Primary Health Care

Definition, Concept and Principles

HealthA state of complete physical, mental and social well
being not merely the absence of disease or infirmity.
(WHO- concept of Health)

Modern Concept of Health

Optimum level of functioning among individuals,
families and communities.

Eco-system which affect this level of

functioning:
1. Political2. Behavioral3. Hereditary4. Health Care Delivery System5. Environmental Influences6. Socio-economic influences-

 Political
The government has the power to promulgate, promote,
implement, and think, of the different ways to alleviate
problems regarding health.
It is written in the Philippine Constitution that the
government provides access for sustainable health.
Political Issue provide people empowerment

 Behavioral
A person level of functioning is affected directly by
culture, habits, attitudes, mores, ethnic backgrounds
and society or his environment.

 Hereditary
There are certain diseases that is hereditary in nature,
therefore individual with this circumstances doesnt
have any control of the situation. It is said therefore that
inheritance plays a part in determining lifespan and
health level of an individual.

 Health Care Delivery System

PHC- in the Philippines setting, it is a partnership
approach of the private group and the government;
they work hand in hand to deliver effective provision of
essential health services.

 Environmental Influences
People living in urban areas are prone to hazards of
health. E.g communicable and non-communicable
diseases are rampant in urban areas compare to those
who are living in rural areas. Likewise those who live in
solitude life is prone to depression.

 Socio-Economic Influence
In Public health centers, families from lower income
brackets are the ones mostly served
Families within the mid-income level can provide basic
health services for their members unlike those who are
at poor sector basic health services are deprived.

Public Health
Dr. C. E. Winslow- science and art of preventing disease,
prolonging life, promoting health and efficiency through
organized community effort for the sanitation of the
environment, control of communicable diseases, the
education of the individuals personal hygiene.

 The organization of medical and nursing services for the

early diagnosis and preventive treatment of the disease
and the development of the social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as
to enable every citizen to realize his birthright of health
and longetivity.

Categories of Health Problems

Health deficits
Health threats
Foreseeable crisis or stress points

 Health Deficit
It occurs when there is a gap between actual health
status and achievable health status.

 Health threats
These are the conditions that promote disease or injury
and prevent people from realizing their health potential.

 Foreseeable Crisis
It includes stressful occurrences such as death or illness
of a family member.

Primary Health Care

As defined by the WHO as an essential health care
made universally accessible to individuals and families
in the community by means acceptable to them through
their full participation and at a cost that the community
and country can afford to maintain at every stage of
their development in the spirit of self-determination.

Legal Basis
Letter of Instruction (LOI) 949 signed on October 19,
1979 by President Ferdinand E. Marcos One year after
the First International Conference on Primary Health
Care which was held in Alma Ata, USSR on September 612 1978, sponsored by the WHO and UNICEF

Goals:
The ultimate goal of primary health care is better health for all.
WHO has identified five key elements to achieving that goal:
Reducing exclusion and social disparities in health (universal
coverage reforms);
Organizing health services around peoples needs and
expectations (servicedeliveryreforms);
Integrating health into all sectors (public policy reforms);
Pursuing collaborative models of policy dialogue (leadership
reforms); and
Increasing stakeholder participation.

Objectives
Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable and other disease.
Reduction in morbidity and mortality rates especially among infants and
children.
Extension of essential health services with priority given to the underserved
sectors.
Improvement in basic sanitation
Development of the capability of the community aimed at self- reliance.
Maximizing the contribution of the other sectors for the social and economic
development of the community.

Rationale
Adopting primary health care has the following
rationales:
Magnitude of Health Problems
Inadequate and unequal distribution of health resources
Increasing cost of medical care
Isolation of health care activities from other
development activities

Concept of PHC
According to DOH- PHC is characterized by partnership
and empowerment of the people that shall permeate as
the core strategy in the effective provision of essential
health services that is a community based, accessible,
acceptable and sustainable at a cost which the
community and the government can afford
The concept of primary health care (PHC) as a strategy
to reach the goal of health for all in 2020.

Four Cornerstone/ Pillars in Primary

Health Care
Active Community Participation
Intra and Inter-sectoral linkages
Use of appropriate technology
Support mechanism made available

 Active Community Participation

There must be a continuing effort to secure meaningful
involvement of the community in the planning,
implementation and maintenance of health services,
beside maximum reliance on local resources such as
manpower, money and materials.

 Intra and Inter-sectoral linkages

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.

 Use of appropriate technology

Is technology that is scientifically sound, adaptable to
local needs, acceptable to those who apply it and for
those for whom it is used and can be maintained by the
people themselves in keeping with the principle of self
reliance with the resources the community and country
can afford.

 Support mechanism made

available
Health services must be shared equally by all people
irrespective of their ability to pay and all (rich or poor,
urban or rural) must have access to health services.
Primary health care aims to address the current
imbalance in health care by shifting the center of
gravity from cities where a majority of people live in
most countries.

8 Essential Health Services in

Primary Health Care
(ELEMENTS)
E Education for Health
L Locally endemic disease control

E Expanded program for immunization

M Maternal and Child Health including responsible
parenthood
E Essential drugs
N Nutrition
T Treatment of communicable and non-communicable
diseases

 E Education for Health

This is one of the potent methodologies for information
dissemination. It promotes the partnership of both the
family members and health workers in the promotion of
health as well as prevention of illness.

L Locally endemic disease control

The control of endemic disease focuses on the
prevention of its occurrence to reduce morbidity rate.
Example Malaria control and Schistosomiasis control

 E Expanded program for

immunization
This program exists to control the occurrence of
preventable illnesses especially of children below 6
years old. Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable disease are
given for free by the government and ongoing program
of the DOH

 M Maternal and Child Health

including responsible parenthood
The mother and child are the most delicate members of
the community. So the protection of the mother and
child to illness and other risks would ensure good health
for the community. The goal of Family Planningincludes
spacing of children and responsible parenthood.

 E Essential drugs
This focuses on the information campaign on the
utilization and acquisition of drugs.In response to this
campaign, the GENERIC ACT of the Philippines is
enacted. It includes the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol,Nifedipine, Rifampicin,
INH (isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine

 N Nutrition
One basic need of the family is food. And if food is
properly prepared then one may be assured healthy
family. There are many food resources found in the
communities but because of faulty preparation and lack
of knowledge regarding proper food planning,
Malnutrition is one of the problems that we have in the
country.

 T Treatment of communicable and

non-communicable diseases
The diseases spread through direct contact pose a great
risk to those who can be infected. Tuberculosis is one of
the communicable diseases continuously occupies the
top ten causes of death. Most communicable diseases
are also preventable. The Government focuses on the
prevention, control and treatment of these illnesses.

S Safe water and sanitation

Environmental Sanitation is defined as the study of all
factors in the mans environment, which exercise or
may exercise deleterious effect on his well-being and
survival. Water is a basic need for life and one factor in
mans environment. Water is necessary for the
maintenance of healthy lifestyle. Safe Water and
Sanitation is necessary for basic promotion of health.

Principles
Primary health care is run with the following principles:
1.4 As = Accessibility, Availability, Affordability
and Acceptability, Appropriateness of health
services.
2.Community Participation
3.People are the center, object and subject of
development.
4.Self-reliance

5.Partnership between the community and the

health agencies in the provision of quality of life.
6.Recognition of interrelationship between the
health and development
7.Social Mobilization
8.Decentralization

 4 As = Accessibility, Availability, Affordability and

Acceptability, Appropriateness of health services.

The health services should be present where the

supposed recipients are. They should make use of the
available resources within the community, wherein the
focus would be more on health promotion and
prevention of illness.

 Community Participation
Community participation is the heart and soul of
primary health care.

 People are the center, object and

subject of development.
Thus, the success of any undertaking that aims at serving the
people is dependent on peoples participation at all levels of
decision-making; planning, implementing, monitoring and
evaluating. Any undertaking must also be based on the peoples
needs and problems (PCF, 1990)
Part of the peoples participation is the partnership between the
community and the agencies found in the community; social
mobilization and decentralization.
In general, health work should start from where the people are
and building on what they have. Example: Scheduling of Barangay
Health Workers in the health center

 Barriers of Community Involvement

Lack of motivation
Attitude
Resistance to change
Dependence on the part of community people
Lack of managerial skills

 Self-reliance
Through community participation and cohesiveness of
peoples organization they can generate support for
health care through social mobilization, networking and
mobilization of local resources. Leadership and
management skills should be develop among these
people. Existence of sustained health care facilities
managed by the people is some of the major indicators
that the community is leading to self reliance.

 Partnership between the community and the

health agencies in the provision of quality of life.

Providing linkages between the government and the

non-government organization and peoples
organization.

 Recognition of
interrelationship between the
health
and
development
Healthis defined asnot merely the absence of disease. Neither is it
only a state of physical and mental well-being. Health being a social
phenomenon recognizes the interplay of political, socio-cultural and
economic factors as its determinant. Good Health therefore, is
manifested by the progressive improvements in the living conditions
and quality of life enjoyed by the community residents
Developmentis the quest for an improved quality of life for all.
Development is multidimensional. It has political, social, cultural,
institutional and environmental dimensions (Gonzales 1994).
Therefore, it is measured by the ability of people to satisfy their
basic needs.

 Social Mobilization
It enhances peoples participation or governance,
support system provided by the government,
networking and developing secondary leaders.

 Decentralization
This ensures empowerment and that empowerment can
only be facilitated if the administrative structure
provides local level political structures with more
substantive responsibilities for development initiators.
This also facilities proper allocation of budgetary
resources.

Types of PHC workers

There are two types of primary health care workers in the
Philippines:
1. Barangay Health Worker or Village Health Worker- It
includes trained community health worker or health
auxiliary volunteer or traditional birth attendant or
healer.
2. Intermediate level Primary Health Worker- these are
the medical practitioners, public health nurse, rural
sanitary inspector and midwives.

Major Strategies:
1.Elevating health to a comprehensive and
sustained national effort
Attaining health for all Filipinos will require expanding
participation in health and health-related programs
whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is the desired outcome.
Advocacy must be directed to national and local policy
making to elicit support and commitment to major
health concerns through legislations, budgetary and
logistical considerations.

2.Promoting and supporting community managed

health care
Thehealth in the hands of the peoplebrings the
government closest to the people. It necessitates a
process of capacity building of communities and
organization to plan, implement and evaluate health
programs at their levels.

3.Increasingefficiencyin health sector

Using appropriate technologywill make services
and resources required for theirdelivery, effective,
affordable, accessible and culturally acceptable.
The development of human resources must correspond
to the actual needs of the nation and the policies it
upholds such as PHC.
The Department of Health (DOH) continue to support
and assist both public and private institutions
particularly in faculty development, enhancement of
relevant curricula and development of standard
teaching materials.

4.Advancing essential national health research

Essential National Health Research (ENHR)is an
integrated strategy for organizing and managing
research using intersectoral, multi-disciplinary and
scientific approach to health programming anddelivery.

Levels of Health Care and Referral

System
1. Primary Level Care
2. Secondary Level Care
3. Tertiary Level Care

1. Primary Level Care

This health service is provided by the physicians, nurse,
and barangay health workers/team.

2. Secondary Level Care

The physician and the health team are responsible for
the assessment and treatment of health related
problem.
In this level, the health care professional can perform
minor surgery.

3. Tertiary Level Care

This care is usually given by the specialist, major
surgeries are included in this level.

Philippine Health Care Delivery

System
1. Primary

Barangay health station

Private Practitioner/
Community Hospitals and Health Centers
Rural Health Unit

2. Secondary
Emergency District Hospital
Provincial/ City Hospitals
Provincial/ City Health Services

3. Tertiary

Regional Health Services

Regional Medical Centers and Training Hospitals
National Health Services
Medical Centers
Teaching and Training Hospitals