PRIMARY HEALTH CARE

Suryani Tawali

May 1988

In a huge conference hall in Washington DC, over

a thousand participants listen with rapt attention
to Muktabai Pol, a village health worker from
Jamkhed, India. The listeners include officials
from WHO and UNICEF, ministers of health,
health professionals and representatives of
universities from many part of the world.
Muktabai shares her experience of providing
primary health care in remote Indian Village

Cont
She concludes her speech by pointing to
the glittering lights in the hall.
This is a beautiful hall and the shining
chandeliers are treat to watch, she
says. One has to travel thousands of
miles to see their beauty. The doctor
are like these chandeliers, beautiful
and exquisite, but expensive and
inaccessible.

Cont

She then pulls out two wick lamp from her

purse. She lights one. This lamp is
inexpensive and simple, but unlike the
chandeliers, it can transfer its light to
another lamp. she lights the other wick
lamp with the first. Holding up both lamps
in her outstretched hands she says, I am
like this lamp, lighting the lamp of better
health. Workers like me can light another
and another and thus encircle the whole
earth. This is Health for All.
The audience rises to its feet in a standing
ovation

Primary Health Care

(PHC)

History of PHC

PHC is a relatively modern approach to

health care
The term officially coined in 1978
PHC is not a template but a mixture of

strategy, philosophy, and list of

priority health actions

PHC: an idea whose time has come

In 1978 at Alma Ata in what is now

Kazakhstan, WHO adopted PHC as the
policy vehicle by which it would
achieve its goal of Health for all by
the year 2000.

Primary Health Care

In its most basis form, Primary
Health Care is:
essential health care made
universally accessible to
individuals and families in the
community by means acceptable
to the, through their full
participation and at a cost that the
community and country can afford
(WHO,1998)

The broad principles of

PHC

Equity in relation to need, including making

essential health care accessible to entire
population
Participation by communities and
individuals in their own health, in some
cases linked to community empowerment
Intersectoral approaches addressing
social determinants of health and
empasising health promotion and disease
prevention
Integrated approaches for efficiency and
quality

Two misconceptions

PHC is not the same as primary care

Primary care refers to first-contact
health service delivery
PHC is not second-rate care for the
poor
PHC aims to use available resources in
the most appropriate, equitable, and
effective way possible
Usually low tech, but not always

Using a PHC lens

PHC can be viewed from three
perspectives:
A health-oriented approach for
community development
An approach to delivering health
services, particularly at the local (or
district) level
A system form organising national
health systems

Using a PHC lens

PHC implementation is complex and and must
viewed in context and so any description of
PHC must distinguish PHC principles as
well as PHC elements (or actions)
The PHC principles can be used as a PHC
analytical framework which can be used to
test and improve initiatives in community
health, health services delivery or health
policy

Four pillars of PHC-the

most important principles

Participation
Equity
Inter-sectoral collaboration with other
sectors
Integration-within the health sector)

Main elements of PHC

Promotion of nutrition
Provision of adequate supply of safe water
Provision of basic sanitation
Maternal and child care including family planning
Immunisation against major infectious diseases
Prevention and control of locally endemic diseases
(such as malaria, TB, HIV)
Education concerning prevalent health problems
and the methods of their prevention and control
Appropriate treatment for common diseases and
injury
Provision of essential drugs and treatments

Main elements of PHC-1

Promotion of nutrition
Breastfeeding and complementary
feeding for infants
Support in pregnancy
Micronutrient supplement for population:
iron iodine, vitamin A
Kitchen gardens, agricultural support,
irigation, animal health

Main elements of PHC-2

Provision of adequate supply of safe

water
Gravity fed from streams or springs,
tube wells or reticulated systems
Clean and safe
Education and ownership

Provision of basic sanitation

VIPs, septics etc
Culturally appropriate acceptable

Main elements of PHC-3

Maternal and child care

Antenatal and perinatal care
Family planning
Immunisation for children
Child nutrition and case management of
illness

A move to integration-especially with

sexual and reproductive health

Main elements of PHC-4

Immunisation against major infectious

disease
EPIs six target
Newer vaccines (HepB, HiB, men,
pneumo)

Prevention and control of locally

endemic diseases, often diseases of
poverty or under development
TB, Malaria, HIV, local priorities eg.
Dengue, filariasis or thachoma

Main elements of PHC 5-6

Education concerning the prevalent

health problems and the methods of
their prevention and control as well as
education in general development
terms
Appropriate treatment for common
diseases and injuries

PHC health sector

activities

Basic infrastructure, Some basic health

facility should be established within reach of
every family. This distance will depend on
terrain, roads and available transport, but
an acceptable average walking distance is
usually taken to be 5 kilometres
Referral system. Health facilities need to
be connected with each other through a
referral mechanism that commences at
primary health care level and proceeds right
up to tertiary hospitals.

PHC health sector

activities

Appropriate training, Clinical or auxiliary

health workers need to be trained to work
in health facilities
Community health workers and other
appropriately deployed staff need to be
trained to work in the community. Training
for each should reflect the different skills
required for different settings.
Both settings need an understanding of
curative as well as promotive and
preventive.

PHC health sector

activities

Prevention of disease, and the

promotion of health, some examples
include:

Immunisation
Hygiene education
Safe sex education
Better lifting
Care-seeking counselling
Childe development counselling
Regulation for food hygiene, medical waste,
seatbelts, etc

PHC health sector

activities

Traditional health systems. Traditional

health services already operate in many
communities. These should be utilised and
included in overall attempts to improve the
health of the community. Cooperation with
traditional health workers should be
encouraged
Maximise available resources
Maximise access to the community
Can enable a conceptual bridge for health
care

PHC health sector

activities
Information for health and
development
Example:
-Community mapping and participatory
planning
- Strengthening formal health
monitoring data through basic
imunisation and vital events recording
- Survey

Pulling diverse activities

together-integration
(horizontal approach)

Real example: effective PHC attribute success to

the provision of a array of services that address
many different health issues at one time (example
of co-morbidity in children)
Crucial to accessible services
Essential fact of life for health staff and managers
at the local level officer in charge simply because
there might nobody else
At the national level it is also critical:
National planners must support the peripheral
level,
National planners should balance all health
priorities in making efficient and cost-effective

Integration balanced by
single-issue (vertical
approach)

They were criticised that they

Created pararel systems of staff and

infrastructure inefficiently focused on a narrow
scope of work
Created replacement mortality rather than
improving overal health
Were more expensive and difficult to sustain

But vertical approaches are benefit to many

health priorities :
Focused advocacy (eg immunisation in late 90s,
HIV) can increase resources and political will
Some diseases need strong centralised support
in terms of equipment, supplies and common
standars (eg to prevent drug resistance)