Primary Health Care

(PHC)

Primary health-care center and services to community population.

 Learning Objectives:
To define PHC
To understand philosophy of PHC
To learn important of PHC
To know pillars of PHC
To classify medical care services
To count PHC principles
To count essential components of PHC
To count PHC services
To learn about PHC declarations
To count PHC challenges
Definition:
Essential health care based on practical, scientifically sound and socially acceptable methods
and technology that are universally accessible to individuals and families in the community
through their full participation and at a cost that the community and the country can afford to
maintain at every stage of their development in the spirit of self reliance and self-determination
(Alma Ata International Conference).

All people, everywhere, have the right to achieve the highest attainable level of health. This is the
fundamental premise of primary health care (PHC).

Primary health care is widely regarded as the most inclusive, equitable and cost-effective way to
achieve universal health coverage. It is also key to strengthening the resilience of health systems
to prepare for, respond to and recover from shocks and crises.

Primary health care is about health at all ages.

Primary health care is not about building specific health facilities.

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 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.

The people have the right and duty to participate individually and collectively in the planning
and implementation of their health care.

The Governments have a responsibility for the health of their people which can be
fulfilled only by the provision of adequate health and social measures.
PHC philosophy
 Holistic understanding of health

 Recognition of multiple determinants of health

 Community control over health services

 Health promotion and disease prevention

 Equity in health care

 Research-based methods

 Accessible, Acceptable, Affordable technology

Important of PHC:

The world has committed to making health for all a reality and primary health care is one of the best
tools for achieving that goal.

It has been proven that health systems with a primary health care-based foundation result in

 Improved clinical outcomes

 Increased efficiency
 Better quality of care
Enhanced patient satisfaction.

It is the first level of contact of individuals, the family and 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.
Pillars of primary health care
The primary health-care system is the key factor for community improvement and balance
socioeconomic conditions. It reduces the inequalities between different groups of a community.

The primary health-care outline is built on four key pillars:

1/ Intersectoral coordination:
Plays a significant role in performing different aspects of health-care services. The involvement of
specialized NGOs, private sectors, and public sectors is important for the successful operation of the
health-care system.
It also refers to delivering health-care services in an integrated way. It is necessary that departments
such as agriculture, animal husbandry, food industry, education, housing, public works, communication,
and other sectors need to be involved in achieving health for all.

2/ Community participation:
Is a process in which community people voluntarily serve their community health care. It is absolutely
a social approach.
The participants should identify the health needs of the community, planning, organizing, decision-
making, and implementation of health programs, sponsored by the government or NGO.
3/ Appropriate technologies:
The technologies to be implemented for health-care system
development should be available and accessible for
health-care services.
The technologies should be scientifically sound, adaptable
to local needs, and acceptable to the doctor and health-care
workforces.

4/ Support mechanism:
Support mechanisms are vital to health and quality of life.
Support mechanism includes that the people are getting personal,
physical, mental, spiritual, and instrumental support to meet goals of primary health care.

Primary health care depends on an adequate number and distribution of trained physicians, nurses,
community health workers, and others working as a health team and supported at the local and referral
levels.
Classification of medical care services:

Primary health-care medical services are extended by physicians, physician assistants, nurses, or other
health professionals who have the first contact with a patient seeking medical treatment or care. About
90% of medical visits can be treated by the primary care provider. These include treatment of acute and
chronic illnesses, preventive care, and health education for all ages and both sexes.

Secondary care medical services are provided by medical specialists in their offices or clinics or local
community hospital for a patient referred by a primary care provider who first diagnosed or treated the
patient.
Tertiary care medical services are provided by specialized hospitals or regional health center well
equipped with diagnostic and treatment facilities. These include trauma center, burn treatment center,
advanced neonatology unit services, organ transplants, high-risk pregnancy, and radiation oncology, etc.

Modern medical care is also well provided by information technology devices for recording and
communicating information in the shortest possible time.
Principles of PHC

 Addressing the main health problems in the community, providing promotive, preventive,
curative and rehabilitative services accordingly

 Focus must be on the health of the entire population, with particular attention to health
promotion, disease prevention & self-care

 Equitable Distribution of PHC (Accessibility, Appropriateness, sustainability)

 Community Participation

 Manpower Development

 Use of Appropriate Technology

 Inter-sectoral collaboration

 Affordability
8 Essential components of PHC
1/ Health Education: Concerning prevailing health problems and the methods of preventing and
controlling them.

o Community health initiatives

o School health
o Occupational health
o Healthy life style

2/ Health Promotion: Malnutrition prevention and treatment

 Food supply and proper nutrition.
 Growth monitoring
 Breast feeding
 Micronutrient distribution (vit A, iodine, folic acid, Iron)
 Food fortification
 Food safety

3/ An adequate supply of safe water and basic sanitation

 Safe water supply
 Waste management (including medical waste)
 Housing condition
4/ Maternal & child health care
• Antenatal visit (At least one, 4 or more visits)
• Skilled attendant at delivery
• Emergency obstetric care
• Family planning
• Integrated management of Child Illness (IMCI)
• Adolescent health
• Harmful practices
• Vaccination coverage:
* BCG, MMR, DPT
* Introduction of new vaccines: Penta, Rota & Pneumonia.

5/ Immunization against the major infectious diseases

o Cold chain management
o Polio eradication
o Measles & tetanus elimination
o Immunization against the major infectious diseases (Meningitis, Yellow fever, Emerging
diseases (Influenza)
6/ Provision of essential drugs

Essential drug list:

• Availability
• Affordability (Free of charge: Malaria, TB, HIV, etc.)
• Quality

7/ Appropriate treatment of common diseases & injuries

NON -Communicable diseases control programs:

 Cardiovascular diseases
 Hypertension
 Diabetes
 Cancers
 Road Traffic Accidents (RTA) & others
8/ Prevention & control of locally endemic diseases
Communicable diseases control programs

• Malaria, Leishmania & filaria control program

• HIV/AIDs control program
• TB & leprosy control program
• Bilharzia control program
• Guinea Worm
• Sleeping sickness
• Blind control

Primary health care (PHC) refers to a broad range of health services provided by medical
professionals in the community. This means universal health care is accessible to all
individuals and families in a community.

Team of PHC: General health-care practitioners, nurses, pharmacists, and associated

health-care providers.
Communicable diseases control programs strategies:
A/ Case detection and management
Prevalence
Treatment protocols
Lab investigation
Drug supplies

B/ Surveillance
Diseases notification (Immediate, weakly & monthly)
Data management
Action

C/ Health education and Promotion

Risk behavior
CHPs
Home management
Counseling
D/ Preventive measures
Vector control
Self protection (bed nets, condoms)
Mass vaccinations
Major features of primary health care

 Primary health care is mainly based on quality and cost effectiveness.

 Primary health care highlights “Health for All”.
 Primary health-care system integrates preventive, promotive, curative, rehabilitative, and palliative
health-care services.
 Primary health care promotes social inclusion: It includes services that are readily accessible and
available to the community.
 Primary health care can be easily available, even at the time of emergency caused due to natural
calamity and biological disaster.
 Primary health-care promotes equity and equality.
 Primary health-care improves safety, performance, and accountability.
 Primary health-care pleads on health promotion and focuses on prevention, screening, and early
intervention of health disparities.
 Primary health care also promotes socioeconomic condition of a community.
International Conference on PHC
Alma-Ata Declaration 1978

The concept of PHC emerged as a major milestone in global health with the Alma Ata Declaration of
1978, which identified PHC as the key to achieving "Health for All".
The declaration emphasized the need for:
Equitable access to healthcare
Community participation
Integrated approach to health services

The first section is about Alma-Ata acceptance of definition of health on primary health care as defined
by the WHO:
“a state of complete physical, mental, and social well-being and not merely the absence of disease or
infirmity,”

Ottawa Charter 1986:

This charter, developed in Canada, provided a framework for health promotion, which included PHC
principles. It emphasized the importance of social and environmental factors in health and called for
collaboration between various sectors to achieve health equity.
Eight Millennium Development Goals (MDGs) by 2015

PHC has moved from simple planning to action. To achieve this, initially, the United Nations (UN)
announced eight Millennium Development Goals (MDGs) by 2015 and the 2030 Agenda for Sustainable
Development, in pursuit of Health for All.

These goals focused on:

Eradicate extreme poverty and hunger

Achieve universal primary education
Reduce child mortality
Promote gender equality and empower women
Improve maternal health
Combat HIV/AIDS, malaria, and other diseases
Ensure environmental sustainability
Develop a global partnership for development
Sustainable Development Goal 3 2015
(SDG 3 or Global Goal 3)

Regarding “Good Health and Well -being", is one of the 17 SDGs established by the UNs in 2015. The
official wording is: "To ensure healthy lives and promote well-being for all at all ages.“
The targets of SDG 3 focus on various aspects of healthy life and healthy lifestyle.
SDG 3 has 13 targets and 28 indicators to measure progress toward targets.

The first 9 targets are outcome targets:

Reducing maternal mortality

Ending all preventable deaths under five yrs. of age
Fighting communicable diseases
Reducing mortality from non-communicable diseases & promoting mental health
Preventing & treating substance abuse
Reducing road injuries & deaths
Granting universal access to sexual & reproductive care, family planning & education
Achieving UHC
Reducing illnesses & deaths from hazardous chemicals & pollution
 The 4 means of implementation targets are:
Implementing the WHO Framework Convention on Tobacco Control
Supporting research, development, and universal access to affordable vaccines & medicines
Increasing health financing & support the health workforce in developing countries
Improving early warning systems for global health risks.

Good health is essential to sustainable development and the 2030 Agenda. It focuses on
broader economic and social inequalities, urbanization, climate crises, and the continuing burden of
HIV and other infectious diseases, while not forgetting emerging challenges such as non-
communicable diseases.

Sustainable Development Goal 3: Good Health and Well Being

Astana Declaration 2018
Astana declaration, after a gap of four decades of Alma-Ata declaration on PHC, world leaders,
government ministers, development partners, civil society, and young people organized a conference on
PHC. The Astana declaration is based on
“Commitment to the fundamental right of every human being to the enjoyment of the highest attainable
standard of health without distinction of any kind.”
The Astana declaration reemphasizes the importance of PHC to address current health care challenges,
renewing political commitment to PHC and achieving UHC with a special reference to the rural community.

The 4 key areas are as follows:

(i) Make bold political choices for health across all sectors (Promote multi-sectors action: governments
at all levels, local communities, & stakeholders)
(ii) Build sustainable PHC
(iii) Empower individuals and communities (community involvement & public participation)
(iv) Align stakeholder support to national policies, strategies, and plans (The stakeholders include health
professionals, academia, patients, civil society, local and international partners, agencies/funds, the
private sector, & NGOs).
Universal Health Coverage
UHC

Meaning of UHC:

UHC is defined as ensuring that all people, regardless of their socioeconomic status or location, have
access to necessary health services, including prevention, treatment, and rehabilitation, without facing
financial hardship.

Key Components of UHC:

UHC encompasses financial risk protection (preventing catastrophic health spending), access to quality
essential health services, and access to safe, effective, quality, and affordable essential medicines and
vaccines.

Importance of UHC:

UHC is seen as crucial for improving health outcomes, reducing poverty, and contributing to economic
growth, especially in low- and middle-income countries.
 Is PHC only for low -recourse settings?
Primary health care is an approach to health system strengthening that can work effectively in both
high and low-resource settings. While it makes health services more accessible to communities, it
also strengthens the referral system between primary care facilities and secondary or tertiary care,
including hospitals.

Is PHC only about basic services?

Primary health care provides essential care that can cover the majority of people’s health needs
throughout their lives. Because primary health care focuses on the person rather than the disease, it
is an approach that moves away from overspecialization. Its goal is to work through multidisciplinary
teams with strong referral systems to secondary and tertiary care when needed.

Is PHC only about Maternal and Child health?

Primary health care is about health at all ages. It involves prevention, health promotion, treatment,
rehabilitation and palliation. This approach empowers people and communities to choose healthier
lifestyles, prevent diseases, access early detection, treatment and recovery services.
 Medical Model vs PHC Model
Medical Model PHC Model
Treatment Lifestyle modification/Promotion
Illness Health
Cure Prevention & curative
Episodic care Continuity of care
Specific problem Comprehensive care
Individual practitioner Team work

Health sector alone Inter-sectoral collaboration

Professional dominance Community participation

Passive reception Joint responsibility

Barbara Starfield, Johns Hopkins University

 Conventional health care vs people-centered primary care
Conventional ambulatory medical Disease control programs People-centered primary care
care in clinics or
Outpatient departments
Focus on illness and cure Focus on priority diseases Focus on health needs

Relationship limited to the moment of Relationship limited to program Enduring personal relationship
consultation implementation

Episodic curative care Programed-defined disease control Comprehensive, continuous and

interventions person centered
care

Users are consumers of the care they Population groups are targets of People are partners in managing their
purchase disease-control interventions own health and that of their
community

Responsibility limited to effective Responsibility for disease-control Responsibility for the health of all in
and safe advice to the patient at the targets among the target population the community along the life cycle;
moment of consultation responsibility for tackling
determinants
Challenges for implementation of PHC
In order to meet the challenges of primary health care, it is necessary to share ideas and experiences,
test new approaches, and share the results to enable successful innovations to spread more rapidly
between organizations and across geographies.

PHC challenges:

 Shortage of well-qualified physicians and health-care workforces to serve the patients in

emergency
 Inadequate technology and equipment
 Poor condition of infrastructure, especially in rural areas
 Concentrated focus on curative health services rather than preventive and promotive health-care
services
 Challenging geographic distribution
 Poor quality health-care services
 Inadequate financial support in health-care programs
 Lack of community participation
 Poor allotment of health-care workforce to serve in the rural locality
 Lack of intersectoral collaboration.
Reform of Health System based on PHC?????
 UHC reforms that ensure health systems contribute to health equity, social justice and the end of
exclusion, primarily by moving towards universal access.
 Service delivery reforms that re-organize health services around people’s needs and expectations,
so as to make them more socially relevant and responsive to realities.
 Public health actions with primary care, by pursuing healthy public policies across sector.
 Leadership reforms that insure inclusive, participatory, negotiation-based leadership indicated by
the complexity of temporary health systems