments.

7. Primary Health Care • The joint WHO – UNICEF international conference in 1978 at Alma – Ata (USSR) the governments of 134 countries and many voluntary agencies called for a revolutionary approach to health care. • Declaring that “The existing gross inequality in the health status of people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable”

8. Primary Health Care • Health for all means that health is to be brought within the reach of every one in a given community. • It implies the removal of obstacles to health – that is to say the elimination of • Malnutrition • Ignorance • Disease • Contaminated water supply • Unhygienic housing etc • It depends on continued progress in medicine and public health.

9. Alma Ata Declaration called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a national health system. • It is left to each country to innovate, according to its own circumstances to provide primary health care • This was followed by the formulation and adoption of the Global Strategy for Health for all by the 34th World Health Assembly in 1981. • Primary Health care got off to a good start in many countries with the theme “Health for All by 2000 AD”

10. Primary Health Care • Primary Health Care is a new approach to health care, which integrates at the community level all the factors required for improving the health status of the population.

11. Concept of PHC • PHC is for all specially the needy Regardless of social and economic status every individual in the nation must have access to good health care • The services should be acceptable to the community and there must be active involvement of the community • The health services must be effective, preventive, promotive and curative • The services should form an integral part of the country’s health system • The programme must be efficient, multi- sectorial because health does not exit in isolation

12. Primary Health Care • 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 country and community can afford

13. Levels of Health Care

14. Levels of Health Care 3 level of health care service

15. Levels of Health Care 3 level of health care service • Primary care level • Secondary care level • Tertiary care level

16. Levels of Health Care • Primary care level • First level of contact of individual, family and community with health system • Most effective and close to the people • PHC • BHU, RHC, THQ • Clinics • RMO • GP

17. Levels of Health Care • Secondary care level • Higher level of care • More complex problem are dealt with • DHQ • THQ • Health centers • Hosp

18. Levels of Health Care • Tertiary care level • Specialized health care • Specific facilities • Specialized health workers • Teaching hosp, • Regional hosp • Central hosp • Specializes hosp • AFIC • AFID • NICVD

19. Primary Health Care PHC is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford

20. PRINCIPLES OF PRIMARY HEALTH CARE

21. PRINCIPLES OF PRIMARY HEALTH CARE • Equity • Community Participation • Intersectoral Coordination • Appropriate Technology

22. Equity/Equitable Distribution • The first key principle in primary health care strategy is equity or equitable distribution of health services • Health services must be shared equally by all people irrespective of their ability to pay and all( rich or poor, urban or rural) must have access to health services • health services are mainly in towns Inaccessibility to majority of population • Social injustice • Availability -Insurance/NHS

23. Community Participation • Overall responsibility is of the State • The involvement of individuals, families, and communities in promotion of their own health and welfare is an essential ingredient of primary health care • PHC coverage cannot be achieved without the involvement of community in planning, implementation and maintenance of health services • Polio. FP

24. Intersectoral Coordination • Declaration of Alma –Ata states that PHC involves in addition to the health sector all related sectors and aspects of national and community development, in particular education, agriculture, animal husbandry, food, industry, education, housing, public works, communication • To achieve cooperation planning at country level is required to involve all sectors

25. Appropriate Technology • Technology that is scientifically sound, adaptable to the local needs, and acceptable to those who apply it and those for whom it is used and can be maintained by the people themselves with the resources of the community and country can afford • luxurious hospitals, costly equipments • 80:20

26. Essential Component / Elements

27. Essential Component / Elements 1. Education concerning prevailing health problems and the methods of identifying, preventing and controlling them 2. Promotion of food supply and proper nutrition, an adequate supply of safe water and basic sanitation 3. Maternal and child health care including family planning 4. Immunization against major infectious diseases

28. Essential component / Elements 5. Prevention and control of locally endemic diseases 6. Treatment of common diseases and injuries 7. Promotion of mental health 8. Provision of essential drugs

29. Millennium Development Goals • MDG,s place health at the heart of development and represent commitments by governments throughout the world to reduce poverty and hunger and to tackle ill health

30. Millennium Development Goals • Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equity • Improve maternal health • Reduce child mortality • Combat HIV/AIDS, malaria, and other communicable diseases • Ensure environmental sustainability • Develop global partnership for development

31. Primary Health Care in Pakistan Basic Health Unit (BHU) Total BHU’s 5374 BHU serve a population of 5,000-10,000 Services provided at BHU are—MCH services, childcare, immunization, diarrheal diseases, malarial control, child spacing, mental and school health service Rural Health Centre (RHC) Total No 595 5-10 BHU are linked with RHC 25 beds, laboratory, X-ray, minor surgery ,dental Dispensaries 4842 MCH Centers 909

32. Primary Health Care in Pakistan Tehsil Hospital 50-100 bedded hosp laboratory, X-ray, surgery ,dental, spec District Headquarters hospital 100-200 bedded hosp laboratory, X-ray, surgery ,dental, all spec

33. Primary Health Care in Pakistan • Hospital 972 • Doctors 153567 • Dental Surg 11740

34. Medical/ Dental Colleges Medical Dental Public 38 10 Private 50 27 Total 88 37 G Total 125

35. Medical Per Addition in 2011-12 • Doctor 4300 • Dentist 450 • Nurses 3000 • Paramedics 4500

36. PHYSICIAN A physician is a person who, having been regularly admitted to a medical school, duly recognized in the country in which it is located, has successfully completed the prescribed courses of studies in medicine and has acquired the requisite qualification to be legally licensed to practice medicine (comprising prevention, diagnosis, treatment and rehabilitation) using independent judgment to promote community and individual health WHO 1972

37. HOSPITAL Hospital is a residential establishment which provides short-term and long-term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturient WHO 1963