CONCEPT OF PRIMARY HEALTH CARE

Introduction The concept of Primary health care is based on practical, scientifically sound and socially acceptable methods and technology. Such care is delivered in multiple settings, such as community nursing centers, health maintenance organizations, and community based clinics.

Primary health care

Primary health care is the strategy evolved to achieve Health for All by 2000 AD by the International Conference on primary health care.

Definition


The concept of primary health care came into lime-light in 1978 following an international conference in Alma-Ata, It has been defined as: "Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination."

Definition
 Primary

health care is essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost the community and country can afford.

GENESIS OF PRIMARY HEALTH CARE:

The Bhore Committee (1946) recommended that an integrated health service comprising primary health care, and other levels of care should be established for rural community.

The Alma-Ata Declaration:

The Alma-Ata conference which in 1978 formally launched primary health care as the main thrust and focus for the promotion of world health. The declaration was formally adopted by representatives of 134 governments thus committing them to the development of primary health care.

The declaration of Alma Ata stated that primary health care includes at least:
       

education about prevailing health problems and methods of preventing 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 infectious diseases; prevention and control of endemic diseases; appropriate treatment of common diseases and injuries; and Provision of essential drugs.

The concept of primary health care involves

Concerted effort to provide the rural population of developing countries with at least the bare minimum of health services.  The list can be modified to fit local circumstances. For example, some countries have specifically included mental health, physical handicaps, and the health and social care of the elderly  The primary health care approach integrates at the community level all the factors required for improving the health status of the population  As a signatory to the Alma Ata Declaration, the Government of India has pledged itself to provide primary health care


Obstacles


To the implementation of primary health care in India include shortage of health manpower, entrenchment of a curative culture within the existing health system, and a high concentration of health services and health personnel in urban areas.

CIRCLE OF PRIMARY HEALTH CARE:

THE PRIMARY HEALTH CARE PHILOSOPHY:

1.Health is fundamentally related to availability and distribution of resources not just health resources such as doctors, nurses, clinics, medicines, but also other socio-economic resources such as education, water supply and food supply. 2. Health is an integral part of overall development. Thus factors, which influence health are social, cultural and economic as well as biological and environmental.

3.

Achievement of better health requires much more involvement of people themselves as individuals, families and communities, in taking action on their own behalf by adopting healthy behavior and ensuring a healthy environment. Selfreliance, separate from and additional to the contributions of conventional health services is required.

PRIMARY HEALTH CARE STRATEGY:

The PHC strategy incorporates the values expressed in the PHC philosophy as follows: a) The need for change in the Health care system b) Intersectoral Action for Health c) Individual and collective responsibility for health d) PHC as a level of Health care

Elements of primary health care

  

    

E -Ensure safe water supply L -Locally endemic diseases control E -Education/Expanded programme of immunization or Universal immunization programme (UIP). M -Maternal and child health. E -Environment sanitation N -Nutritional services (nutrition and food supply) T -Treatment of minor ailments/common diseases S -School health services.

FUNCTIONS OF PRIMARY HEALTH CENTRE:

           

Medical care Maternal child health Control of communicable disease Collection and reporting of vital statistics Immunization services Improvement in environment sanitation. School health services. Referral services National health programmes Prevention of food adulteration practices. Nutritional services. Training Programmes.

Principles of primary health care

distribution  Community participation  Focus on prevention  Inter sectoral co-ordination  Appropriate technology
 Equitable

Equitable distribution:
Goal of HA/2000 was a vision founded on social equity.  Essential health care facilities/services must be,


Available for all  Accessible to all  Acceptable by all  Affordable by all



No uncovered/neglected pockets exist in the rural/tribal/peri-urban areas.  Urban areas due to political and socio economic forces enjoy the advantage of concentration of health care resources for many years  Social equity calls for redistribution/preferential allocation of resources to underserved areas.


Community involvement (Participation):

Community participation means involvement of the people in the development process voluntarily and willingly.  Close contact between health services and the community is essential and should be a two-way process.  Health workers and the services must remain responsive to the perceived and real health needs of the people.


 

Similarly, the community must understand the objectives and constraints of the health system Community leaders can be particularly valuable in mobilizing resources and assisting health workers for effective delivery of health care. Various community organizations and social networks such as village development committees, youth associations, religious organizations etc. can serve as the mechanism for participation.

Focus on prevention:
         

Three levels of prevention/intervention in health care Primary: Health promotion Specific protection Secondary: Early detection/diagnosis Treatment Tertiary: Disability limitation Rehabilitation

Intersectoral co - operation:

Appropriate Technology:


Internationally conference on PHC (1978) has defined technology as an association of methods, techniques and equipments, which, together with the people using them, can contribute significantly to solving a health problem.

      

Appropriate means that the technology is scientifically sound acceptable to those who apply it and to those for whom it is used compatible with local culture capable of using adapted and further developed if necessary understandable by the PHC workers and in some instances even by individuals, family, community cost-effective

CHARACTERISTICS OF PRIMARY HEALTH CARE:

Primary health care is essential health care made universally accessible to individuals, families in the community.  It is socially acceptable to all implies that care has to be appropriate  Affordable primary health care implies that whatever the methods of payment used  It is made available to them through their full participation.


In primary health care we use appropriate technology, which means using appropriate methods and techniques and with locally available supplies and equipment  It is based on socially accepted methods which the country can afford. Thus, selfreliance and self determination are emphasized


SEVEN SUPPORTING ACTIVITIES FOR PRIMARY HEALTH CARE:

PRIMARY HEALTH CARE IN INDIA:

 In

1977, the Government of India launched a rural health scheme, based on the principle of placing peoples health in peoples hands. It is the three tier system of health care delivery in rural areas based on the recommendation of the Shrivastav committee in 1975.

 The

National Health policy (2002) includes all that is wanted from a progressive document and protect and provide primary health care to all.

a) Village level:
One of the basic tenets of primary health care is universal coverage and equitable distribution of health resources. To implement this policy at the village level, the following schemes are in operation: (i) Village health Guides (ii) Local Dais (iii) Anganwadi worker


(b) Sub-centre level:

The sub-centre is the peripheral out post of the existing health delivery system in rural areas.  Each sub-centre is manned by one male and one female multipurpose health worker. The functions of sub-centre is, mother and child health care, family planning, immunization, IUD insertion and simple laboratory investigations like routine examination of urine for albumin and sugar.


(c) Primary health centre level:



The Bhore committee in 1946 gave the concept of a primary health centre as a basic health unit, to provide, as close to the people as possible, an integrated curative and preventive health care to the rural population, preventive and promotive aspects of health care.

Functions of Primary health centres:

         

Medical care Maternal child health including family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases Collection and reporting of vital statistics. Education about health National health programmes as relevant Training of health guides, health workers, local dais and health assistants. Referral services. Basic laboratory services.

Staffing pattern of primary health centre:

           

Medical office:1 Pharmacist :1 Nurse mid-wife:1 Health worker (female)/ANM :1 Block extension educator:1 Health assistant (male) :1 Health assistant (female)/LHV:1 U.D.C : 1 L.D.C: 1 Lab technician: 1 Driver (subject to availability to vehicle):1 Class IV: 4 ---------15

(d) Community Health centre:



In each community health centre covering a population of 80,000 to 1.20 lakhs with 30 beds and specialists in surgery, medicine, obstetrics and gynaecology and pediatrics with X-ray and laboratory facilities.

Staff for community health centre:

            

Medical officer Nurse-midwives Dresser Pharmacist/Compounder Lab technician Radiographer Ward boys Dhobi Sweepers Mali Choukidar Aya Poen

1 -

7 - 1

1 1 2 - 1 3 1 1 1 -----------25

(e) Role of nurse in primary health care:

      

Collaborator Adviser Consultant Advocate Prevent or of illness Promoter of health Care provider

     

Team leader Observer Potentiator Manager Participant Practitioner

Nurses role in the delivery of Primary health care Primary care environment  Society  Primary care delivery system  Primary health care providers  Professional competence  Interpersonal competence  Intraprofessional and Interprofessional competence


contd
Multicultural competence  Client and family  Health promotion  Disease prevention  Health protection  Technological resources  Community based practice


contd
Community -oriented primary care  The community as a partner in primary care  The nursing process and the delivery of primary care services


CONCLUSION:


Health promotion strategies are not limited to a specific health problem, not at a specific set of behaviors. The primary health care should be community based with the involvement of community. It aims to provide a total package of health and developmental activities in a community/nation.