2

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Organized at 3 levels & each lvl sp by a higher lvl
to which Patient is referred
Primary Health Care
First lvl of contact between indl & health sys
Essential health care is provided
BHU, RHC
Closest to people & less costly
Majority of health problems satisfactorily
dealt here
LEVELS OF HEALTH CARE
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Secondary Health Care
Lvl at which more complex problems are dealt
Usually provided at district hospitals
Comprises curative services
1
st
referral level
Tertiary Health Care
Lvl which offers super specialist care
Provided by regional & central hospitals
Provide training progms
Costly
LEVELS OF HEALTH CARE
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BACKGR
Growing concern in world over unacceptably low
lvls of health status of world population
Special concerns
Rural areas
Disparities in health between rich & poor
Urban & rural
both between countries and within countries

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BACKGR
3 decades of dissatisfaction
World Health Assembly (May 1977) decided that
main social goal of govts & WHO in coming yrs
should be:
Attainment by all people of the world by yr 2000
of lvl of health that will permit them to lead a
socially & economically productive life
Given the name Health for all by year 2000
HFA
Decision to hold conference to achieve this
concept in 1978
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ALMA ATA DECLARATION
Unicef collaborated effort (1978) held at Alma Ata
(former USSR) with 188 countries & NGOs
All countries should deliver at least basic health
svc to indls by 2000
All govts to plan & develop policies / take actions
to implement Primary Health Care in the country
Key to attainment of health for all ???
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10

Essential health care that is based on practical,
scientifically sound, socially acceptable methods &
technologies made universally accessible to indls &
communities through their full participation & at the
cost that community & country can afford to
maintain at every stage of their dev in the spirit of
self reliance & self determination

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E Health edn about prevailing health problems
L Prevention & Control of locally endemic diseases
E Provision of essential drugs
M MCH care (Maternal & Child health) incl family
planning
E (EPI) Immunization against infectious diseases
N Proper nutrition and food supplies
T Treatment of common diseases & injuries
S Adequate safe water supply & sanitation
ELEMENTS/COMPONANTS OF PHC
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Equity
According to needs
First key principle - equitable distribution of
health svcs
Health svcs must be shared equally by all
irrespective of their ability to pay & as per need
Aim of PHC is to redress the imbalance by:
Shifting the centre of gravity of health care
sys from cities to villages
Imbalance of preventive health care svcs &
curative health svcs
PRINCIPLES OF PHC
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Community Participation
A process by which people individually or
collectively assume inc responsibility for their
own health needs
No universal coverage without involvement of
local community
Community should be involved from
Inception of needs
Planning
Implementation & maint of health svcs
besides reliance on local resources(MMMT)
PRINCIPLES OF PHC
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Intersectoral Coordination
Componants of PHC cannot be provided by health
sector alone
Alma Ata declaration states:
PHC Involves in addition to health sector all related
sectors & aspects of national & community dev in
particular agriculture, food, edn,
public works, & others
It can be at the lvl of
Planning
Policy making
Progm & Svc delivery
Implementation, monitoring & eval
PRINCIPLES OF PHC
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Appropriate Technology
Technology that is scientifically sound,
adoptable to local needs, acceptable to those
who apply it & can be maint by people
themselves
4 x As
Available to community
Accessible to community
Acceptable to community
Affordable by the community
is called the appropriate technology
PRINCIPLES OF PHC
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Essential health care that is based on practical,
scientifically sound, socially acceptable methods &
technologies made universally accessible to indls &
communities through their full participation & at the
cost that community & country can afford to
maintain at every stage of their dev in the spirit of
self reliance & self determination

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Safe water supply within 15 minute walk
100% safe excreta disposal
Provn of health svcs at max of 20 min drive or 01
hour walk
100% immunization coverage to all under 5
children
IMR should be less than 50/1000 live births
MMR should be less that 2/1000 live births
INDICATORS / TGTS OF PHC
EVAL STRATEGIES
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Literacy rate more than 70%
Family planning coverage to 60% or more eligible
couple
Life expectancy > than 62 (for both genders)
Provn of 23 essential drugs to all
Birth wt of all newborn babies should be > 2500
gm (2.5 kg)
INDICATORS / TGTS OF PHC
EVAL STRATEGIES
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Govt of Pakistan embarked on PHC prior to Alma
Ata declaration
Build up sys of Integrated rural health complex
which comprises of whole sys of BHU, RHCs,
Tehsil hospitals and DHQs
EPI, CDD, TBAs trg, malaria &TB control progm
are integral part of this sys
PHC IN PAKISTAN
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PHC IN PAKISTAN
BHU BHU
RHC
RHC
BHU BHU BHU
BHU BHU
BHU BHU BHU
THQ
DHQ
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Almost one third of Pakistan's 170 million people
live in poverty
More than 60 % live on less than 2 dollars/ day
The infant mortality rate for Pakistan is 76.7 per
1,000 live births
Maternal Mortality Rate 350/ 100,000 live births
40% of population has access to safe water
supply
Literacy rate ???
Life expectancy ???
CURRENT STATUS /
INDICATORS OF PAKISTAN
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Political Climate
Afghan Russian War with large number of
refugees
Rapidly changing political climate -- failure of
proper implementation
Law & Order Sit in various areas of Pakistan were
the reason of failure to achieve goals
Lack of political cmt by govt
Lack of appreciation of multifaceted apch
Multiple horizontal progm
Curative svcs given pri over preventive svcs
WHY PHC FAILED
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Lack of involvement of community & pte sector
Lack of awareness regarding PHC among health
professionals
Shortage of health manpower & unequal distr of
resources
Technical reasons & lack of implementation
Illiteracy, Poverty & population explosion
WHY PHC FAILED
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Idea was to give pri to certain diseases
Prevalence of disease
Morbidity & disability
Effectiveness of measures and their cost
UNICEF proposed selective apch (1982)
G - Growth monitoring
O - ORT
B - Breast feeding
I - Immunization
F - Family planning
F - Female literacy
F - Food supplements for children & pregnant women
SELECTIVE HEALTH CARE
APCH
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Cmt to Health For All again renewed (1998) by
World Health Assembly
HFA for 21
st
century or HFA by yr 2000 & beyond
Progm cmt to continue till achievement of its tgts
ANOTHER MILESTONE
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Appropriateness
Availability
Adequacy
Accessibility
Acceptability
Affordability
Assessability
Accountability
BASIC REQ FOR SOUND PHC
8 AS & 3 CS
Completeness
Comprehensiveness
Continuity

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Millennium declaration (Sep 2000) -- 189 members
states of UN made cmt to address poverty
Set date of 2015 for MDG achievement
8 goals defined -- broken down in 21 quantifiable
tgts & measured by 60 indicators
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Eradicate extreme poverty & hunger
Achieve universal primary edn
Promote gender equity
Reduce child mortality
Improve maternal health
Combat HIV/AIDS / Malaria & other diseases
Ensure environmental sustainability
Dev a global partnership for dev
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