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Specific approaches have since been made for the control and prevention of diseases but in recent years the World Health Organization has again promoted PHC and many of its concepts underline the new approach of WHO to universal health coverage.
Primary Health Care
On the origin of primary health care
WHO and primary health care
Principles and Components of Primary Health Care
Primary Health Care in India
Primary Health Care in the 21st Century
Alma-Ata put health equity on the international political
agenda for the first time, and PHC became a core concept
of the World Health Organization’s (WHO) goal of Health
BARE FOOT DOCTORS
“Chinese experience showed that to promote primary health care, the key issues are human resources
and medicine. Chairman Mao advocated there was no need for five years’ training; one year was
enough to train a doctor. Short-term training focusing on specific types of work, such as antiviral
treatment or prenatal care, is sufficient to meet the demands of primary health care, especially in the
countryside or poverty-stricken areas.”
The Rural Reconstruction Movement pioneers village health
workers trained in basic health as a part of a coordinated
system of rural uplift programs in the areas of health,
education, employment etc.
Underlined the importance of a firm
national policy of providing health
care for the underprivileged, in order
to overcome the inertia or opposition
of the health professional and other
well-entrenched vested interests.
“the important role that
universities could play in
developing learning settings most
suitable for supporting
League of Nations Health
Organization Conference on
Rural Hygiene that was held in
Bandoeng, Indonesia in 1937—a
recognized public health “mile-stone”.
Focus – Problem of rural hygiene from an
“intersectoral and interagency perspective and
focused not only on the need to improve access
to modern medicine and public health but also
on the fundamental challenges of education
uplift, economic development, and social
League of Nations
HENRY SIGERIST AND SOCIALIZED
“Socialized medicine is a term used to describe
and discuss systems of universal health care:
medical and hospital care for all by means of
government regulation of health care and
subsidies derived from taxation.”
UNICEF’s program in basic services;
ILO’s in basic needs; and
UNRISD’s in civil society served as
models for broader developmental
Primary health care is essential health care
Socially acceptable methods and technology
Universally accessible to individuals
and families in the community through
their full participation and
at a cost the community and country can afford to
maintain at every stage of its development in a spirit of
Self-reliance and self determination
- Alma ata declaration 1978
“A revolution in
1. PHC reflects and evolves from the economic conditions and sociocultural and
political characteristics of the country and its communities
2. PHC is based on the application of the relevant results of social, biomedical and
health services research and public health experience
3. PHC addresses the main health problems in the community, providing promotive,
preventive, curative and rehabilitative services accordingly.
4. PHC includes at least: 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 major
infectious diseases; prevention and control of locally endemic diseases; appropriate
treatment of common diseases and injuries; and provision of essential drugs;
5. PHC should be sustained by integrated, functional and mutually supportive referral
systems, leading to the progressive improvement of comprehensive health care for all, and
giving priority to those most in need.
6. PHC relies, at local and referral levels, on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as
needed, suitably trained socially and technically to work as a health team and to respond to
the expressed health needs of the community.
• First key principle
• Health services must be shared equally by all people irrespective of their
ability to pay, and all (rich or poor, rural or urban) must have assess to the
•Involvement of the individuals, family, communities in the promotion of the
their own health and welfare and not merely the government; is essential
component of primary health care
Inter sectoral coordination
Primary health care involves in addition to health sector, all
related sectors and aspects of national and community
development, in particular agriculture, animal husbandry, food,
industry, education, housing etc.
It is defined as “technology that is scientifically sound, adaptable to local
needs, and acceptable to those who apply it and those for whom it is used,
and that can be maintained by the people by themselves in keeping with the
principle of self reliance with the resources the community and country can
Focus on prevention
Health services should promote health & healthy lifestyle
Not curative only
CRITICISM TO PRIMARY HEALTH
• During the early 1980s, conservative and neoliberal policies
became prominent and subverted the ideals of PHC.
• Neoliberal legislation reduced government programs and
expenditures, cut taxes, curbed inflation, and—contradictorily—
increased spending on national defence.
The emergence of Selective Primary Health
• WHO did not establish a clear source of funding for PHC.
• deadline of “by the year 2000” was unrealistic.
• A “selective” approach attacks the most severe public health problems facing a
locality in order to have the greatest chance to improve health and medical care in
less developed countries.
• “vertical approach”, refers to the implementation of a single disease programme
that may have a significant impact on reducing high morbidity and mortality within
a short time frame. Some examples are polio eradication, making pregnancy
safer, immunization programme, control of HIV/AIDS, tuberculosis and
GOBI—The SPHC mantra
• A set of specific, low cost interventions associated with the acronym GOBI.
• Growth monitoring to reduce the risk of death and abnormal growth because
of inadequate nutrition (an intervention that meant the use of child growth
charts by mothers in their homes),
• Oral rehydration techniques for diarrhoeal diseases,
• Breast feeding
• Later, some agencies added FFF to the acronym GOBI, creating GOBI-FFF.
• Food supplementation
• Female literacy
• Family Planning
Expanded program on immunization
• In 1974 WHO launched an Expanded Program on Immunization, EPI, with the mandate to fight six
diseases of infants: diphtheria, pertussis (whooping cough), neonatal tetanus, measles,
poliomyelitis and tuberculosis.
• before EPI there was no accurate global immunization information system, it was estimated that in the
mid-1970s, most developing countries had low immunization coverage; 5 per cent on average
• For example, measles, which in the mid-1980s, killed about two per 10,000 cases in the US; killed two per
100 cases in developing countries
Put forward concept of Primary Health Care.
Integrated cadre of MPWs.
KARTAR SINGH COMMITTEE
GoI launched a Rural Health Scheme based on
principle of ‘ placing people’s health in people’s hand.’
SRIVASTAVA COMMITTEE (recommendation 1975)
1978 Health for All through Primary Health Care.
ALMA ATA DECLARATION
• Bhore Committee – PHC/ 10- 20,000 population.
• Mudaliar Committee (1962) – PHC/ 40,000 population.
• Fifth Plan (1975-80) – PHC was catering health needs of 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
Population Norms for PHC
The Ultimate Goal of PHC
1. Reducing exclusion & social disparities in health. (Universal Health Coverage
2. Organizing health services around people’s needs. ( Service delivery reforms)
3. Integrated health in to all sectors ( Public Policy Reforms)
4. Pursuing collaborative models of policy dialogue (Leadership reform)
5. Increasing stake holder participation
The objectives of IPHS for PHCs are:
i. To provide comprehensive primary health care to the
community through the Primary Health Centres.
ii. To achieve and maintain an acceptable standard of
quality of care.
iii. To make the services more responsive and sensitive to the
needs of the community.
• From Service delivery angle, PHCs may be of two types, depending upon
the delivery case load – Type A and Type B.
• Type A PHC: PHC with delivery load of less than 20 deliveries in a
• Type B PHC: PHC with delivery load of 20 or more deliveries in a
INDIAN PUBLIC HEALTH STANDARDS
1. Medical Care
24 hours emergency services
2. Maternal and child health care including
Proficient in identification and basic treatment for PPH,
Eclampsia , Sepsis and prompt referral
New born Care
Care of child
Promotion of safe drinking water and basic
Prevention of local endemic diseases
Carry out various health programs
Routine urine , cbc , stool tests
Diagnosis of STI/RTI
Rapid test for featal contamination of water
Basic laboratory and diagnostic services
Essential Drugs In PHC
Anti infective agents.
2. Co-Trimoxazole and Cephalosporins
3. Gentamycin, Kanamycin and Amikacin
4. Erythromicin and related group of antibiotics
5. Broad spectrum antibiotics like the tetracyclins and chloramphenicol
6. Anti-TB and Anti-Leprosy Drugs
7. Anti-viral agents like acyclovir, and zidovudin (optional )
NATIONAL PROGRAMS RUNNING
THROUGH PHCs• RNTCP
National Programme for blindness (NPCB)
National Leprosy Elimination Programme (NLEP)
National AIDS Control Programme (NACP)
National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular diseases & Stroke
National Program For Health Care of the Elderly (NPHCE)
Programmes for Iodine Deficiency, Tobacco Control
Integrated Disease Surveillance Project (IDSP)
National Programme for Prevention and Control of Deafness (NPPCD)
National Mental Health Programme (NMHP)
National Programme for Prevention and Control of Fluorosis (NPPCF) Essential in Fluorosis affected Villages
Infrastructure for rising population: Size & diversity
Changing demographic profile – Ageing population
Triple burden of diseases
Man power crisis
Quality care & client satisfaction
Quality research in PHC
Challenges In Providing Effective PHC
PRIMARY HEALTH CARE: THE PATH TO UNIVERSAL HEALTH COVERAGE
Health for all is an
indispensable need which
must be integrated into an
overall framework for
organising and delivering
care based on a patient
centered, efficient, fair, and
The four reforms of
primary health care
A recent study on 102 low- and
middle-income countries reported
that broader coverage of primary
care services was linked to longer
life expectancy, lower infant
mortality and lower under-five
mortality, suggesting that
investment in primary care is a
Strengthening primary health
care systems, combined with
financial protection by
universal coverage, seems to
be the gold pathway to
achieve health for all.
PHC is definitely not an old and ineffective bureaucratic concept …
On the contrary, it is a modern, comprehensive and updated tool,
providing drafts of plans for actions for improving health for all,
through a holistic (individual and people-centred) and realistic
(addressing financial and political issues) Primary Health Care.
1) WHO (2008) World health report, The World Health Report 2008: Primary Health Care
(Now More Than Ever).
2) Chan M. From primary health care to universal coverage-the" affordable dream. Ten years
in public health. 2007;2017:5-12.
3) Medcalf AJ, Bhattacharya S, Momen H, Saavedra MA, Jones M. Health for all: the journey
to universal health coverage. Orient Blackswan.
4) Powell-Jackson T, Acharya A, Mills A. An assessment of the quality of primary health care
in India. Economic and Political Weekly. 2013 May 11:53-61.
5) Hsieh VC, Wu JC, Wu TN, Chiang TL (2015) Universal coverage for primary health care is a
wise investment: evidence from 102 low- and middle-income countries. Asia Pac J Public
Health 27: NP877- NP886.