1. HEALTH PROMOTION
&
PRIMARY HEALTH CARE
BY:
MR. J.C. FRANK M.SC (N)
ASSISTANT PROFESSOR

2. HEALTH PROMOTION AND
PRIMARY HEALTH CARE

3. HEALTH PROMOTION
 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 state had a direct
responsibility for the health of the individual.

4. DEFINITION:
“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).

5. GOALS OF HEALTH PROMOTION
To create environments that allow all
the ability to access all needed services.
 To equip with the skills to determine their own
health needs.

6. INTERVENTIONS AREA IN HEALTH
PROMOTION:
1. Health
education
2.
Environmental
modifications
3. Nutritional
interventions
4. Lifestyle
and behavioral
changes

7. HEALTH EDUCATION
 This is one of the most cost-effective
interventions. A large number of diseases
could be prevented with little or no medical
intervention if people were adequately
informed about them and if they were
encouraged to take necessary precautions in
time.

8. HEALTH EDUCATION
CONTT……
The targets of educational efforts may
include the general public, patients,
priority groups, health providers,
community leaders and decision-makers.

9. ENVIRONMENTAL MODIFICATION
A comprehensive approach to
health promotion requires
environmental modifications,
such as provision of safe water;
installation of sanitary latrines;
control of insects and rodents;
improvement of housing etc.

10. ENVIRONMENTAL MODIFICATION
The history of medicine has shown that many
infectious diseases have been successfully
controlled in many countries through
environmental modifications.

11. NUTRITIONAL INTERVENTIONS
 These comprise food distribution and
nutritional improvement of vulnerable groups:
child feeding programmes,food fortification;
nutritional education,etc.

12. Legislation measures
 Law related to prevention of motor vehicle accidents
 Laws related to control of environmental pollution
 Laws related to maintain food hygiene
 Laws related to alcohol use/ tobacco use/ drug abuse
 Laws related to crime

13. LIFE STYLE AND BEHAVIOURAL
CHANGES
 The conventional public health measures or
interventions have not been successful in making in
roads into lifestyle reforms. The action of prevention
in this case, is one of individual and community
responsibility for health.

14. LIFE STYLE AND BEHAVIOURAL
CHANGES
The efforts are directed towards discouraging
from adopting harmful lifestyles eg. Smoking,
eating patterns, lack of exercise, alcoholism etc.

15. PRINCIPLES
 Health promotion involves population as a whole in the context of their
everyday life.
 Health promotion is directed towards action on the determinants of
health.
 It includes communication, education, legislation, fiscal measures,
organizational change and local activities against health hazards.
 It aims public participation.
 It is basically an activity in health and social field and not a medical
service.

17.  Preventive, protective and promotive measures are
required to achieve health. These measures have to
be adopted continuously to remain healthy.

18. Maintenance strategy
NUTRITION
EXERCISE
HYGIENE
REDUCE
STRESS
SAFE
ENVIRONMENT

19. PRIMARY HEALTH CARE

20. INTRODUCTION:
 With increasing recognition of the failure of existing
health services to provide health care, alternative ideas
and methods to provide health care have been
considered and tried. The concept of primary health
care came into limelight in 1978 following an
international conference in Alma-Ata, USSR

21. DEFINITION:
“Primary health care is the essential health care made
universally accessible to individuals and acceptable to
them, through their full participation and at a cost the
community and the country can afford.”

22. ELEMENTS OF PRIMARY HEALTH CARE:
The Alma-Ata conference outlined 8 essential components of
primary health care.
“MAD PEPSI”
 Maternal and child health care, including family planning. (m)
 Appropriate treatment of common diseases and injuries (a)
 Provision of essential drugs. (d)
 Promotion of food supply and proper nutrition (p)

23.  Education concerning prevailing health problems and the
methods of preventing and controlling them. (e)
 Prevention and control of locally endemic diseases. (p)
 An adequate supply of safe water and basic sanitation (s)
 Immunization against major infectious diseases.(i)

24. PRINCIPLES OF PRIMARY HEALTH
CARE
PRINCIPLES
EQUITABLE
DISTRIBUTION
COMMUNITY
PARTICIPATION
APPROPRIATE
TECHNOLOGY
INTER
SECTORAL
COORDINATION

25. PRINCIPLES OF PRIMARY HEALTH CARE:
EQUITABLE DISTRIBUTION:
The first key principle in the primary
health care strategy is equity or equitable
distribution of health services.

26. EQUITABLE DISTRIBUTION
CONTT……
 Health services must be shared equally by all
people irrespective of their ability to pay, and all
must have access to health services.
 At present health services are mainly concentrated
in the major towns and cities resulting in inequality
of care to the people in rural areas.

27. EQUITABLE DISTRIBUTION:
CONTT……
The worst hit are the poor and the needy
and vulnerable groups of the population in
rural areas and urban slums. This has been
termed as social injustice.
The failure to reach the majority of the
people is due to inaccessibility.

28. EQUITABLE DISTRIBUTION:
CONTT……
Primary health care aims to redress this
imbalance by shifting the centre of gravity
of the health care system from cities to the
rural areas and bring these services as near
people’s homes as possible.

29. COMMUNITY PARTICIPATION:
 The overall responsibility of the central and state
governments, the involvement of individuals,
families, and communities in promotion of their
own health and welfare, is an essential ingredient
of primary health care..

30.  Countries are now conscious of the fact that the
universal coverage by primary health care
cannot be achieved without the involvement of
the local community

31.  There must be a continuous effort to secure
meaningful involvement of the community in the
planning, implementation and maintenance of health
services, besides maximum reliance on local
resources such as manpower, money and materials
.In short, primary health care must be built on the
principle of community participation (or
involvement).

32. INTER SECTORAL COORDINATION:
 There is an increasing realization of the fact that the
components of primary health care cannot be
provided by the health sector alone.

33. INTER SECTORAL COORDINATION
CONT…
The declaration of Alma-Ata states, primary health care
involves in addition to the health sector, all related sectors
and aspects of national and community development, in
particular agriculture, animal husbandry, food, industry,
education, housing, public works, communication
and other sectors”

34. INTER SECTORAL COORDINATION
CONTT……
 This requires strong political will to translate values
into action, an important element in intersectoral
approach is planning –planning with other sectors to
avoid unnecessary duplication of activities.

35. APPROPRIATE TECHNOLOGY:
 Appropriate technology has been defined as
“technology that is scientifically sound, adaptable to
local needs, and acceptable to those who apply it and
for those for whom it is used, and that can be
maintained by the people themselves in keeping with
the principle of self reliance with the resources the
community and the country can afford”

36. APPROPRIATE TECHNOLOGY
CONTT……
 The term appropriate is emphasized because in
some countries, large luxurious hospitals that are
totally in appropriate to the local needs are built,
which absorb a major part of the national health
budget, effectively blocking any improvement in
general health services.

37. This also applies to use of costly equipment,
procedures and techniques when cheaper,
scientifically valid and acceptable ones are
available, viz, oral rehydration fluid.

38. ROLE OF NURSES IN PRIMARY
HEALTH CARE
 Assessing the health status of individuals and
communities.
 Health Education
 Food Supply And Proper Nutrition
 Water supply and basic sanitation.
 Maternal and Child Health Care including Family
Planning.

39.  Immunization
 Treatments of Minor
ailments.
 Mobilizing community
involvement.
 Providing integrated health
care including the treatment of
emergencies and making referrals.

40. LEVELS OF PREVENTION
PRIMORDIAL
PREVENTION
PRIMARY
PREVENTION
SECONDARY
PREVENTION
TERTIARY
PREVENTION

41. PRIMORDIAL PREVENTION
 This primary prevention is purest in its sense.
 It implies prevention of the emergence or development of
risk factors in population groups in which they have not yet
appeared.
 The main intervention in primordial prevention is through
individual & mass education

42. PRIMARY PREVENTION
 Primary prevention can be defined as “action taken prior to the
onset of disease, which removes the possibility that a disease
will occur”.
 It signifies intervention in the pre pathogenesis phase of a
disease or health problem.
 Primary prevention may be accomplished by measures designed
to promote general health & well being, & quality of life of
people or by specific protective measures.

43. 1. HEALTH PROMOTION
General Health promotion
 Health education
 Environmental modifications
 Nutritional interventions
 Lifestyle and behavioural changes.

44. 2. SPECIFIC PROTECTION
 Use of Specific immunization (BCG, DPT,MMRvaccines)
Chemoprophylaxis (tetracycline for Cholera, dapsone
for Leprosy, Chloroquine for malaria,etc.,)
Use of specific nutrients (vitamin A for Children, ironfolic acid
tablets for Pregnant mothers)
Protection against accidents (Use of helmet,seatbelt,etc.,)
Protection against occupational hazards.
Avoidance of allergens.
Protection from air pollution.

45. SECONDARY PREVENTION
 Secondary prevention can be defined as “action which halts the progress
of a disease at its incipient stage & prevents complications”.
 The specific interventions are early diagnosis & prompt treatment.
 Secondary prevention attempts to arrest the disease process, restore health
by seeking out unrecognized disease & treating it before irreversible
pathological changes have taken place & reverse communicability of
infectious diseases.

46. Objectives of secondary prevention:
Complete cure and prevent the progression of disease process.
To prevent the spreads of disease by curing all the known cases.
To prevent the complications and sequel of disease.
To shorten the period of disability.

47.  INTERVENTIONS:
Individual and mass case-finding measures.
Screening surveys(urine examination for diabetes,etc.,)
Selective examination

48. TERTIARY PREVENTION
 When disease process has advanced beyond its early stages, it is still
possible to accomplish prevention by what might be called “tertiary
prevention”.
 It signifies intervention in the late pathogenesis phase.
 Tertiary prevention can be defined as “all measures available to reduce or
limit impairments & disabilities, minimize suffering caused by existing
departures from good health & to promote the patient’s adjustment to
irremediable conditions.

49.  REHABILITATION:
Medical rehabilitation: (restoration of Bodily Function).
Vocational rehabilitation:( restoration of the capacity to earn a
livelihood)
Social rehabilitation: (restoration of family and social
relationship).
Psychological rehabilitation: (Restoration of personal dignity
and confidence)

50. BIBLIOGRAPHY
 Basheer.P. Shebeer,KhanYaseen, Advance Nursing Practice,
1st Edition, EMMESS, Medical Publisher,2012.Pp:689-93
 Basavanthappa. BT, Community Health Nursing, 1st
Edition, Jaypee Brothers Medical Publishers,Pp.99-103.
 Park.K, Textbook of Preventive and Social Medicine,17th
Edition, M/S BanarsidasBhanot Publishers,Pp.10
 http://www.ncbi.nlm.nih.gov/pubmed/19305227