Abioye Adeola precious

Matric:Au22AN4714

The General History of Primary Health Care.

Dr Socrates Litsios.

Author Information and Affiliations

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. 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. These principles stressed the need for shaping
PHC around the life patterns of the population; for their involvement; for maximum reliance on available
community resources while remaining within cost limitations; for an integrated approach of preventive,
curative and promotive services for both the community and the individual; for interventions to be
undertaken at the most peripheral practicable level of the health services by the workers most simply
trained for this activity; for other echelons of services to be designed in support of the needs of the
peripheral level; and for PHC services to be fully integrated with the services of the other sectors
involved in community development.

The PHC concept paper was prepared under the guidance of Kenneth Newell, Director of WHO’s
Strengthening of Health Services Division. The team responsible for writing it was influenced by many
individuals and publications, some of which I am going to trace here. As a member of that team,
personally, the most important influences, aside from the case studies that appeared in the publications
Health by the People and Alternatives Approaches, were the contact with staff of the Christian Medical
Commission (CMC) and its Board—James McGilvray, Nita Barrow, Haken Hellberg, Jack Bryant, and Carl
Taylor; they provided inspiration, encouragement and knowledge which extended ours.1 But there were
also influences which stretch further back into history: PHC-like ideas dated back to at least the early
decades of the twentieth century. Rural health programs in China developed with the assistance of the
Rockefeller Foundation and the League of Nations Health Organization in the 1930s and, along with
conferences organized by the latter, brought ideas together and outlined a direction for the future. The
chapter will explore the actions of some of the personalities involved, their interconnections, ideas and
experiences and the role they played in the formation and passing of this declaration.

Interconnections and personalities

UNICEF’s program in basic services; ILO’s in basic needs; and UNRISD’s in civil society served as models
for broader developmental frameworks well-suited for PHC’s community focus. Similarly, the writings of
Paulo Freire, Ivan Illich, and Ernst Schumacher, each in their own way, contributed to the importance
given to appropriate technology and community participation.2 In my belief the PHC of the 1970s was
rooted in the work of earlier individuals, the most important of which I believe are Jack Bryant, Rex
Fendall, John Grant, Selskar Gunn, Sydney Kark, Maurice King, Milton Roemer, Henry Sigerist, and
Andrija Štampar.3

Bryant’s book Health and the Developing World (1969) outlined the important role that universities
could play in developing learning settings most suitable for supporting community-level work. Roemer,
who wrote the conclusions in the Alternative Approaches study, underlined the importance of a firm
national policy of providing health care for the underprivileged, in order to overcome the inertia or
opposition of the health professional and other well-entrenched vested interests.

King’s collection of essays reinforced these messages as well as others. He stressed the importance of
organizing medical services from the bottom up and not from the top down. Fendall’s numerous papers
were drawn upon for the writing of the chapters on health centers and auxiliaries. Fendall also played a
central role in the Rockefeller Foundation’s study that led to Bryant’s publication. Another contributor,
Kark, outlined an approach to public health which featured the use of community diagnosis for
gathering epidemiological data; among the actions needed he considered that of health education as
the most essential one. Influence was, however, taken from many areas: evidence suggests that the key
South African health leaders, for whom Kark would later work, who were in China in the early 1930s,
learned of various innovative rural health programs and brought those ideas back to South Africa on
their return.

Here's a brief history of Primary Health Care (PHC) in Nigeria:

Primary health care in Nigeria has its roots in the 1970s, but it gained significant momentum in 1985
when Professor Olikoye Ransome-Kuti was appointed the Minister of Health. He adopted the Primary
Health Care approach in 52 local government areas as models based on the Alma Ata Declaration of
1978.¹

However, the concept of primary health care was first introduced in Nigeria from 1975 to 1980, with the
development of the National Basic Health Services Scheme (NBHSS) based on a primary health care
approach.
*Pre-Colonial Era (Before 1914)*

1. *Traditional Health Practices*: Nigerians relied on traditional healers, herbalists, and spiritual leaders
for healthcare.

2. *Community-Based Care*: Communities provided care for the sick, elderly, and vulnerable.

*Colonial Era (1914-1960)*

1. *Introduction of Western Medicine*: British colonial authorities introduced Western medicine,

building hospitals and training medical professionals.

2. *Focus on Curative Care*: Healthcare focus was on curative care, with little emphasis on preventive
care.

*Post-Colonial Era (1960-1970s)*

1. *Expansion of Healthcare Services*: The Nigerian government expanded healthcare services, building
more hospitals and training more healthcare professionals.

2. *Introduction of Preventive Care*: Preventive care, such as vaccinations and public health campaigns,
was introduced.

*Alma-Ata Declaration (1978)*

1. *Primary Health Care (PHC) Concept*: The Alma-Ata Declaration introduced the concept of PHC,
emphasizing community-based, preventive, and curative care.

2. *Nigeria's Adoption of PHC*: Nigeria adopted the PHC approach, aiming to provide universal access to
healthcare.

*National Health Policy (1988)*

1. *Integration of PHC into National Health System*: The National Health Policy integrated PHC into the
national health system, emphasizing community participation and ownership.

2. *Establishment of Primary Health Care Centers*: Primary Health Care Centers were established across
the country, providing basic healthcare services.

*Current Status (2000s-Present)*

1. *Renewed Focus on PHC*: The Nigerian government has renewed its focus on PHC, aiming to
strengthen healthcare systems and improve health outcomes.

2. *Challenges and Opportunities*: Despite progress, Nigeria's PHC system still faces challenges, such as
funding constraints, brain drain, and infrastructure deficits. However, opportunities exist for innovation,
partnership, and community engagement to improve PHC services.

Here are some key laws related to Primary Health Care (PHC) in Nigeria:

1. *National Health Act (2014)*: This act provides a framework for the development and
implementation of health policies and programs in Nigeria, including PHC.

2. *Primary Health Care Development Agency Act (2011)*: This act establishes the National Primary
Health Care Development Agency (NPHCDA) to coordinate PHC services in Nigeria.

3. *National Primary Health Care Development Agency (Establishment) Act, 2011 (Act No. 4)*: This act
provides for the establishment of the NPHCDA and its functions.

4. *Nigerian National Health Insurance Scheme Act (1999)*: This act establishes a national health
insurance scheme to provide financial protection for individuals and families accessing health services,
including PHC.
5. *Constitution of the Federal Republic of Nigeria (1999)*: Section 17(3) states that "the State shall
direct its policy towards ensuring... that there are adequate medical and health facilities for all persons."

These laws provide a legal framework for the development, implementation, and regulation of PHC
services in Nigeria.

References;

Brown TM, Fee E. The Bandoeng Conference of 1937: A Milestone in Health and Development. AJPH.
2008;98(no. 1):42. [PMC free article] [PubMed]

Report of the Intergovernmental Conference of Far-Eastern Countries on Rural Hygiene. Geneva: League
of Nations Health Organization; 1937. p. 23. [PMC free article] [PubMed]

See Litsios S. Selskar ‘Mike’ Gunn and Public Health Reform in Europe. In: Borowy Iris, Hardy Anne,
editors. Of Medicine and Men: Biographies and Ideas in European Social Medicine between World Wars.
Germany: Peter Lang Internationaler Verlag der Wissenschaften; 2008. pp. 23–43.

Brown TM, Fee E. The Bandoeng Conference of 1937: A Milestone in Health and Development. AJPH.
2008;98(no. 1):42. [PMC free article] [PubMed]