NCM 104

Module 1
Lesson 4
LEARNING OUTCOMES

At the end of the lesson you are expected

to:
1. Assume responsibility for lifelong
learning, own personal development and
maintenance of competence
2. Engage in advocacy activities to
influence health and social care service
policies and access to services
3. Model professional behaviour as a
community health nurse
TOPICS NCM 104 MOD. 1
LESSON 4
C. Primary Health Care (PHC)
1. Brief History
2. Legal Basis
3. Definition
4. Goals
5. Elements
6. Principles and Strategies
D. Levels of Prevention
E. Universal Health Care ( UHC)
HISTORY OF PRIMARY
HEALTH CARE

● Primary health care was defined in

the Declaration of Alma-Ata at the
International Conference on
Primary Health Care, Alma-Ata,
USSR, in 1978. Delegates to the
conference expressed "the need
for urgent action by all
governments, all health and
development workers, and the
world community to protect and
promote the health of all the
people of the world
HISTORY OF PRIMARY
HEALTH CARE
● Primary Health Care (PHC) is usually
associated with the declaration of the 1978
International Conference in Alma Ata,
Kazakhstan (known as the “Alma Ata
Declaration”)
● Alma-Ata put health equity on the
international political agenda for the first
time, and PHC became a core concept of the
World Health Organization’s (WHO) goal
of Health for all.
HISTORY OF PRIMARY
HEALTH CARE
● This PHC concept was proposed in a
paper submitted to the Executive Board
of WHO in January 1975 in the form of
seven principles to be followed by
governments wishing to improve their
health services
 PRIMARY HEALTH CARE
HTTPS://EN.WIKIPEDIA.ORG/WIKI/PRIMARY_HEALTH_CARE

● Primary Health Care, or PHC refers to

"essential health care" that is based on
scientifically sound and socially
acceptable methods and technology.
● This makes universal health care
accessible to all individuals and
families in a community.
● It is 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-reliance and
self-determination.
● PHC is an approach to health beyond
the traditional health care system that
focuses on health equity-producing
social policy.[
● PHC includes all areas that play a role
in health, such as access to health
services, environment and lifestyle.[
PRIMARY HEALTH CARE

● Primary health care is the first point

of contact for individuals who are
unwell and to promote healthy
lifestyles in order to prevent illness
from occurring.
● Principles of primary health care are
a set of beliefs and values that
revolve around equity and fairness
for all, eliminating discrimination, so
that all people have access to
primary health care whenever they
need it.
● Under the principles, primary care
should be organized and distributed
to minimize costs, so that health care
is affordable and accessible.
PRIMARY HEALTH CARE

● is an essential health care based on

practical, scientifically sound and socially
acceptable methods and technology
made universally, accessible to
individuals and families in the community.
● it is made acceptable to community,
through their full participation and at a
cost that community and country can
afford to maintain at every stage of their
development in the spirit of self-reliance
and self-determination.
● It forms an integral part of both the
country’s health system, of which it is the
central function and the main focus and
of the overall social and economic
development of the community.
PRIMARY HEALTH CARE
●PHC means Involvement of communities
in planning of care; its delivery and
evaluation of such care.
●It needs an active role for other sectors in
health activities.
Health care workers responsibilities:
maintain, restock and secure medical
a.

supplies on a regular basis.

Does case findings with the observance
b.

of community-based principles,
record keeping;
c.

community monitoring of immunizations,

d.

prenatal care, disease prevention, health

promotion, and
Apply basic measures to ensure
e.

community sanitation
PRIMARY HEALTH CARE
● Thus, primary healthcare and public
health measures, taken together, may
be considered as the cornerstones of
universal health systems.
● The World Health Organization, or
WHO, elaborates on the goals of PHC
as defined by three major categories:
A, "empowering people and
communities,
B. multisectoral policy and action; and
C. primary care and essential public
health functions as the core of
integrated health services

❖ Based on these definitions, PHC can

not only help an individual after being
diagnosed with a disease or disorder,
but actively prevent such issues by
understanding the individual as a
whole.
 GOALS AND PRINCIPLES
ultimate goal
●the attainment of better health services for
all.
❖It is for this reason that the World Health
Organization (WHO), has identified five key
elements to achieving this goal:
1. universal coverage reforms or
reducing exclusion and social disparities
(inequalities) in health ;
2. service delivery reforms or
organizing health services around people's
needs and expectations ;
3. public policy reforms or
integrating health into all sectors ;
4. leadership reforms pursuing
collaborative models of policy dialogue (; and
5. increasing stakeholder participation.
PRINCIPLES AND STRATEGIES OF
PHC
PHCHTTP://WWW.UOBABYLON.EDU.IQ/UOBCOLEGES/LECTURE.ASPX?FID=1
5&DEPID=1&LCID=41359#:~:TEXT=MUST%20HAVE%20KNOWLEDGE%20OF
%20COMMUNITY,MEASURES%20TO%20ENSURE%20COMMUNITY%20SANITA

TION
●
.
1. Universal coverage of the population,
with care provided according to need:
No one should be left out, no matter how
poor or how remote. It means the all in
health for all.

2. Services should be promotive,

preventive, curative, and rehabilitative:
Services should not be only curative, but
also should be promotive to the
population s understanding of health and
healthy style of life, and reach toward the
root causes of diseases with preventive
emphasis. Treatment of illness and
rehabilitation are important as well.
PRINCIPLES AND STRATEGIES OF
PHC

● 3. Services should be effective,

culturally accepted, affordable and
manageable:
Services must be effective, cultural
acceptability and effectiveness are
mutually dependent. Services
must be affordable in local terms
as governmental resources are
limited.
● 4. Community should be involved
to promote self- reliance:
The community should be actively
involved in the process of defining
health problems and needs,
developing and implementing and
evaluating programs.
PRINCIPLES AND STRATEGIES
OF PHC

●5. Approaches to health should be

related to other sectors of
development:
Actions should be taken to deal with
cause of ill health. Education for
literacy, clean water and sanitation,
improved housing, ecological
sustainability, building of roads or
waterways, income supplement,
enhancing roles for women, more
effective marketing of products. All
theses have a substantial impact on
health.
6. 5. Essential Health Services in
Primary Health Care (ELEMENTS)
5. 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
S - Safe water and sanitation
LEVELS OF
PREVENTION
● Prevention includes a wide range of
activities — known as “interventions”
— aimed at reducing risks or threats
to health. You may have heard
researchers and health experts talk
about three categories of prevention:
primary, secondary and tertiary.
What do they mean by these terms?
CATEGORIES OF
PREVENTION
Primary prevention
Primary prevention aims to prevent disease
or injury before it ever occurs. This is done
by preventing exposures to hazards that
cause disease or injury, altering unhealthy
or unsafe behaviors that can lead to disease
or injury, and increasing resistance to
disease or injury should exposure occur.
Examples include:
•legislation and enforcement to ban or
control the use of hazardous products (e.g.
asbestos) or to mandate safe and healthy
practices (e.g. use of seatbelts and bike
helmets)
•education about healthy and safe habits (e.g.
eating well, exercising regularly, not
smoking)
•immunization against infectious diseases.
 CATEGORIES OF
PREVENTION
Secondary prevention
Secondary prevention aims to reduce the impact
of a disease or injury that has already occurred.
This is done by:
a.detecting and treating disease or injury as soon
as possible to halt or slow its progress,
b.encouraging personal strategies to prevent
re-injury or recurrence, and
c.implementing programs to return people to
their original health and function to prevent
long-term problems.
Examples include:
•regular exams and screening tests to detect
disease in its earliest stages (e.g. mammograms
to detect breast cancer)
•daily, low-dose aspirins and/or diet and exercise
programs to prevent further heart attacks or
strokes
•suitably modified work so injured or ill workers
can return safely to their jobs.
CATEGORIES OF
PREVENTION
Tertiary prevention
Tertiary prevention aims to soften the
impact of an ongoing illness or injury that
has lasting effects. This is done by helping
people manage long-term, often-complex
health problems and injuries (e.g. chronic
diseases, permanent impairments) in order
to improve as much as possible their ability
to function, their quality of life and their life
expectancy.
Examples include:
•cardiac or stroke rehabilitation programs,
chronic disease management programs (e.g.
for diabetes, arthritis, depression, etc.)
•support groups that allow members to share
strategies for living well
•vocational rehabilitation programs to
retrain workers for new jobs when they have
recovered as much as possible.
 SCOPE OF PHC –

SCOPEHTTPS://WWW.IWH.ON.CA/WHAT-RESEARCHERS-MEAN-BY/PRIMARY-SECONDA
RY-AND-TERTIARY-PREVENTION

●it is referred to the provision of

ambulatory or first-level of personal
health care services.
● In other contexts, primary health
care has been understood as a set of
priority health interventions for
low-income populations (also called
selective primary health care).
●Others have understood primary
health care as an essential
component of human development,
focusing on the economic, social and
political aspects
●
 PRIMARY HEALTH CARE
DEFINITION ACCORDING TO WHO

●meeting people’s health needs through

comprehensive promotive, protective, preventive,
curative, rehabilitative, and palliative care
throughout the life course, strategically prioritizing
key health care services aimed at individuals and
families through primary care and the population
through public health functions as the central
elements of integrated health services;
●systematically addressing the broader determinants
of health (including social, economic,
environmental, as well as people’s characteristics
and behaviours) through evidence-informed public
policies and actions across all sectors; and
●empowering individuals, families, and communities
to optimize their health, as advocates for policies
that promote and protect health and well-being, as
co-developers of health and social services, and as
self-carers and care-givers to others.
 PHC – MISSION

Renewing primary health care and

●

placing it at the centre of efforts to

improve health and wellbeing are
critical for three reasons:
WHO recognizes the central role of
●

primary health care for achieving

health and well-being for all, at all
ages.
WHO works with countries to:
●
 WHO WORKS WITH COUNTRIES TO:

Identify priority areas for improving

●

health and context-specific approaches

which draw on the technical expertise
across the WHO.
Support countries to develop inclusive
●

policies, in country leadership and health

systems based on primary health care
which promote health equity and works
towards achieving the Sustainable
Development Goals and universal health
coverage.
Address the wider inequity and social
●

determinants of health through

multi-sectoral action.
PHC - IMPORTANCE

● Stronger primary health care is

essential to achieving the
health-related Sustainable
Development Goals (SDGs) and
universal health coverage. It will
contribute to the attainment of
other goals beyond the health goal
(SDG3), including those on poverty,
hunger, education, gender equality,
clean water and sanitation, work
and economic growth, reducing
inequality and climate action.