PRIMARY HEALTH CARE

PRIMARY HEALTH CARE-

Primary Health Care (PHC) is usually associated with the declaration of the 1978 International Conference in Alma Ata, Kazakhstan (known as the “Alma Ata Declaration”). Alma-Ata put health equity on the international political agenda for the first time, and PHC became a core concept of the World Health Organization’s (WHO) goal of Health for all. This PHC concept was proposed in a paper submitted to the Executive Board of WHO in January 1975 in the form of seven principles to be followed by governments wishing to improve their health services.

Definition 

 “Primary Health Care is essential health care made universally accessible to individuals & acceptable to them, through their full participation & at a cost the community & country can afford”.

PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle.

Population covered by one PHC-

  • Rural populations in the plains - 30,000
  • In hilly, tribal & backward areas- 20,000

 ELEMENTS OF PRIMARY HEALTH CARE

  • Education concerning prevailing health problem & the methods of preventing & controlling them.
  • Promotion of food supply & proper nutrition.
  • An adequate supply of safe water & basic sanitation. 
  • Maternal & child health care, including family planning.
  • Immunization against major infectious diseases.
  • Prevention & control of locally endemic diseases.
  • Appropriate treatment of common diseases & injuries.
  • Provision of essential drugs.

PRINCIPLES OF PRIMARY HEALTH CARE

  1. Equitable distribution.
  2. Community participation.
  3. Intersectoral coordination.
  4. Appropriate technology.
  5. Prevention

1. EQUITABLE DISTRIBUTION -

  • Health services must be shared equally by all people irrespective of their ability to pay.
  • Rich or poor / rural or urban must have access to health services.
  • 80% percentage of people live in rural areas & only 20% live in the urban areas, but the proportion of the health services is grossly inversely propotionate.ie, 80% of people are catered by only 20% & 20% are catered by 80% of health services.
  • This has been termed as social injustice.
  • Primary Health Care aims to readdress this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas, & bring these services as near people’s home as possible.

2. COMMUNITY PARTICIPATION - 

  • Involvement of the individuals & community in promotion of their own health & welfare, is an essential ingredient of primary health care.
  • There must be a continuing effort to secure meaningful involvement of the community in planning, implementing & maintenance of health services, besides maximum reliance on local resources such as manpower, money & materials.
  • One approach - the VHG & Trained Dais has been successfully tried in India.
  • They are selected by the local community & trained locally in the delivery of primary health care to the community they belong.
  • By overcoming cultural & communication barriers, they provide primary health care in ways that are acceptable to the community.
  • It is now considered that “Health Guides” & “Trained Dais” are an essential feature of primary health care in India.

3. INTERSECTORAL CO - ORDINATION

  • There is an increasing realization that HFA cannot be provided by the health sector alone.
  • The declaration of Alma Ata states that primary health care involves in addition to health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & other sectors.
  • To achieve such cooperation, countries may have to review their administrative system, reallocate their resources & introduce suitable legislation to ensure that coordination can take place.
  • This requires a strong political will to translate values into action.
  • An important approach is the inter sectoral approach.

4. APPROPRIATE TECHNONOLOGY

  • Appropriate technology has been defined as “technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & for those whom it is used & that cab be maintained by the people themselves in keeping with the principles of self reliance with the resources the community & country can afford”.
  • The term appropriate is emphasized because in some countries luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking many improvement in general health services.
  • This also implies use of costly equipments, procedures & techniques when cheaper, scientifically valid & acceptable ones are available. (ORS packets over house to house sand pipe connections)

5. Prevention-

  • Education concerning prevailing health problems and the methods of preventing and controlling them.
  • Promotion of food supply and proper nutrition.
  • An adequate supply of safe water and basic sanitation.
  • Maternal and child health care, including family planning.
  • Immunization against major infectious diseases.
  • Prevention and control of locally endemic diseases.
  • Appropriate treatment of common diseases and injuries.
  • Provision of essential drugs

ROLE OF A NURSE

  • The role of a nurse to deal health needs and health problems of people at community level was realized by WHO in 1970s.
  •  The same was recognized in 1977 during 30th WHO Assembly and also during International Conference on Primary Health care in 1978 at Alma Ata.
  •  In 1970, the International Council of Nurses affirmed its commitment to primary health care.
  •  It felt since nurses provide and continue to provide large part of health care in most countries, their training should and role in health care must be enlarged and enriched to fit into the changing health care approach.


WHO study group in 1985 highlighted the following roles and functions of nurses in primary health care.


1. DIRECT CARE PROVIDER-

 The nurse provide direct care to individual, families and community with reference to 8 elements of primary health care.
 E.g.,  For MCH care the nurse has to identify pregnant mothers, register them, conduct complete physical and obstetrical examination, identify high risk factors, give TT injection, IFA tablets, and health educate them about diet, rest and sleep, exercise etc.


2.  HEALTH EDUCATOR & TEACHER-

  • In order to promote health, prevent disease, regain and maintain health, the nurse educates individuals, families and community at large about healthful behaviour, sanitary environment, prevention of diseases etc.,
  •  Whatever she does, even the care of the sick at home, she educates family members to take are of the sick in her absence and also other preventive measures.
  • As a teacher, she trains other health workers such as ANMs, health Guides, Village Dais.

3. PLANNER & CARE MANAGER-

  • The nurse working for primary health care makes assessment of health needs, health problems of individuals, families and community.
  • The nurse plans care accordingly for them and implements the planned care.
  • The nurses involves individuals, families and community in planning and implementing of the care.
  • The nurses makes use of the community resources and guides them in giving care.
  • The nurse listens to and communicates with them and advise them accordingly.
  • She makes referrals when required.
  • She maintains the record of care given and evaluates the effectiveness of the same.

4. GUIDE & SUPERVISOR -

As a nurse engaged in providing primary health care, she is expected to supervise, guide and help other personnel in providing care, planning health services for families and for the community.


5. SPECIFIED FUNCTIONS

  • Assessment of health needs and health problems of individuals and community.
  • Provide integrated comprehensive primary health care service related to 8 essential elements.
  • Mobilize involvement of individuals, families and community in providing primary health care.
  • Surveillance of locally endemic diseases.
  • Training and supervision of health workers.
  • Working in collaboration with other socioeconomic sectors.
  • Maintenance of accurate, complete and up-to-date records of health care services rendered.
  • Monitoring and analysis of health condition to determine the progress in primary health care.

#