This is a presentation that (I made during my post graduation study years.

2. FRAMEWORK
 Concept & importance of Primary Health
Care
 Brief History Of Primary Health Care in India
 Evolution of PHC in India
 Current Structure of PHC
 Services Provided Through PHC

3. INTRODUCTION
 Health: A state of complete physical,
mental, and social well being and not
merely absence of disease or infirmity.
 What does health for all means?
• “Large numbers of the world’s
people, perhaps more than
half, have no access to health
care at all, and for many of the
rest the care they receive does
not answer the problems they
have.”

4. WHAT IS PRIMARY HEALTH CARE
 PHC is essential health care that is a socially
appropriate, universally accessible, scientifically
sound first level care provided by a suitably trained
workforce supported by integrated referral systems
and in a way that gives priority to those most in
need, maximises community and individual self-
reliance and participation and involves
collaboration with other sectors.
 It includes the following:
 health promotion
 illness prevention
 care of the sick
 advocacy
 community development

5. HISTORY
 1946 – Bhore Committee- put forward concept
of Primary Health Care.
 1974- Integrated cadre of MPWs.
 In 1977, GoI launched a Rural Health Scheame.
based on principle of ‘ placing people’s health in
people’s hand.’ ( Recommendation of Shrivastava
Committee
1975)
 1978 – Alma Ata Decleration-Health for All
through Primary Health Care.

6. The Joint WHO –
UNICEF
international
conference in 1978
at Alma-Ata (USSR)
Declared that
“the existing gross
inequalities in the
status of health of
people particularly
between developed and
developing countries
as well as within the
countries is politically,
socially and
economically
unacceptable.”

7. POPULATIONNORMSFOR PHC
 Bhore Committee – PHC/ 10- 20,000 population.
 Mudaliar Committee (1962) – PHC/ 40,000
population.
 ByFifth Plan (1975-80) – PHCwascatering health
needsof 1,00,000 population.
 Alma Ata – New philosophy of Primary Health
Care
 1983- National Health Plan – PHC/ 30,000 in
plain areas & per 20,000 in hilly region.

8. CURRENT STATUS OF PHC
TheUltimateGoal of PHC
1. Reducingexclusion& social disparities in health.
( Universal Health Coverage Reform)
2. Organizing health services around people’s
needs. ( Service delivery reforms)
3. Integrated health in to all sectors( Public
Policy Reforms)
4. Pursuingcollaborative modelsof policy dialogue
( Leadership reform)
5. Increasing stakeholder participation

9. SERVICESPROVIDEDTHROUGH PHC
Services
Provided
From
PHC
Provision of
Essential
Drugs
Health
Education
Food Supply &
Nutrition
Safe water &
Sanitation
Mother & Child
Health &
Family
Welfare
Immunization
Prevention &
Control Of
Diseases
Appropriate
Treatment of
Common
Diseases &
Injuries

10. SPECTRUM OF PRIMARY HEALTH CARE
Preventive
Promotive
Curative
Rehabilitative
Supportive

11. THE 30TH WORLD HEALTH ASSEMBLY
IN MAY 1977 RESOLVED
 The main social target of governments
and WHO in the coming decades should
be the attainment by all citizens of the
world by the year 2000 AD of a level of
health that will permit them to lead a
socially and economically productive
life.’’
HEALTH FOR ALL BY 2000 AD

12. Principles of primary
health care
Equitable
distribution
Community
participation.
Inter-
sectoral
coordination
Appropriate
technology

13. PRINCIPLES OF PHC
PHC 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 community and the country can
afford … (Alma-Ata, 1978)

14. CONTINUED….
• PHC based on the following principles :
– Social equity
– Nation-wide coverage
– Self-reliance
– Inter-sectoral coordination
– People’s involvement in the planning and implementation
of health programs

15. CORE ACTIVES OF PHC
 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 the
 Prevention and control of
locally endemic diseases
 Appropriate treatment of
common diseases and
injuries
 Basic laboratory services
and provision of essential
drugs.
 Training of health guides,
health workers and health
assistants.
 Referral services

16. WHO STRATEGIES OF PHC
1. Reducing excess mortality of poor marginalized
populations:
PHC must ensure access to health services for the
most disadvantaged populations, and focus on
interventions which will directly impact on the major
causes of mortality, morbidity and disability for
those populations.
2. Reducing the leading risk factors to human health:
PHC, through its preventative and health promotion
roles, must address those known risk factors, which
are the major determinants of health outcomes for
local populations.

17. CONTINUED….
3. Developing Sustainable Health Systems:
PHC as a component of health systems must
develop in ways, which are financially sustainable,
supported by political leaders, and supported by
the populations served.
4. Developing an enabling policy and institutional
environment:
PHC policy must be integrated with other policy
domains, and play its part in the pursuit of wider
social, economic, environmental and development
policy.

18. THE BASIC REQUIREMENTS FOR SOUND PHC
(THE 8 A’S AND THE 3 C’S)
 Appropriateness
 Availability
 Adequacy
 Accessibility
 Acceptability
 Affordability
 Assessability
 Accountability
 Completeness
 Comprehensiveness
 Continuity

19. MAINNATIONAL HEALTHPROGRAMMES THROUGHPHC
☼ RNTCP
☼ National Programmefor blindness (NPCB)
☼ National Leprosy Elimination Programme (NLEP)
☼ NVBDCP
☼ National AIDSControl Programme (NACP)
☼ National Program for Prevention & Control of
Cancer,Diabetes, Cardiovascular diseases&
Stroke
☼ National Program ForHealth Care of the
Elderly (NPHCE)
☼ Programmesfor Iodine Deficiency,Tobacco
Control

20. OBSTACLES FOR THE IMPLEMENTATION OF THE
PHC STRATEGY
 Misinterpretation of the PHC concept
 Lack of political will
 Centralized planning and management

21. OBSTACLES TO THE IMPLEMENTATION OF THE
PHC STRATEGY
☼ Misinterpretation of the PHC concept
☼ Lack of political will
☼ Centralized planning and management
☼ Infrastructure for rising population Size& diversity
☼ Rapid urbanization
☼ Changing demographic profile –Ageing
population
☼ Triple burden of diseases
☼ Manpower crisis
☼ Quality care & client satisfaction
☼ Quality research in PHC

22. SUMMARY
Primary care is an approach that:
 Focuses on the person not the disease,
considers all determinants of health
 Integrates care when there is more than one
problem
 Uses resources to narrow differences