Unit 3: Primary Health Care (PHC)

Introduction:
According to the World Health Organization, primary health care is a
whole-of-society approach to health and well-being centered on the
needs and preferences of individuals, families and communities. It
addresses the broader determinants of health and focuses on the
comprehensive and interrelated aspects of physical, mental and social
health and wellbeing.

Why is primary health care important? First, primary health care is well-
positioned to respond to rapid economic, technological, and
demographic changes, all of which impact health and well-being. It has
also proven that Primary health care had been a highly effective and
efficient way to address the main causes and risks of poor health and
well-being today, as well as handling the emerging challenges that
threaten health and well-being tomorrow. Lastly, Stronger primary
health care is essential to achieving the health-related Sustainable
Development Goals (SDGs) and universal health coverage.

Learning Outcomes

At the end of this unit, students will be able to:

1. Define Primary Health Care.

2. Explain the definition of health by the WHO.
3. Outline the historical background of PHC.
4. Relate the application of the PHC key principles in the implementation of Public
health programs.
 Presentation of Contents

All for Health towards Health for All

The Duterte Health Agenda

“ Lahat para sa Kalusugantungo sa Kalusugan para sa Lahat”

Values
• Filipinos able to access services with least financial, cultural and geographical
barriers
o Preference for the underserved
• Filipinos able to demand quality and compassionate services at par with global
clinical and non-clinical standards
• Filipinos able to continuously get the most health from resources allocated
(cost-effective)
• Filipinos able to make informed choices with respect to their health and
participate in holding the government accountable to the people

Vision
• Financial Protection
- Filipinos protected from health-related impoverishment
• Better Health Status
- Filipinos attain best possible health outcomes with less disparity
• Responsiveness
- Filipinos feel respected and valued in all of their interaction with the
health system
Triple Burden of Disease
a. SERVICES THAT ADDRESS THE TRIPLE BURDEN OF DISEASE
o Communicable
o Non-communicable, including malnutrition
o Diseases of rapid urbanization and industrialization (e.g. Injuries, mental
health (including suicide prevention) and alcohol /drug use)

b. SERVICES THAT CORRESPOND TO THE FULL SPECTRUM OF CARE FOR

ALL LIFE STAGES (minimal exclusions)
o Promotive, preventive, curative, rehabilitative, palliative
o Emphasis on role of health promotion and primary care
o (annual health check)

c. INTERVENTIONS THAT MODIFY BUILT ENVIRONMENT AND MOBILIZE

COMMUNITIES
o Trigger behavioral shift towards healthy lifestyle/habits
o Adopt and scale-up community-based interventions
o Create strategic partnerships to promote healthy homes, workplaces,
schools and transport

Primary Health Care

- A strategy that engages both the health workers and the people themselves
as partners, and a strategy that is affordable to the government yet still
effective and acceptable to the communities. A strategy that ensures access
to health care regardless of economic class.

Declaracion Alma Ata 1978

Primary Health Care
1. Reflects and evolves from the economic conditions, socio-cultural and political
characteristics of the country, and its communities, and is based on the application
of the relevant results of social, biomedical and health services research and
public health expenditures

2. Address the main health problems in the community, providing promotive,

preventive, curative and rehabilitative services accordingly

3. Includes at least – education about prevailing health problems and the methods
of preventing and 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 major infectious diseases;
prevention and control of locally endemic diseases; appropriate treatment of
common diseases and injuries; and provision of essential drugs.

4. Involves in addition to the health sector, all related sectors and aspects of
national and community development in particular, agriculture, animal husbandry,
food industry, education housing, public works, communication and other sectors;
and demands the coordinated efforts of all those sectors
5. Requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of primary health
care, making fullest use of local, national and other available resources; and to this
end develops through appropriate education the ability of communities to
participate

6. Should be sustained by integrated, functional and mutually supportive referral

system leading to the progressive improvement of comprehensive health care for
all, and giving priority to those in need

7. Relies at the local and referral levels of health workers, including physicians,
nurses, midwives, auxiliaries and community workers as applicable, as well as
traditional practitioners as needed; who are suitably trained, socially and
technically, to work as a health team and to respond to the expressed health
needs of the community.

The WHO defines PHC as:

“Essential health care made universally accessible to individuals & families in the
community through their full participation & at a cost that community and country
can afford to maintain at every stage of their development in the spirit of self-
reliance & self-determination”

History of PHC:
o May 1977- The 30th World Health Assembly adopted resolution WHA 3043,
which decided that the main social target of the government & WHO should be
the attainment of a level of health that would lead people to a socially &
economically productive life by year 2000.
🡪 “Health for all by year 2000”

o September 6-12, 1978: First International Conference in PHC was held at Alma
Ata, USSR (Russia) on PHC
• 🡪 PHC is the key to attain the “Health for All” goal

o October 19, 1979: LOI 949

• 🡪 Legal Basis of PHC in the Philippines
• 🡪 Issued by Pres. F. Marcos, which mandated the Ministry of Health to
adopt PHC

o September 11, 1981: Launching of PHC by Sec. Azurin in the Philippines.

o 1990: “Health in the hands of the people by year 2020”
o AO No. 11 of 1993: Installed PHC as a course strategy in program thrusts of
the government at national and local community leaders to enable their people
in active participation for better health and self-reliance

The Alma Ata Conference on PHC made the following declarations:

▪ Health is a basic fundamental right.
▪ There exists global burden of health inequalities among populations.
▪ Economic and social development is of basic importance for the full
attainment of health for all.
▪ Governments have a responsibility for the health of their people.
Why adapt PHC?
o Magnitude of health problems
o Inadequate and unequal distribution of health resources
o Increasing cost of medical care

4 Pillars or Cornerstone:
> Active community participation
> Intra & inter-sectoral linkages
> Use of appropriate technology
> Support mechanism made available

Essential Health Services of PHC

Education for Health
Locally Endemic Disease Control
Expanded Program on Immunization
Maternal and Child Health and Family Planning
Envt’l Sanitation and Promotion of Safe Water Supply
Nutrition and Promotion of Adequate Food Supply
Treatment of CD and Common Illness
Supply of Essential Drugs

Who are the PHC workers?

In general, the PHC team may consist of:
> Physician
> Nurses
> Midwives
> Nurse auxiliaries
> Locally trained community health workers
> Traditional birth attendants and healers

Three Levels of PHC Workers

1.Village or Grassroot Health Workers
o first contacts of the community and initial links of health care
o provide simple curative and preventive health care measures and in promoting
healthy environment
o trained community health workers, volunteers or traditional birth attendants or
healers

2. Intermediate Level Health Workers

o represent the first source of professional health care
o provide support to the front-line health workers in terms of supervision,
training, supplies, and services
o General Medical practitioners, PH nurses
3. First Line Hospital Personnel
o provide back up health services for cases that require hospitalization or
diagnostic facilities not available in the health center
o Physicians with specialty, nurses, dentist, pharmacists, other health
professionals who are working in primary hospitals

Level of Health Care Facilities

o Primary Level
o Secondary Level
o Tertiary Level

Primary Level
• The “first” level of contact between the individual and the health system
• Serves as the foundation of health care
• RHUs, their sub-centers, chest clinics, malaria eradication units, and
schistosomiasis control units, puericulture centers, TB clinics and hospitals
• Provide basic curative and preventive health care measures; first aid

Secondary Level
• The 1st referral level
• Consists of a smaller , non-departmentalized hospitals including emergency
and regional hospitals
• Services are offered to patients with symptomatic stage of disease, which
require moderately specialized knowledge and technical resources for
adequate treatment.

Tertiary Level
• has highly technological and sophisticated services offered by medical
centers and large hospitals
• specialized national hospitals
• provide training programs
TRADITIONAL AND ALTERNATIVE HEALTH CARE

RA 8423 or the TRADITIONAL & ALTERNATIVE MEDICINE ACT OF 1997 🡪 this

created the Philippine Institute of Traditional and Alternative Health Care, which is
tasked to promote and advocate the use of traditional and alternative health care
modalities through scientific research and product development.

RA 8423 defined TRADITIONAL MEDICINE as…

“the sum total of knowledge, skills, and practice on health care, not necessarily
explicable in the context of modern, scientific, philosophical framework, but
recognized by the people to help maintain and improve their health towards the
wholeness of their being, the community and the society, and their interrelations
based on culture, history, heritage, and consciousness”

ALTERNATIVE HEALTH CARE

Other forms of nonallopathic, occasionally nonindigenous or imported healing
methods, though not necessarily practiced for centuries nor handed down from
one generation to another.
ALTERNATIVE HEALTHCARE MODALITIES

1. Acupressure
- a method of healing and health promotion that uses the application of
pressure on acupuncture points without puncturing the skin.
2. Acupuncture
- a method of healing using special needles to puncture and stimulate
specific anatomical points on the body
3. Aromatherapy
- the art & science of the sense of smell whereby essential aromatic oils are
combined and then applied to the body in some form of treatment
4. Chiropractic
- a discipline of the healing arts concerned with the pathogenesis,
diagnosis, therapy, and prophylaxis of functional disturbances,
pathomechanical states, pain syndromes, and neurophysiological effects
related to the static and dynamics of locomotor system, especially of the
 spine and pelvis
5. Herbal medicine / phytomedicine
6. Massage
- a method wherein the superficial soft parts of the body are rubbed,
stroked, kneaded, or tapped for remedial, aesthetic, hygienic, or limited
therapeutic purposes
7. Nutritional therapy
- the use of food as medicine and to improve health by enhancing the
nutritional value of food components that reduces the risk of a disease.
- “nutritional healing”
8. Pranic healing
- a holistic approach that follows the principle of balancing energy
9. Reflexology
- it is based on the principle that internal glands and organs can be
influenced by properly applying pressure to the corresponding reflex points
on the body

Reflection

Now that you have reached this far, it is time to reflect and make a move by
answering the following questions?

1. Which strategies of this studying do you find effective? Which are not?

2. How can you improve your style?

3. How did you gain learning?

References:

Araceli S. Maglaya.(2009). Nursing Practice in the Community,

Cuevas, Frances Prescilla L.(2007). Public Health Nursing in the Philippines 10th
edition, c.

Louise Simmers. (2005). Introduction to Public Health.

Primary Health Care. World Health Organization. 2019. Retrieved from:

https://www.who.int/news-room/fact-sheets/detail/primary-health-care