HEALTH PROMOTION AND PRIMARY HEALTH
At the beginning of the 20th century, a new concept, the concept of
health “promotion” began to take shape.
It was realized that public health had neglected the citizen as an
individual, and that the state had a direct responsibility for the health
of the individual.
Consequently in addition to disease control activities, one more goal
was added to public health i.e health promotion of the individuals.
It was initiated as personal health services, such as mother and child
health services, mental health and rehabilitation services.
Public health departments began expanding their programmes towards
health promotional activities.
Since the state had assumed direct responsible for the health of the
individual, two great movements were initiated for human
development during the first half of the present century namely
a. Provision of “basic health services” through the medium of
primary health centres and sub centres for rural and urban areas.
b. The second great movement was the community development
programmes to promote village development through the active
participation of the whole community and on the initiative of the
This programme tried to do too much too quickly with
inadequate resources. It was a great opportunity lost, because it
failed to survive. However, the establishment of primary health
Centres and sub centres provided the much needed infrastructure
of health services, especially in the rural areas.
Health promotion is the process of enabling people to
increase control over, and to improve health. it is not directed
against any particular disease, but is intended to strengthen the
host through a variety of approaches (interventions).
The well known interventions in this area are
Life style and behavioural changes
This is one of the most effective interventions. A large number of
diseases could be prevented with little or no medical interventions. If
people were adequately informed about them and if they were
encourage to take necessary precautions in time “the extension to all
people of the benefits of medical, psychological and related
knowledge is essential to the fullest attainment of health”.the targets
of educational efforts may include the general public,patients,priority
groups, health providers, community leaders and decision makers.
A comprehensive approach to the health promotion requires
environmental modifications such as provision of safe water,
installation of sanitary latrines, control of insects and rodents,
improvement of housing etc. the history of medicine has shown that
many infectious diseases have successfully controlled in many
countries through environmental modification, even prior to the
development of the specific vaccines or chemotherapeutic drugs.
Environmental interventions are non clinical and do not involve any
These comprise food distribution and nutrition improvement of
vulnerable groups, child feeding programmes, food fortification,
nutrition education etc.
LIFE STYLE AND BEHAVIORAL CHANGES
The conventional public health measures and interventions have not
been successful in making inroads into life style reform. The action of
prevention in this case is one of the individual and community
responsibilities for health. The physician and in fact each health team
worker acts as an educator than the therapist. Health education is the
basic element of all health activity. It is of paramount importance in
changing the views, behaviour and habits of people.
Hence health promotion consist of a broad spectrum of activities, a
well conceived health promotion programme would attempt first to
identify the target groups or at risk individuals in a population and
then direct more appropriate message to them. Goals must be defined.
Means and alternative means of accomplishing them must be
explored. It involves organizational, social, political and economic
interventions designed to facilitate environmental and behavioural
adaptations that will improve to protect health.
Primary health care
The concept of primary health care came into limelight in 1978
following an international conference in alma Ata, USSR. It has been
"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"
The primary health care approach is based on the principal of
social equity nationwide coverage, self reliance, intersectoral
coordination and people’s involvement in the planning and
implementation of health programmes in the pursuit of common
health goals. The approach has been described as “health by the
people” and placing people’s health in people’s hands”. Primary
health care was accepted by the member countries of WHO as
the key in achieving the goals of “health for all”by they year
The declaration of Alma-Ata stated the primary health care
Education about prevailing health problems and 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
Immunization against infectious diseases.
Prevention and control of endemic diseases.
Appropriate treatment of common diseases and injuries.
Provision of essential drugs.
The concept of primary health care involves a concerted
effort to provide the rural population of developing
countries with at least the bare minimum of health
services. The list can be modified to fit local
circumstances. for example: some countries have
specifically included mental health, physical handicaps,
and the health and social care of the elderly. The primary
health care approach integrates at the community level
all the factors required for improving the health status of
PRINCIPLESOF PRIMARY HEALTH CARE
Equitable distributionof health care –
according this principle, primary care and other services to
meet the main health problems in a community must be
provided equally to all individuals irrespective of their gender,
age, caste, color, urban/rural location and social class.
Community participation –
in order to make the fullest use of local, national and other
available resources. Community participation was also a
reaction to unsustainable vertical health-approaches which refers
to when a wealthier country funds a poorer country's health care.
This model is unsustainble while a grass roots, community
based Primary Health Care system is sustainable due to its
emphasis on self-sufficiency.
Health workforce development –
comprehensive health care relies on adequate numbers and
distribution of trained physicians, nurses, allied health
professions, community health workers and others working as a
health team and supported at the local and referral levels.
Use of appropriatetechnology–
medical technology should be provided that is accessible,
affordable, feasible and culturally acceptable to the community
(e.g. the use of refrigerators for vaccine cold storage).
Appropriate technology, which is the concept of health tool that
is used for socioeconomic development, is the opposite to
medical elitism. Some example of un appropriate technology
include disease-oriented technology and urban hospitals. The
former referred to such technology as body scanners or heart-
lung machines. These machine are rarely used or needed by the
poor. Urban hospital are institution created in developing
countries. These hospitals only served and benefited a minority
but draw a large share of scares source and manpower.
recognition that health cannot be improved by intervention
within just the formal health sector; other sectors are equally
important in promoting the health and self-reliance of
communities. These sectors include, at least: agriculture (e.g.
food security); education; communication (e.g. concerning
prevailing health problems and the methods of preventing and
controlling them); housing; public works (e.g. ensuring an
adequate supply of safe water and basic sanitation); rural
development; industry; community organizations (including
Panchayats or local governments, voluntary organizations, etc.).
Health work was no longer a short-lived intervention but an on-
going process of improving people's live conditions in poor.
There should be a link, which had political implications,
between health and development. Health is a tool that helped
people that increase their life, and it should not be the result of
Role of nurse in primary health care
It is an integral part of all health services and hence all health
personnel, including nurses are responsible for educating people as to
how they can improve their own health.
The community nurse has to play an important role in organizing
appropriate health education programmes according to needs of
community, collaborating and coordinating with intradisciplinary
And interdisciplinary terms. Health education to community should
be a prime function of the health workers and village level
2. food supply and proper nutrition
The community health nurse has to provide essential health services.
These include surveillance and case finding through use of growth
charts in children, making provision for supply of iodized salt,
vitamin A supplements in collaboration with other members of the
*community health nurse also take suitable measures for prevention
and treatment of diarrhoeal diseases.
* Health promotional measures like encouraging adequate child
spacing, promote longer breast feeding, and safe weaning practices.
*Teaching community members to cook the supplementary food for
3] water supply and basic sanitation
Sanitary and male health workers are responsible for safe and garbage
disposal. Community health nurse has to cooperate with the sanitary
inspectors and health workers to inform people about germ theory,
hygienic personal habits, causes of insanitation, benefits of sanitary
regulations and so on.
4] Maternal and child health care including family planning
Community health nurses are assigned to carry out maternal and child
health care, which includes antenatal prenatal and postnatal care.
Nurses and nursing team plans immunization programmes for adults
and children particularly infants and pregnant women.
Encouragement and persuation are strategies used in monitoring and
6] Prevention and control of endemic diseases
The nurses and the nursing team collects and record data about
communicable diseases, provide care for ill, offer health education
Visit and follow up cases, and provide surveillance over the target
population to ensure that communicable diseases are eradicated or
7] Treatment of minor ailments
Nurses have been trained to treat patient under a doctor’s standing
order. The emergency treatment and primary care provided by nurses
help to reduce morbidity and mortality rate.
8] Provision of essential drugs
The community health nurse has to procure and keep and also utilize
whenever necessary the essential drugs to treat minor ailments. She
should be aware of the resources and facilities for getting essential
drugs to inform the client within a short distance.
With regards to the role of nurse and primary health care who
identified four self explanatory roles of the nurses as
1. Nurse as a direct care provider.
2. Nurse as a teacher and educator.
3. Nurse as a supervisor and manager.
4. Nurse as a researcher and evaluator.
These self explanatory roles enable the nurses to contribute to
the better establishment of the primary health care to the people
of the country.
Problem in implementing primary health care
The basic resources are
a. Health man power
b. Money, material and time
Resources are needed to meet the vast needs of the
community. The lack of resources which is very acute in
some states, certainly a contributing factor to the poor
performance of primary health care system. In poor states
spending levels are low while an expectation for coverage
2. Population problem
Biggest problem faced by the country by today is its
inevitable consequences on aspects of development,
Especially employment, education, housing, health care
sanitation of environment. The country’s population has
already reached one billion.
3. Absence of political support and lack of interest in the
problems of rural areas
4. Medical care problems
80/ of health care facilities are concentrated in urban areas.
Even in urban areas there is an unequal distribution of
doctors. The rural areas were nearly 74/ of the population line
do not enjoy benefits of the modern curative and preventive
health services. The major medical problem in india is
inequitable distribution of available health resources between
below and rural areas.
5. Other factors
The rising cost of health care
Nursing and other health worker’s shortage.
Natural and manmade disasters.
Inadequate supervision and follow up.
Failure to restore medical supplies on a higher basis.
Lack of cooperation on the part of health services.
Communicable and non-communicable diseases.
Illiteracy, life span, overcrowding etc
It will be seen from the above discussion that primary
Care is qualitatively a different approach to deal with
the health problems of a community. This approach
signifies a new dynamism in health care and has been
described as health by the people, placing people’
At the end of presentation the group will be able to understand health
promotion, primary health care, definition, principles & role of nurse
in primary health care.
At the end of presentation the group should,
1) Explain the health promotion
2) Define the primary health care
3) Enlist the elements of primary health care
4) Discuss the principle of primary health care
5) Describe the role of nurse in primary health care