Primary Health care definition, goal, Principles and Strategies.
History of PHC
👉“Primary Care”- 1920 in England, Lord Dawson reported on “First Contact Medical Care and the Promotion of Primary Health Centre”.
👉Health care and medicine were synonymous but this concept needed to be changed as medicine was a subset of health care
👉In 1962, the term was used in Britain to denote General Practice
👉Prior to Alma Ata, nations had one system or the other of health care delivery
👉Existing health care services were mostly curative in nature and accessible to only a small part of the population.
👉Nigeria had Basic Health Service Scheme( BHSS) in the 70’s.
👉Nigeria formulated her 2nd and 3rd ,5yrs development plan to run from 1970 – 1974, and 1975 – 1980.
👉The outcome of the 2 development plan was the BHSS.
👉It was designed to extend free medical treatment as provided under previous plan to d whole nation.
BHSS IN NIGERIA
👉The BHSS was the first attempt at implementing PHC in Nigeria.
👉Unfortunately ,the BHSS concentrated on the provision of health facilities and training of health workers, without giving much attention to community participation and use of appropriate technology.
Objectives:
👉Increase access to appropriate health services by the end of 1975-1980
👉Prevention and health promotion services to be integrated with curative services
👉Basic Health Units to achieve integration
👉Develop new cadre of primary health care workers to man the health facilities to be constructed
Implementation:
1 BHU with Four categories of Health Facility:
👉1 comprehensive HF at apex – 50,000 pop.
👉4 PHC centers – 10,000 pop. each
👉20 health clinics – 2,000 pop. each
👉5 mobile clinics – 40,000 pop. each
👉The second attempt at implementing PHC was btw 1980 and 1985.
👉Government began the implementing of the various programme components of PHC without ant attempt to integrate the services.
👉This led to fragmentation of services with both the states and the federal government pursuing different objectives agreeable to them .
Health clinic ; is the first level of care of BHU in rural area and each HC is to carter for a population of 2,000.
Activities :
👉Out patient medical treatment services
👉Control of communicable disease by immunization
👉Family health services
👉School health programme
👉Health education
Primary health centre:
Activities here include;
👉School health
👉Supervision of health clinics
👉Referral
👉Mass campaign
👉Dental health
👉Heath education
👉Family health.
Comprehensive health centre
Activities include:
👉Out patient services
👉Casualty clinic
👉In patient (delivery room,10 maternity beds,10 emergency beds,10 children cots, surgical theatre, x-ray and health office).
REASON FOR FAILURE OF BHSS
👉Reliance on unsustainable structures and equipments
👉Little community participation and inter-sectoral collaboration
👉Selection based on political expediency
👉The training of health personnel were also institutional based
👉Workers integration problems
👉Same reason for preference of urban posting persists
REASONS FOR NEW APPROACH
👉Gross inequalities exists between developed and developing countries and also within countries – leading to inequity
👉High cost of technology
👉Access problems
👉People have a right to participate individually and collectively in their own health care
👉Sustainability of many health interventions in doubt
NATIONAL HEALTH CARE DEVELOPMENT AGENCY.
👉In order to ensure sustainability of PHC in Nigeria, the federal government by decree number 29 of 1992 set up NPHCDA, as a parastatal of FMOH.
👉The NPHCDA is to mobilize support nationally and internationally for programme implementation, administer or commission studies on PHC issues to monitor the PHC programme.
👉Nigeria is divided into 6 zones with a zonal cordinator for each zone (bauchi, kaduna, enugu, ibadan, benin and jos )
PRIMARY HEALTH CARE DEFINITION
👉In search for solution to the growing demand for improved health, the idea of Health For All was initiated.
👉IN 1978,under the super vision of WHO, and UNICEF, an international conference on PHC was held in Alma Ata.
the Alma Ata declaration Defined PHC as:
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 the country can afford to maintain at every stage of their development in the spirit of self reliance and self determination.
Features of the PHC
👉An integral part of both the country’s health system
👉Overall social and economic development of the country.
👉First level of contact of individuals, the family and the community with the National Health System,
👉Bringing health-care as close as possible to where people live and work
PRINCIPLES OF PRIMARY HEALTH CARE
PHC based on 5 principles;
👉Universal coverage/political will
👉Community participation
👉Use of appropriate technology
👉Inter sectoral collaboration for health
👉equitable distribution.
Community participation:
This involves empowering community and individuals to assume responsibility for their own health and welfare. The community should be involved in the planning, implementation, and maintenance for health.There is reliance on local recourses ( man ,money, materials ).
Appropriate technology:
this is technology that is scientifically sound, yet adaptable to local needs and acceptable to those who apply it.It should be maintained by the people themselves.
Intersectoral collaboration :
Components of PHC can not be provided by the health sector alone. These sectors come together during the planning stage to avoid duplication of activities. They include agriculture sector, education, housing, communication.
Equity:
health services must be shared according to felts needs , irrespective of their ability to pay for the services.
Components of PHC
👉Health Education and promotion
👉Immunization against major infectious diseases
👉Prevention and control of locally endemic and epidemic diseases
👉Adequate supply of good water and basic sanitation
👉Promotion of food supply and proper nutrition
👉Maternal and child health care including family planning
👉Appropriate treatment of common diseases and injuries
👉Provision of essential drugs and revolving system.
👉*Dental health care
👉*Mental health care
👉*Primary eye care
👉Geriatric care
Read more about the components of PHC here.
THE REFERRAL SYSTEM
👉Referral system, is a process by which a health care provider transfers the responsibility of the patients management temporarily or permanently to another health care provider.
👉Usually from the lowest to the highest cadre of level of care.
👉A good referral practice should be two way referral system
IMPLEMENTATION OF PHC
👉From 1986: Process of reorientation of health services towards PHC approach
👉Stepwise implementation with 52 LGAs at inception
👉In August 1987, the federal government launched its Primary Health Care plan
👉Bamako initiative was introduced in 1988
👉1993-1999: Period of low PHC activity
CURRENT ISSUES IN PHC
👉Ward Health System (WHS): represents the current national strategy for the delivery of PHC services.
👉Utilises the electoral ward from which a representative councillor is elected as the basic operational unit
Aims of WHS:
👉To promote full and active community participation at the grass root level
👉To improve access to quality health care and ensure equity
👉To promote local initiatives and encourage poverty alleviation activities in the ward
👉To reinforce political commitment at grass root level
👉To reduce morbidity and mortality especially amongst women and children under five years
STRATEGIES FOR IMPLEMENTATION AT THE LG LEVEL
1. DIVISION INTO LGA OR WARDS:
👉Already existing boundaries may be adopted but sometimes they are too large.(standard is that a health ward should have a population of 20 000 -50 000).
👉Aim is to have clearly defined target areas for PHC activities
👉Identify a health facility as the operational base and first referral facility in that district.
2. ASSIGNMENT OF HEALTH TEAM TO EACH WARD
Steps involved is to;
👉Form the health team by ensuring a category mix.
👉Designate the most senior worker as the team leader, ward or supervisor
👉Assign the health team to the identified referral facility in the ward
👉Utilize ward referral facility for training of health teams .
3. NUMBERING OF HOUSES WITH SPECIAL PHC NUMBERS
👉This is done to facilitate referral and follow up of patients and channelling of services to homes of potential recipients.
👉Done on only permanent residences,exclude public buildings
👉PHC/02/002/000.
👉Ward(01-99),settlement(001-999),house no
4. PLACEMENT OF HOME BASED RECORDS
This is done to reduce waiting time at the health facility
And to enhance community participation by placing the responsibility for record keeping directly on the patients
Facilitate referral
To facilitate information system
To enhance continuity of care
5. PLACEMENT OF HOME BASED RECORDS
👉This is done to reduce waiting time at the health facility
👉And to enhance community participation by placing the responsibility for record keeping directly on the patients
👉Facilitate referral
👉To facilitate information system
👉To enhance continuity of care
👉A household is a group of individuals living to gather and eating from the same pot.
👉Numbering code –has to do with individuals in the family (PHC personal nos).
👉PHC address – this is the house no.
How to assign PHC personal number;
👉01 –head of household(male) husband
👉02 –other household head
👉03 – 19 –wives
👉20 -59 –children
👉60 -69 –grannies
👉70 – 79 –dependents
👉80 – 89 –household helps
👉90 – 99 –others.
Credit:
This article on Primary Health Care Definition, Goal, Principles and Strategies was written by:
DR UWAIBI N.
DEPARTMENT OF COMMUNITY HEALTH
UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY.
