Primary Health Care

Nursing 105
Donna Pierrynowski Gallant PhD, RN
October 1, 2008

02/04/09 1
Objectives
 Explain the terms primary health care and primary
care.
 Describe the historical significance of the
Declaration of Alma Ata (1978) and the Lalonde
Report (1974)
 List and describe the five principles and eight
essentials of primary health care.
 Describe the barriers to achieving primary health
care.
 Discuss the contribution of nurses toward primary
health care.

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 Primary health care is the single most
important basis from which to renew the
health care system…

Roy Romanow

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Alma Ata Conference
 In 1978 at an International conference in Alma
Ata, formerly in USSR, representatives from 189
countries gathered and committed themselves
and their resources to the achievement of health
for all by the year 2000 through primary health
care.

(McMurray, pg. 30)

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Why?
 Inadequate illness management systems were not creating
healthier societies

 Response on the part of the World Health Organization

(WHO) to address the issues of unjust suffering and death
that was/is occurring world wide, especially in the poorer
countries.

(McMurray pg.30)

 ”

 .

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Definition: Primary Health Care
(PHC)
 PHC is a philosophy and model for improving
health that “focuses on promoting health/wellness
and preventing illness”. Attention is primarily on
aspects of people’s lives that make them sick
(CNA, 2003). Addresses issues such as diet,
lifestyle choices, income, housing, education,
relationships, and environmental toxins.
 Goal: Build community capacity to achieve
sustainable health and well-being (McMurray,
pg.28).

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LaLonde Report (1974)
 Health is not achievable from health care services
alone.. Must consider human biology, lifestyle,
environment, organization of health care…
 Lifestyle received the most attention…
 What is wrong with this focus?

(Potter & Perry, pg. 4).

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Primary health care approach
conceptualizes health as a
 Fundamental right
 Individual and collective responsibility
 An equal opportunity concept
 Essential component of socio-economic
development

 (McMurray, pg.31; Besner, J. (2004), p. 352)

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Essentials of PHC
 Health education
 Safe food supply and adequate nutrition
 Adequate supply of safe water and basic sanitation
 Maternal and child care
 Immunization against basic infectious diseases
 Prevention and control of locally endemic diseases
 Appropriate treatment of common diseases and injuries
 Essential drugs.

 (World Health Organization)

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Primary Health Care Principles
 Accessibility
 Public Participation
 Intersectoral collaboration
 Appropriate Technology
 Health Promotion and Illness Prevention

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Social Justice (Equitable access for all)
 Deliberate consideration of the needs and
agendas of all people.
 Must supersede individual goals so that the
least advantaged people in a community
receive equal care and service to those
who are advantaged by virtue of finances
and knowledge.
 (McMurray, pg 34)

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 Accessibility
 Health for all people means equal access
to opportunity for all people whether they
differ by geography, race, age, gender,
income, employment status, language,
functional capacity, to name a few.
(McMurray, pg.33)

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Barriers to Accessibility
 Poverty/Socioeconomic Status:
Wealthy usually have better access to food
and a better lifestyle.
Need to provide services that are
responsive to the poor and help them cope
and avoid the worst effects of poverty.

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Barriers
 Cultural Minorities
Cultural bias can pose a barrier to
accessibility and have an impact on a
community’s health status and program
development.

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Barriers
 Geography/ Rural
communities: People who
live in rural areas have
fewer resources than
those in urban
environments.
Problems revolve around
limited resources
inaccessible and
inappropriate services.

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Barriers
 Stigma: Population groups with certain
health problems, AIDS, addictions,
hemophiliacs, homeless people…
 In Canada people with HIV/AIDS have
described insensitivity, prejudice, and
avoidance from nurses and physicians,
other HP and friends (Health Canada)

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Barriers
 Lack of education or information. Should
the informed person who demands certain
services from the health care system have
an advantage over someone who is not
aware of what is available? Internet. (p.35,
McMurray).

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Nurses Role: Accessibility
 Act as an entry point for access.
 Identify and facilitate use of health
resources.
 Provide health information.
 Care should be appropriate in content and
amount to satisfy the essential needs of
the people, and it has to be provided by
methods acceptable to them.

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Questions to ask yourself
 How does the client get here? How much does parking cost
and does the client have sufficient money?
 Are services and programs available in the needed
languages?
 Are the hours user friendly?
 Is any print materials in literacy appropriate language?
 How much do the drugs cost and can lower priced options be
suggested?
 Is the site wheel chair accessible?

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Public Participation
 All person’s are encouraged to participate
individually and collectively in the planning and
implementation of their health care.

 Shift from professionally driven to people driven.

Example: Community health boards.
 (McMurray, pg 42; CNA, 2005)

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Public Participation
Empowerment
 Based on the premise that if people are prepared for events or
circumstances with both information and community support
systems, they can become empowered and chart their own course
of action.
 Empowered community members enjoy broad participation in
health policies, choosing priorities for health services and initiatives
and in developing appropriate conditions for living and working.
 Empowerment helps build community capacity.

(McMurray, pg 16-17)

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Examples of Barriers to Public
Participation
 Client’s isolation and vulnerability when
confronting bureaucratic organizations.
 Tokenism of health boards.

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Nursing role: Public Participation
 Promote the client as the
center of care
 Using community
development approaches.
(Community development is
the process of empowering
communities to improve their
health and wellbeing).
 Example Lillian Wald
(Besner, 2004, pg. 353).

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Questions to ask yourself
 How has the community been involved in
determining whether this program is
needed/performing as it should?
 Is this program reflective of a need or problem
identified by the client or community, or is this a
professionally defined need?
 Is the community working in partnership, or are
they just implementing what professionals tell
them to?

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Intersectoral & Interdisciplinary
Collaboration
 Collaboration between all disciplines within the
community. (health, education, housing,
transportation and government). (McMurray p.41)
 The basic determinants of health cross many
disciplines.
 Do we need work in this area?
 Are human resource issues affecting the
implementation of primary health care?

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Nurses Role: Intersectoral
Collaboration
 Collaborating with other sectors
 Coordinating health services/referrals..

 Ask the questions: What other professional

colleagues should be involved in supporting this
person? What community information, services
and referrals does this person need? What
services are available in this community and how
does the client access them?

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Appropriate Skills and Technology
 A very broad definition
that encompasses
appropriate use of all
health care resources
such as funds,
personnel, facilities
and equipment.
(CNA, 2005)

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Technology
 Technology needs to be appropriate to the
community’s social, economic and cultural
development. Must be affordable by the
community.
 Also means that individuals will receive
appropriate care from the appropriate HCP
within a time frame that is appropriate.
 (CNA, 2005)

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Technology
 Recognizes the importance of developing
and testing innovative models of health
care and disseminating the results of
research related to health care.

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Technology
 Should be subordinate to the goal of
improving people’s health.
 A question: We have the technology to
keep very small birth weight babies alive,
yet should we do so at the expense of
others?
 Do we need a MRI in every hospital?

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Nurses role: Appropriate Technology
 Demonstrating cost effective, evidence
based (informed) care.
 Being part of developing, implementing and
evaluating technology.

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Questions
 Is this the most cost effective way of
dealing with this issue?
 Does the client know how to use the
equipment safely?
 Is the most appropriate professional
working with the person?
 Are professionals being used in the most
cost effective ways?

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Health Promotion & Illness
Prevention
 Move away from the medical model to one
of prevention and health promotion.
 Process of enabling people to increase
control over and to improve their own
health (WHO, 1986).
 Range from local initiatives to interacting
with the global community.

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Barriers
 Canadians value
expensive technology
and quick fix cures….

(CNA, 2002)

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Nurses role
 Initiate health education and other
activities that assist, promote, support
clients as they strive to achieve the
highest possible level of health.

 (CNA, 2002)

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Questions to ask yourself
 What community resources are available to
clients you deal with?
 How are clients involved in the preparation and
implementation of your health
education/promotion programs?
 Do the health education and health promotion
programs include a focus on the determinants of
health?
 Is there a focus on enabling people to increase
control over and improve their health?

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Ottawa Charter
 Throughout the past two decades health
promotion advocates have used the Ottawa
Charter for Health Promotion as a framework to
encapsulate the goals of Primary Health Care…..
(Build healthy public policy, create supportive
environments, strengthen community action,
develop personal skills, and reorient health
services)

(McMurray, pg. 26).

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Primary health care vrs. Primary
care
 Primary Care:
 Primary management of a person’s
condition. First level of contact an individual
has with an organized health system.

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PC vrs PHC
 Primary care  PHC
 individual focused  community focused
 emphasis on cure  emphasis on
 care provided by promotion and
health professionals prevention
 professional  care provided by a
dominance wide variety of people
 self reliance

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PHC and Nursing
 If the millions of nurses in a thousand
different places articulate the same ideas
and convictions about primary health care,
and come together as one force, then they
could become a powerhouse for change.
(Mahler, 1985)

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PHC and Nursing
 Nursing in a PHC system involves the
person, family and community. It starts
where the person is at and acknowledges
the many factors that affect that person's
health and illness.

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If we want to be sure that we have a health
system based on PHC principles, nurses need
to be sitting at the decision making tables.
What can you do to ensure that the changes
taking place will reflect a PHC model?

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Additional References
 Besner, J. (2004). Nurses role in advancing primary health care: a call to
action. Primary Health Care Research and Development, 5, 351-358.
 Canadian Nurses Association (2005). Primary health care: A
summary of the issues. Retrieved on October 1, 2007 from http://
www.cnanurses.ca/CNA/documents/pdf/public
ations/BG7_Primary_Health_Care_e.pdf
 Canadian Nurses Association (2003). Primary health care: The
time has come. Nursing Now, 16, 1-4.
 Canadian Nurses Association (2002). A New Approach to
Primary Health Care. Retrieved on October 2, 2007 from
http://www.cnanurses.ca/CNA/documents/pdf/publications/PH
C_presentation_Kirby_6602_e.pdf

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Case studies

 Can you identify the components of primary

health care in this case study?
 RAKKU

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Summary
 Primary health care and primary care.
 Historical significance of the Declaration of Alma
Ata (1978) and the Lalonde Report (1974)
 Five principles and eight essentials of primary
health care.
 Barriers to achieving primary health care.
 Contribution of nurses toward primary health
care.

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