Community Health Nursing-I

Unit II: “Primary Health Care (PHC)”

GBSN Year.1 , Semester.2

By Asif Ali Lashari,

RN,DP, PostRn BScN,
Nursing Lecturer
Unit II: Primary Health Care (PHC)
In this unit, students will have an opportunity
to discuss:
 the Declarations of Alma Ata
 and its strategy: Primary Health Care.
 Furthermore, they will discuss the elements

principle and application of PHC in Pakistan.

Unit objectives:
At the completion of this unit, students will be
able to:
 1. Explain Alma Atta Deceleration “Health for
 All by the Year 2000” and beyond.
 2. Define Primary care and PHC.
 3. Describe the five basic principles of PHC.
 4. Explain the elements of PHC in relation to

health.
 5. Discuss application of PHC in Pakistan.
Alma Ata Deceleration
Introduction:
 International Conference on Primary Health

Care, Alma-Ata, 6-12 September 1978. The

Alma-Ata Declaration of 1978 emerged as a
major milestone of the twentieth century in
the field of public health, and it identified
primary health care as the key to the
attainment of the goal of Health for All.
ALMA-ATA DECLARATION
1. (Almaty) formerly known as Alma-Ata is the former
capital city of Kazakhstan.
2. Conference held by WHO in 1978 from 6th
to 12th of September 1978.
3. 134 Government agencies attended the conference.
4. 67 NGO’s attended the conference.
5. Its goal/Target was HEALTH FOR ALL UP
TO 2000 AD.
6. Its goal was provided 8 elements of PHC to
all people of the world up to 2000 AD
(within 22 years).
 Slogan of Alma Ata Deceleration
 (HEALTH FOR ALL)
Achieving health for all.
In 1977, the World Health Assembly decided that
the main social target of governments and of
WHO should be the attainment by all the
people of the world by the year 2000 of a level
of health that would permit them to lead a
socially and economically productive life.
Declaration: (Main points)
I. The Conference strongly reaffirms that
health is a fundamental human right and
that the attainment of the highest possible
level of health is a most important worldwide
social goal.
II. Equality in the health status of the people
particularly between developed and
developing countries.
Conti…
III. Economic and social development:
The promotion and protection of the
health of the people is essential to
sustained economic and social
development and contributes to a better
quality of life and to world peace.
IV. The people have the right and duty to
participate individually and collectively in
the planning and implementation of their
health care.
Conti…
V.
A main social target should be the
attainment by all peoples of the world by
the year 2000: of a level of health that will
permit them to lead a socially and
economically productive life.
Provision of adequate health and social
measures by governments.
Conti…
VI.
Primary health care is essential health care
based on practical, scientifically sound
and socially acceptable methods and
technology made universally accessible
to individuals and families in the
community at a cost that the community
and country can afford.
Conti…
VII.
Primary health care.

VIII.
All governments should formulate national
policies, strategies and plans of action to
launch and sustain primary health care as
part of a comprehensive national health
system and in coordination with other
sectors.
Conti…
IX.
All countries should cooperate in a spirit of
partnership and service to ensure primary
health care for all people since the
attainment of health by people in any one
country directly concerns and benefits
every other country.
Conti…
X.
An acceptable level of health for all the
people of the world by can be attained
through a fuller and better use of the
world's resources, a considerable part of
which is now spent on armaments ‫اسلحہ‬
and military conflicts.
Primary Health Care (PHC)
As defined in Alma-Ata Declaration
States:
 PHC is essential health care based on

practical, scientifically sound and socially

acceptable method and technology made
universally acceptable to individuals and
families in the community through their full
participation and at a cost which the
community and country can afford to
maintain at every stage of their development
in the spirit of self-reliance and self-
determination.
"Essential health care" that is based on
scientifically sound and socially acceptable
methods and technology, which make
universal health care accessible to all
individuals and families in a community.
PRINCIPLES OF PRIMARY HEALTH
CARE
There are five basic principles identified in the
primary health care approach:
1. Equitable distribution.
2. Manpower development.
3. Community participation.
4. Appropriate technology.
5. Multi-sectoral approach.
Five Basic Principles of PHC
 1. EQUITABLE DISTRIBUTION:-
It means that health services must be
shared equally to all people irrespective of
their ability to pay, and all the people – rich
or poor, rural or urban – must have access
to health services,
because the experience and studies have
shown that there is unequal distribution of
health and family welfare services and also
other related services, i.e. education.
2. MANPOWER DEVELOPMENT:-
Primary health care aims at mobilizing the
human potential of the entire community
by making use available resources.
Vigorous action to be taken to ensure
availability of adequate number of
appropriate health personnel required to
divide and implement plan of action.
This would require reorientation of the
existing health workers, development of
new categories of workers in health and
related sectors and motivation and training
of all manpower to serve the community,
doctors, nurses and other paramedical
workers.
3. COMMUNITY PARTICIPATION:-
It is the process by which individuals, families
and communities assume responsibility in
promoting their own health and welfare.
For the success of primary health care,
community involvement and participation will
be most vital.
Community involvement is concerned with the
level of community resident participation in
health decision-making.
To promote the development of the
community and the community’s selfreliance,
residents themselves need to
participate in decisions about the health of
the community.
Residents and health providers need to
work together in partnership to seek
solutions to the complex problems facing
communities today.
4. APPROPRIATE TECHNOLOGY:-
Appropriate technology refers to health care
that is relevant to people’s health needs and
concerns, as well as being acceptable to them.
It includes issues of costs and affordability of
services within the context of existing
resources as the number and type of health
professionals and other workers, equipment,
and their pattern of distribution throughout the
community.
In other words, appropriate technology
means those which are decentralized,
require low capital investment, conserve
natural resources, are managed by their
users, and are in harmony with the
environment.
Thus, appropriate technology is the
technology which is scientifically or
technically sound, adaptable to local needs,
culturally acceptable and financially
feasible.
5. MULTI-SECTORAL APPROACH:-
Health and Family Welfare Programs
cannot stand on its own in an isolated
manner.
It is recognized that the health of a
community cannot be improved by
intervention within just the health sector;
other sectors are equally important in
promoting the community’s health and self-
reliance
These are, agriculture, irrigation, animal
husbandry, education, housing, public
works, communications, rural development,
cooperatives, industries, panchayats,
voluntary organizations.
Therefore, these sectors need to work
together in a multi-sectoral approach to
coordinate their goal, plans and activities to
ensure that they contribute the health of the
community and to avoid conflicting or
duplicating efforts.
 MNEMONIC
1. Education
2. Locally Endemic Diseases
3. Essential Drugs
4. Maternal and Child Health Care
5. EPI (Immunization)
6. Nutrition
7. Treatment
8. Safe Water
Elements / Components of PHC
 ELEMENTS OF PRIMARY HEALTH CARE (PHC):
The Alma-Ata declaration further stated the
essential elements in health services and
included in primary health care. There are
at least eight 8 essential health elements
/ components in the provision of primary
health care.
Elements / Components of PHC
1. Education concerning prevailing health problems
and the methods of preventing and controlling
them.
2. Promotion of food supply and proper nutrition.
3. Maternal and child health care, including family
planning.
4. Adequate safe water supply and basic sanitation.
5. Immunization against major infectious diseases.
6- Prevention and control of local endemic
diseases.
7. Appropriate treatment of common diseases and
injuries.
8. Provision of essential basic household drugs for
the community.
 Conti…
1. Education for the identification and
prevention/control of prevailing ( (‫غا لبہونا‬
health problems:-

Emphasis should be placed on health related

problems such as violence (homicide,suicide, domestic
violence, and sexual
Exploitation, unhealthy lifestyles, growing numbers of
elderly persons with special needs,
substance abuse of all kinds, HIV/AIDS,
tuberculosis, increasing homeless-ness, and
environmental pollution.
It was once thought that many of these
problems were found only in poor
communities among ethnic and racial
minorities, but it is now clear that they are
found at all levels of society and in all
communities, from the very rich to the
very poor.
Of course, the poor and those with limited
resources suffer the most from the
diseases of poverty-malnutrition,
diarrhea, acute respiratory infections, and
the vaccine-preventable diseases.
2. Proper food supplies and nutrition:-
Because of the direct relationship between
nutrition and illness, attention to the ‘’food
security” of communities is essential.
People are hungry because they are trapped
in low-paying jobs, cannot afford adequate
housing or child care, have mental health or
addiction problems that make it difficult for
them to hold jobs or care their families.
In more affluent communities,
malnutrition may result from unhealthy
lifestyles, excessive consumption
patterns of food and alcohol, and eating
disorders such as anorexia and bulimia
.(‫)ب ھوکا‬
“Food security” has become a critical issue
in many parts of the world where civil
disturbances exacerbate existing
problems of drought (‫ ) خشکسا لی‬and
underdevelopment.
3. Adequate supply of safe water and
basic sanitation:-

A safe water supply and clean disposal of

wastes are essential to the health and
well-being of any community, and over
the years, there have been many
improvements in access to safe water
and adequate sanitation.
Water and sanitation problems are
becoming more prominent in the world.
Major environmental health problems
related to industrial development in the
regions fragile ecosystem.
Rapid urbanization, caused by major
movements of people seeking better lives, has
placed new strains on
already inadequate water treatment and
human and toxic waste disposal facilities.
Although the poor suffer most from these
problems, many environmentally caused
diseases respect no borders or social
class and affect the whole community.
Community health nurses in such areas,
aware of the links between industrial
development, trade, the environment and
health, see involvement in these and
similar issues as an integral part of their
practice.
4. Maternal and child care, including family
planning:-

It is estimated that throughout the world 12

million children die each year of disease or
malnutrition before their 5th birthday (UNDP,
1998).
Ironically (unexpected), the majority of these deaths
could be prevented.
It is equally tragic that, according to the IPPF
(1998), an estimated 600,0000 women
worldwide die in pregnancy and child birth
each year.
Another 50 million women suffer ill health and
disability as result of their pregnancies.
The voices of women throughout the world
are becoming louder and louder as they
demand increased respect for their rights
as women (including their reproductive
rights).
Women are also calling attention to the
needs of their entire families for PHC.
No one doubts improved maternal and child
health (MCH) care is essential for
healthier families.
However, it is important to realize that
education, employment opportunities, an
end to gender discrimination and the general
empowerment of women may ultimately
have more impact on women’s and
children’s health status than specific MCH
efforts.
Women continue to demand an end to gender
discrimination and violence against women,
recognition of their human rights and access
to health care across the life span for
themselves and their children. Believing that
health is a fundamental human right.
5. Immunization against the major infectious diseases;
prevention and
control of locally endemic diseases:-

Great strides (‫ ) عظیم پ یشق دمی‬have been made in

immunizing the world’s children against the
six major vaccine-preventable diseases.
Vaccines capable of saving millions more
children’s lives each year-it should be possible to save
many of these children.
Wherever they live in the world, children have
the right to protection from the preventable
suffering and death caused by the major
childhood diseases.
In addressing the main health problems of a
community’s children, a PHC approach
requires the provision of appropriate “
promotive, preventive, curative and
rehabilitative services.”
Referral should be made to “integrated,
functional and mutually-supportive referral
systems, leading to the progressive
improvement of comprehensive care for all.
Giving priority to those most in needed”
(WHO, 1978).
Effective management practices at all levels of
the health care system are also critical for
successful PHC.
6. Appropriate treatment of common
diseases using appropriate technology:-

Community workers of all kinds have found

that simple, affordable technologies, often
produced locally, can be extremely effective
in easing common health problems.
Technologies can be as simple, yet
scientifically sound, as oral dehydration
solutions for diarrhea or orthopedic aids built
of local materials to give mobility and
independence to a community’s disabled
members.
Other health workers and communities
have found the use of herbal medicines
and alternatives healing methods as
effective in the treatment of common
illnesses.
At all levels, the appropriate treatment of
common diseases relies on the
appropriate mix of health workers.
The PHC health team may include not only
physicians, nurses, midwives and auxiliaries,
but also community health workers and
traditional practitioners (herbalists,
curanderos and shamans).
When such nontraditional members are added
to the health team, care should be exercised
in their selection, training and ongoing
supervision.
The goal should be to concentrate on the
expressed needs of the community and to
work with it in achieving its health-related
goals.
7. Promotion of mental health:-

Although not included as an essential

element of PHC in all countries, the
promotion of mental health is extremely
important for the well-being of any
community.
Recent developments in mental health and
the care of the mentally ill have a profound
impact on the overall health of the
community.
Modern life can be extremely stressful and
provoke mental difficulties.
The PHC team should concentrate on those
mental health problems that are of highest
priority in and for the community.
The involvement and mobilization of the
community are necessary to lessen the
burden of mental illness.
8. Provision of essential drugs:-

The WHO has long been convinced that

adequate provision of essential drugs at a cost
that the community can afford is critical to the
success of PHC.
Appropriate treatment requires the provision of
essential drugs that are safe and effective; of
high quality; capable of being adequately
supplied, stored, and distributed; and of
course, affordable.
To achieve this goal, the pharmaceutical
industry, health professionals, communities,
schools, universities and governments must
all collaborate and cooperate.
Broader attainment of this, like other goals
of PHC, will require political will and
commitment.
Application of PHC in Pakistan
Pakistan has a relatively large primary health
care infrastructure. This includes
5000 basic health units, 600 rural health
centers, 7500 other first-level care facilities
and over 100,000 lady health workers
providing services across Pakistan.
These primary health care services are
supported by a network of 989 secondary
care hospitals, at tehsil and district levels,
for referrals.
The national programme for family planning
and primary health care, commonly referred
to as the lady health workers programme
was launched in 1994 to increase access to
basic preventive health care services,
particularly in rural areas.
The main objectives of the programme are
to reduce poverty and improve national
health indicators through the provision of
essential primary health care services.
Lady health workers deliver a range of
services related to maternal and child health
including promoting childhood immunization,
growth monitoring, family planning and health
promotion.
They treat minor ailments and
injuries and are trained to identify and refer
more serious cases.
Lady health workers are involved in supporting
the implementation of many public health
programs including those on tuberculosis
treatment, malaria control, immunization, polio
eradication, health education, maternal,
newborn and child health and family planning.
 Community Health Nursing
B. T. Basavanthappa
First Edition 1998

https://www.who.int/teams/social-determinants-of-health/declaration-of-
alma-ata
http://www.emro.who.int/pak/programmes/primary-a-secoundary-health-
care.html