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Primary Health Care

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Updated information of primary health care in India as well as a gist of global scenario.

Veröffentlicht in: Gesundheit & Medizin
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Primary Health Care

  2. 2. Contents 01 02 03 04 05 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
  3. 3. 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 for all.
  4. 4. On the origin of primary health care
  5. 5. 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.
  6. 6. 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.
  7. 7. “the important role that universities could play in developing learning settings most suitable for supporting community-level work”
  8. 8. 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 advancement. League of Nations
  9. 9. HENRY SIGERIST AND SOCIALIZED MEDICINE “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.”
  10. 10. UNICEF’s program in basic services; ILO’s in basic needs; and UNRISD’s in civil society served as models for broader developmental frameworks
  11. 11. Primary health care is essential health care based on Practical Scientifically sound Socially acceptable methods and technology made 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 CONCEPT “A revolution in organizing and delivering care”
  12. 12. CHARACTERISTICS 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.
  13. 13. CHARACTERISTICS 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;
  14. 14. CHARACTERISTICS 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.
  15. 15. Principles of primary health care
  16. 16. Equitable Distribution • 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 health services.
  17. 17. Community participation •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
  18. 18. 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.
  19. 19. Appropriate technology 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 afford”
  20. 20. Focus on prevention Health services should promote health & healthy lifestyle Not curative only Eg: Immunization
  21. 21. CRITICISM TO PRIMARY HEALTH CARE • 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.
  22. 22. The emergence of Selective Primary Health Care (SPHC) • 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 malaria.
  23. 23. 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 • Immunization.
  24. 24. GOBI-FFF • Later, some agencies added FFF to the acronym GOBI, creating GOBI-FFF. • Food supplementation • Female literacy • Family Planning
  25. 25. 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 among infants. • 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
  27. 27. HISTORY
  29. 29. TIME LINE 1974 1977 Put forward concept of Primary Health Care. BHORE COMMITTEE 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) 1946 1978 Health for All through Primary Health Care. ALMA ATA DECLARATION
  30. 30. • 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 region. Population Norms for PHC
  31. 31. Number of PHCs
  32. 32. The Ultimate Goal of PHC 1. Reducing exclusion & 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. Pursuing collaborative models of policy dialogue (Leadership reform) 5. Increasing stake holder participation
  33. 33. Services Provided Through PHC Octagon of PHC
  35. 35. 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.
  36. 36. • 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 month • Type B PHC: PHC with delivery load of 20 or more deliveries in a month
  37. 37. INDIAN PUBLIC HEALTH STANDARDS 1. Medical Care 1. Essential OPD Services 24 hours emergency services Referral services In-patient services 2. Maternal and child health care including family planning 1. Essential Antenatal Care Intra-natal care Proficient in identification and basic treatment for PPH, Eclampsia , Sepsis and prompt referral Postnatal Care New born Care Care of child Family welfare
  38. 38. Promotion of safe drinking water and basic sanitation Prevention of local endemic diseases Carry out various health programs Health promotion Referral services Training
  39. 39. 1. Essential Routine urine , cbc , stool tests Diagnosis of STI/RTI Sputum testing MPFT UPTGRBS Rapid test for featal contamination of water 2. Desirable Blood Cholestrol ECG Basic laboratory and diagnostic services
  40. 40. Essential Drugs In PHC Anti infective agents. 1. Penicillins. 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 )
  41. 41. NATIONAL PROGRAMS RUNNING THROUGH PHCs• RNTCP National Programme for blindness (NPCB) National Leprosy Elimination Programme (NLEP) NVBDCP 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
  42. 42. Village Level
  43. 43. Infrastructure for rising population: Size & diversity Rapid urbanization 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
  44. 44. Primary Health Care in the 21st Century
  45. 45. 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 cost-effective way
  46. 46. The four reforms of primary health care renewal
  47. 47. 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 wise choice
  48. 48. Strengthening primary health care systems, combined with financial protection by universal coverage, seems to be the gold pathway to achieve health for all.
  49. 49. CONCLUSION 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.
  50. 50. REFERENCES 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.
  51. 51. THANK YOU