PRIMARY HEALTH CAREPRIMARY HEALTH CARE

ByBy

Dr Naseer Alam TariqDr Naseer Alam Tariq

HealthHealth

• Health is a fundamental human rightHealth is a fundamental human right• State responsibility for the health of State responsibility for the health of

its peopleits people• National Govt all over the world are National Govt all over the world are

striving to expand and improve their striving to expand and improve their health care serviceshealth care services

• The current situation isThe current situation is– Urban orientedUrban oriented– Mostly curative in natureMostly curative in nature– Accessible to a small part of populationAccessible to a small part of population

HealthHealth

Health is a state of complete Health is a state of complete physical, mental and social physical, mental and social wellbeing and not merely wellbeing and not merely absence of disease or infirmityabsence of disease or infirmity

((WHO Definition of Health 1948)WHO Definition of Health 1948)

Primary Health CarePrimary Health Care• At the international level, the Universal At the international level, the Universal

Declaration of Human Rights established a Declaration of Human Rights established a breakthrough in 1948, by stating in Article breakthrough in 1948, by stating in Article 25:25:

““Everyone has the right to a standard Everyone has the right to a standard of of living adequate for the health and living adequate for the health and wellbeing of himself and his family” wellbeing of himself and his family”

• The preamble to the WHO Constitution The preamble to the WHO Constitution also affirms that it is one of the also affirms that it is one of the fundamental rightsfundamental rights of every human being of every human being to enjoy “The highest attainable standard to enjoy “The highest attainable standard of health”of health”

Primary Health CarePrimary Health Care

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

Primary Health CarePrimary Health Care• Against the above background, the 30Against the above background, the 30thth

World health Assembly resolved in May World health Assembly resolved in May 1977 1977 at Almata , thatat Almata , that

“ “the main social target of governments the main social target of governments and WHO in the coming decades should beand WHO in the coming decades should be

The attainment by all citizens of the world The attainment by all citizens of the world by the year 2000 of a level of health that by the year 2000 of a level of health that will permit them to lead a socially and will permit them to lead a socially and economically productive life”economically productive life”

• This culminated in the international This culminated in the international objective of objective of HEALTH FOR ALL by the year HEALTH FOR ALL by the year 20002000 as the social goal of all governments. as the social goal of all governments.

Primary Health CarePrimary Health Care

• The joint WHO – UNICEF international The joint WHO – UNICEF international conference in conference in 19781978 at Alma – Ata (USSR) the at Alma – Ata (USSR) the governments of 134 countries and many governments of 134 countries and many voluntary agencies called for a voluntary agencies called for a revolutionary approach to health care.revolutionary approach to health care.

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

Primary Health CarePrimary Health Care

• Health for all means that health is to be Health for all means that health is to be brought within the reach of every one in a brought within the reach of every one in a given community. given community.

• It implies the removal of obstacles to It implies the removal of obstacles to health – that is to say the elimination of health – that is to say the elimination of – MalnutritionMalnutrition– IgnoranceIgnorance– DiseaseDisease– Contaminated water supplyContaminated water supply– Unhygienic housing etcUnhygienic housing etc

• It depends on continued progress in It depends on continued progress in medicine and public health.medicine and public health.

• Alma Ata Declaration called on all Alma Ata Declaration called on all governments to formulate national governments to formulate national policies, strategies and plans of action policies, strategies and plans of action to launch and sustain primary health to launch and sustain primary health care as part of a national health system.care as part of a national health system.

• It is left to each country to innovate, It is left to each country to innovate, according to its own circumstances to according to its own circumstances to provide primary health careprovide primary health care

• This was followed by the formulation This was followed by the formulation and adoption of the Global Strategy for and adoption of the Global Strategy for Health for all by the 34Health for all by the 34thth World Health World Health Assembly in 1981.Assembly in 1981.

• Primary Health care got off to a good Primary Health care got off to a good start in many countries with the theme start in many countries with the theme “Health for All by 2000 AD” “Health for All by 2000 AD”

Primary Health CarePrimary Health Care

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

Concept of PHCConcept of PHC

• PHC is for all specially the PHC is for all specially the needyneedyRegardless of social and economic status every individual in the Regardless of social and economic status every individual in the nation must have nation must have accessaccess to good health care to good health care

• The services should be The services should be acceptableacceptable to the community and there to the community and there must be active involvement of the communitymust be active involvement of the community

• The health services must beThe health services must be effective effective, preventive, promotive and , preventive, promotive and curativecurative

• The services should form an The services should form an integral partintegral part of the country’s health of the country’s health systemsystem

• The programme must be efficient, The programme must be efficient, multi- sectorialmulti- sectorial because health because health does not exit in isolationdoes not exit in isolation

Primary Health CarePrimary Health Care

• Essential Health care based on Essential Health care based on practical, scientifically sound, and practical, scientifically sound, and socially socially acceptableacceptable methods and methods and technology made universally technology made universally accessibleaccessible to individuals and to individuals and families in the community through families in the community through their full their full participationparticipation and at a and at a costcost that the country and community that the country and community can affordcan afford

Levels of Health CareLevels of Health Care

Levels of Health CareLevels of Health Care

3 level of health care 3 level of health care serviceservice

Levels of Health CareLevels of Health Care

3 level of health care service3 level of health care service

• Primary care levelPrimary care level

• Secondary care levelSecondary care level

• Tertiary care levelTertiary care level

Levels of Health CareLevels of Health Care

• Primary care levelPrimary care level– First level of contact of individual, First level of contact of individual,

family and community with health family and community with health systemsystem

– Most effective and close to the peopleMost effective and close to the people– PHCPHC– BHU, RHC, THQBHU, RHC, THQ– ClinicsClinics– RMORMO– GPGP

Levels of Health CareLevels of Health Care

• Secondary care levelSecondary care level– Higher level of careHigher level of care– More complex problem are dealt More complex problem are dealt

withwith– DHQDHQ– THQ THQ – Health centersHealth centers– HospHosp

Levels of Health CareLevels of Health Care• Tertiary care levelTertiary care level

– Specialized health careSpecialized health care– Specific facilitiesSpecific facilities– Specialized health workersSpecialized health workers– Teaching hosp,Teaching hosp,– Regional hospRegional hosp– Central hosp Central hosp – Specializes hosp Specializes hosp

•AFICAFIC•AFIDAFID•NICVDNICVD

Primary Health CarePrimary Health Care

PHC is essential health care PHC is essential health care made universally made universally accessibleaccessible to to individuals and families in the individuals and families in the community by means community by means acceptableacceptable to them, through their full to them, through their full participationparticipation and at a and at a costcost that that the community and country can the community and country can affordafford

PRINCIPLES OF PRINCIPLES OF PRIMARY HEALTH CAREPRIMARY HEALTH CARE

PRINCIPLES OF PRIMARY HEALTH PRINCIPLES OF PRIMARY HEALTH CARECARE

• EquityEquity

• Community ParticipationCommunity Participation

• Intersectoral CoordinationIntersectoral Coordination

• Appropriate TechnologyAppropriate Technology

Equity/Equitable Equity/Equitable DistributionDistribution• The first key principle in primary The first key principle in primary

health health care care strategy is strategy is equityequity or or equitable equitable distribution of distribution of health health servicesservices

• Health services must be shared Health services must be shared equally equally by by all people irrespective of all people irrespective of their their ability to pay ability to pay and and all( rich or poor, all( rich or poor, urban or rural) must urban or rural) must

have access have access to health servicesto health services• health services are mainly in townshealth services are mainly in towns

Inaccessibility to majority of Inaccessibility to majority of population population

• Social injusticeSocial injustice• Availability -Insurance/NHSAvailability -Insurance/NHS

Community ParticipationCommunity Participation• Overall responsibility is of the Overall responsibility is of the

StateState• The The involvementinvolvement of individuals, of individuals,

families, and communities in families, and communities in promotion of their own health and promotion of their own health and welfare is an welfare is an essential ingredient of essential ingredient of

primary health careprimary health care• PHC coverage cannot be achieved PHC coverage cannot be achieved

without the involvement of without the involvement of community community in planning, in planning, implementation and implementation and maintenance maintenance of health servicesof health services

• Polio. FPPolio. FP

Intersectoral Intersectoral CoordinationCoordination

• Declaration of Alma –Ata states that Declaration of Alma –Ata states that PHC involves in addition to the PHC involves in addition to the

health health sector all related sectors and sector all related sectors and aspects aspects of of national and community national and community development, in particular education, development, in particular education, agriculture, animal agriculture, animal husbandry, food, husbandry, food, industry, education, housing, industry, education, housing, public public works, communicationworks, communication

• To achieve cooperation planning at To achieve cooperation planning at country country level is required to involve all level is required to involve all sectorssectors

Appropriate TechnologyAppropriate Technology• Technology that is scientifically Technology that is scientifically

soundsound, , adaptableadaptable to the local to the local needs, needs, and and acceptableacceptable to those to those who apply it who apply it and those for whom and those for whom it it is used and is used and can can be be maintainedmaintained by by the people the people themselves with the themselves with the resources of the resources of the community and community and country can affordcountry can afford

• luxurious hospitals, costly luxurious hospitals, costly equipmentsequipments

• 80:2080:20

Essential Component / ElementsEssential Component / Elements

Essential Component / Essential Component / ElementsElements 1. 1. Education concerning prevailing Education concerning prevailing

health health problems and the methods problems and the methods of identifying, of identifying, preventing and preventing and controlling themcontrolling them

2.2. Promotion of food supply and proper Promotion of food supply and proper nutrition, nutrition, an adequate supply of safe an adequate supply of safe water and basic water and basic sanitationsanitation

3.3. Maternal and child health care Maternal and child health care including including family planningfamily planning

4.4. Immunization against major infectious Immunization against major infectious diseasesdiseases

Essential component / Essential component / ElementsElements

5.5. Prevention and control of Prevention and control of locally locally endemic endemic diseasesdiseases

6. 6. Treatment of common diseases Treatment of common diseases and and injuriesinjuries

7.7. Promotion of mental healthPromotion of mental health

8. 8. Provision of essential drugsProvision of essential drugs

Millennium Development Millennium Development GoalsGoals

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

Millennium Development Millennium Development GoalsGoals

• Eradicate extreme Eradicate extreme poverty and hungerpoverty and hunger• Achieve universal primary Achieve universal primary educationeducation• Promote gender equityPromote gender equity• Improve maternal healthImprove maternal health• Reduce child mortalityReduce child mortality• Combat HIV/AIDS, malaria, and other Combat HIV/AIDS, malaria, and other

communicable diseasescommunicable diseases• Ensure environmental sustainabilityEnsure environmental sustainability• Develop global partnership for Develop global partnership for

developmentdevelopment

Primary Health Care in Primary Health Care in PakistanPakistanBasic Health Unit (BHU)Basic Health Unit (BHU) Total BHU’s 5374Total BHU’s 5374

BHU serve a population of 5,000-10,000BHU serve a population of 5,000-10,000Services provided at BHU are—MCH services, Services provided at BHU are—MCH services, childcare, immunization, diarrheal diseases, childcare, immunization, diarrheal diseases, malarial control, child spacing, mental and malarial control, child spacing, mental and school health serviceschool health service

Rural Health Centre (RHC)Rural Health Centre (RHC)Total No 595Total No 5955-10 BHU are linked with RHC5-10 BHU are linked with RHC25 beds, laboratory, X-ray, minor 25 beds, laboratory, X-ray, minor surgery ,dentalsurgery ,dental

DispensariesDispensaries 48424842MCH CentersMCH Centers 909909

Primary Health Care in Primary Health Care in PakistanPakistanTehsil HospitalTehsil Hospital

50-100 bedded hosp50-100 bedded hosp

laboratory, X-ray, surgery ,dental, speclaboratory, X-ray, surgery ,dental, spec

District Headquarters hospitalDistrict Headquarters hospital

100-200 bedded hosp100-200 bedded hosp

laboratory, X-ray, surgery ,dental, all laboratory, X-ray, surgery ,dental, all specspec

Primary Health Care in Primary Health Care in PakistanPakistan

• Hospital Hospital 972 972

• DoctorsDoctors 153567153567

• Dental SurgDental Surg 11740 11740

Medical/ Dental Medical/ Dental CollegesColleges

MedicalMedicalDentalDental

PublicPublic 38 38 10 10

PrivatePrivate 50 50 27 27

Total 88Total 88 37 37

G TotalG Total 125125

Medical Per Addition in 2011-Medical Per Addition in 2011-1212

• DoctorDoctor 43004300

• DentistDentist 450 450

• NursesNurses 3000 3000

• ParamedicsParamedics 4500 4500

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

WHO 1972WHO 1972

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

WHO WHO 1963 1963