Primary Health CarePrimary Health CareLooking at the Alma Ata Looking at the Alma Ata

DeclarationDeclarationLectured by Bien Eli Nillos, MDLectured by Bien Eli Nillos, MD

Objectives of the LectureObjectives of the Lecture

Define Primary Health CareDefine Primary Health Care Discuss the points on Primary Health Discuss the points on Primary Health

care as presented in the Alma Ata care as presented in the Alma Ata DeclarationDeclaration

Discuss current situations on the primary Discuss current situations on the primary health care in the Philippineshealth care in the Philippines

Primary Health CarePrimary Health Care

What is Health?What is Health?““a state of complete physical, mental, and social a state of complete physical, mental, and social

well-being and not merely the absence of well-being and not merely the absence of disease or infirmity” (WHO, 1948)disease or infirmity” (WHO, 1948)

““a resource for everyday life, not the objective of living. a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and Health is a positive concept emphasizing social and personal resources, as well as physical capacities. ” personal resources, as well as physical capacities. ”

(Ottawa Charter for Health Promotion , 1986)(Ottawa Charter for Health Promotion , 1986)

““Without health life is not life; it is only a state of langour Without health life is not life; it is only a state of langour and suffering - an image of death. ” (Buddha)and suffering - an image of death. ” (Buddha)

What is Primary Health What is Primary Health Care?Care?

“Primary health care 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.” (Alma Ata Declaration, 1978)

Levels of Health CareLevels of Health Care

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.

Components of Primary Components of Primary Health CareHealth Care

Public education and participation regarding Public education and participation regarding prevention and control of health problems.prevention and control of health problems.

Promotion of food supply and proper Promotion of food supply and proper nutrition for everyone.nutrition for everyone.

An adequate supply of safe water and basic An adequate supply of safe water and basic sanitation for everyone.sanitation for everyone.

Comprehensive maternal and child health Comprehensive maternal and child health care, including family planning.care, including family planning.

Global immunization against major Global immunization against major infectious diseases.infectious diseases.

Prevention and control of locally endemic Prevention and control of locally endemic diseases.diseases.

Appropriate and accessible treatment of Appropriate and accessible treatment of common diseases and injuries.common diseases and injuries.

Provision of essential drugs to all.Provision of essential drugs to all.

Public Public Education/ParticipationEducation/Participation

““Primary health care starts with people. Our common Primary health care starts with people. Our common humanity compels us to respect people’s universal humanity compels us to respect people’s universal aspiration for a better life. It compels us to respect the aspiration for a better life. It compels us to respect the resilience and ingenuity of the human spirit, and the resilience and ingenuity of the human spirit, and the great capacity of individuals and communities to solve great capacity of individuals and communities to solve their own problems. This is where the unique ethic of their own problems. This is where the unique ethic of volunteer service also counts most.” volunteer service also counts most.” (Margaret Chan, (Margaret Chan, Director-General, WHO)Director-General, WHO)

Nutrition and Food Nutrition and Food SupplySupply

Leading Causes of Leading Causes of Hunger in the Hunger in the WorldWorld

1.1. NatureNature

2.2. WarWar

3.3. PovertyPoverty

4.4. Lack of Agricultural Lack of Agricultural InfrastructureInfrastructure

5.5. Over-exploitation of Over-exploitation of the Environmentthe Environment

(Source: World Food Program, UN (Source: World Food Program, UN http://http://www.wfp.orgwww.wfp.org/hunger/causes/hunger/causes))

Safe Water and Safe Water and SanitationSanitation

““Sanitation generally Sanitation generally refers to the provision refers to the provision of facilities and services of facilities and services for the safe disposal of for the safe disposal of human urine and human urine and feces.” (WHO)feces.” (WHO)

Maternal and Child Health Maternal and Child Health CareCare

Maternal deathMaternal death is the death of a woman while  is the death of a woman while pregnant or within 42 days of termination of pregnant or within 42 days of termination of

pregnancy, irrespective of the duration and site of the pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by pregnancy, from any cause related to or aggravated by

the pregnancy or its management but not from the pregnancy or its management but not from accidental or incidental causes. accidental or incidental causes.

The infant mortality rate (IMR)The infant mortality rate (IMR) is the ratio of the is the ratio of the number of deaths among children less than one year number of deaths among children less than one year old during a given year to the number of live births old during a given year to the number of live births during the same year. during the same year.

ImmunizationImmunization

GOAL: By 2010, ensure routine GOAL: By 2010, ensure routine immunization of children under one year of immunization of children under one year of age reaches 90 per cent nationally and at age reaches 90 per cent nationally and at least 80 per cent coverage in every district least 80 per cent coverage in every district or equivalent administrative unit. (UNICEF) or equivalent administrative unit. (UNICEF)

Prevention and Control of Prevention and Control of Endemic DiseasesEndemic Diseases

““We must anticipate more new diseases, and we must We must anticipate more new diseases, and we must accept that the speed of spread and the social and accept that the speed of spread and the social and economic impact will be much greater in our globalized economic impact will be much greater in our globalized society. We must accept that the best defence strategy society. We must accept that the best defence strategy is to detect and contain emerging diseases at source. is to detect and contain emerging diseases at source. That means good local surveillance and reporting That means good local surveillance and reporting systems.” (Margaret Chan, Director-General, WHO)systems.” (Margaret Chan, Director-General, WHO)

Accessible TreatmentAccessible Treatment

59% out of pocket

23% government

18% Shared-Risk Schemes Including National Health Insurance (PhilHealth)

No. 1 Exporter of NursesNo. 1 Exporter of Nurses

““An estimated 85% of employed An estimated 85% of employed Filipino nurses (more than 150,000) are Filipino nurses (more than 150,000) are working internationally.” (Aiken et al working internationally.” (Aiken et al 2004)2004)

““70% of all Filipino nursing graduates 70% of all Filipino nursing graduates are working overseas.” (Bach 2003)are working overseas.” (Bach 2003)

No. 2 Exporter of DoctorsNo. 2 Exporter of Doctors

““68% of Filipino doctors work 68% of Filipino doctors work overseas, next to India.” (Mejia, WHO overseas, next to India.” (Mejia, WHO 1975)1975)

200 hospitals have closed down200 hospitals have closed down within the past two within the past two years – no more doctors and nursesyears – no more doctors and nurses

800 hospitals have partially closed800 hospitals have partially closed (with one to two (with one to two wards closed) – lack of doctors and nurseswards closed) – lack of doctors and nurses

Nurse to patient ratios in provincial and district Nurse to patient ratios in provincial and district hospitals now 1: 40 to 1: 60hospitals now 1: 40 to 1: 60

Loss of highly skilled nurses in all hospitals across Loss of highly skilled nurses in all hospitals across the countrythe country

(Galvez-Tan, 2009)(Galvez-Tan, 2009)

……but but 70%70% of Filipinos have of Filipinos have no no accessaccess to essential drugs. to essential drugs.

There are more There are more than than 16,000 16,000 registered registered medicine in the medicine in the country…country…

PROVISION OF ESSENTIAL PROVISION OF ESSENTIAL DRUGSDRUGS

WHO World Medicines Situation, 2004

What Does Alma Ata What Does Alma Ata Say?Say?

““The Conference strongly reaffirms that health…is a fundamental human right”

“The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable”

LEB over LEB over 8080 years yearsIMR less than IMR less than 1010MM less than MM less than 1515

LEB underLEB under 60 60 yearsyearsIMR over IMR over 9090MM over MM over 150150

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

“Governments have a responsibilityresponsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures”

“An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts.”

AquinoAquino RamosRamos EstradaEstrada ArroyoArroyo

EducationEducation 12.312.3 15.515.5 18.718.7 15.115.1HealthHealth 3.13.1 2.62.6 2.42.4 1.81.8HousingHousing 0.10.1 0.60.6 0.80.8 0.40.4DefenseDefense 6.16.1 6.76.7 5.65.6 5.05.0Debt service Debt service

(interest only)(interest only) 40.040.0 25.325.3 19.219.2 25.225.2

Are the visions and mission Are the visions and mission of Alma Ata still relevant of Alma Ata still relevant

today?today?

“Health For All”

““Mens sana in corpore sano. Mens sana in corpore sano. 

(Your prayer must be for a sound mind in a sound body(Your prayer must be for a sound mind in a sound body..)”)” - - JuvenalJuvenal

““The part can never be well unless the whole is well.”  The part can never be well unless the whole is well.”  -Plato-Plato