Primary Health care

(PHC)
By Qaro Q. (BSc/PH, MPH/HSM, Ass. Prof.)
 What is Primary Health Care (PHC)?

• Primary Health Care (PHC) is the health care that is

available to all the people at the first level of health
care.
• According to WHO, ‘Primary Health Care is a basic
health care and is a whole of society approach to
healthy well-being, focused on needs and priorities
of individuals, families and communities.’
• Primary Health Care (PHC) is a new approach to
health care which integrates at the community
level all the factors required for improving the
health status of the population.
• Primary health care is both a philosophy of
health care and an approach to providing
health services.

• It is developed with the concept that the

people of the country receive at least the
basic minimum health services that are
essential for their good health and care.
• Primary health care was defined by the WHO’s
Declaration of Alma-Ata (1978) as follows:

– An essential health care based on

– Practical,
– scientifically sound &
– socially acceptable methods & technologies made
universally accessible to individuals and
families in the community through their full
participation and at a cost that the community
and country can afford to maintain at every
stage of their development in the spirit of self
reliance and self determination.
• It is the first level of contact of individuals, the family
and, the community with the national health system,
bringing healthcare as close as possible to where
people live and work, and constitutes the first
element of a continuing health care process.
 History of Primary Health Care:
• In 1950’s there were vertical health service
strategies, which were expensive & unsuccessful.

• 1960’s basic health service with the attention of

rural health service.

• 1970’s integration of specialized disease

programs.
• Before 1978, globally, existing health services were
failing to provide quality health care to the people.
• Different alternatives and ideas failed to establish a
well-functioning health care system.
• As a result;
– Millions of people in the world had unacceptable level of
health despite fundamental right
– Health status of disadvantaged remain low
– Limited health institutions failed to satisfy demand
– Isolated health sector
– Lack of community participation in the care they receive
• These has led WHO & its partners to re-
examine the existing health policies.
• Considering these issues, a joint WHO-UNICEF
international conference was held in 1978 in
Alma Ata (USSR), commonly known as Alma-
Ata conference.
• The conference included participation from
governments of 134 countries and other
different agencies.
• The conference has jointly called for a
revolutionary approach to the health care.
• The conference declared ‘The existing gross inequality in
the health status of people particularly between developed
and developing countries as well as within countries is
politically, socially and economically unacceptable’.
• The points stressed at the conference were:
– Health is basic human right
– Governments are responsible to assure this right
– It is Right & duty of people to participate in their own health care.
– The need for scientifically, socially & economical sound
technologies.
• Thus, the Alma-Ata conference called for acceptance of
WHO goal of ‘Health for All’ by 2000.
• Finally a strategy to attain the “health for all” declaration
was designed & adopted and that strategy was PHC.
• In this way, the concept of Primary Health Care came into
existence globally in 1978 from the Alma-Ata Conference.
 Objectives of Primary Health Care

• To increase the programs and services that affect the

healthy growth and development of children and youth.
• To boost participation of the community with government
and community sectors to improve the health of their
community.
• To develop community satisfaction with the primary health
care system.
• To support and advocate for healthy public policy within all
sectors and levels of government.
• To support and encourage the implementation of provincial
public health policies and direction.
• To provide reasonable and timely access to
primary health care services.
• To apply the standards of accountability in
professional practice.
• To establish, within available resources, primary
health care teams and networks.
• To support the provision of comprehensive,
integrated, and evidence-based primary health
care services.
 Principles/strategies/Approaches of PHC

• These are the pillars of PHC on which the

strategy was built;
– Inter-sectoral collaboration
– Community participation
– Appropriate technology
– Equity
– Focus on prevention & promotion
– Decentralization
 Community Participation
• Community participation is a process in which community
people are engaged and participated in making decisions about
their own health.
• It is a social approach to point out the health care needs of the
community people.
• Community participation involves participation of the
community people from identifying the health needs of the
community, planning, organizing, decision making and
implementation of health programs.
• It also ensures effective and strategic planning and evaluation
of health care services.
• In lack of community participation, the health programs cannot
run smoothly and universal achievement by primary health
care cannot be achieved.
 Inter-sectoral Coordination
• Inter-sectoral coordination plays a vital role in performing
different functions in attaining health services.
• The involvement of specialized agency, private sectors, and
public sectors is important to achieve improved health facilities.
• Inter-sectoral coordination will ensure different sectors to
collaborate and function interdependently to meet the health
care needs of the people.
• It also refers to delivering health care services in an integrated
way.
• Therefore, the departments like agriculture, animal husbandry,
food, industry, education, housing, public works,
communication, and other sectors need to be involved in
achieving health for all.
 Appropriate Technology
• Appropriate healthcare technologies are an important
strategy for improving the availability and accessibility of
healthcare services.
• It has been defined as ‘’technology that is scientifically
sound, adaptable to local needs and acceptable to those
who apply it and to whom it is applied and that can be
maintained by people themselves in keeping with the
principle of self-reliance with the resources the community
and country can afford.’’
• Appropriate technology refers to using cheaper, scientifically
valid and acceptable equipment and techniques.
• When introducing any new technology, the authorities must
be assured that it will not contravene the beliefs and
practices of the local culture.
• It is also necessary to ensure that the
technology is:
– Scientifically reliable and valid
– Adapted to local needs
– Acceptable to the community people
– Accessible and affordable by the local resources
 Equity

• Confused with equality

– Related to social justice

• A variety of possible definitions
– Equal health
– Equal access to health care
– Equal utilization of health care
– Equal access to health care according to need
– Equal utilization of health care according to need
– In short, “equality for equals and inequality for
unequals”.
• If all cannot be served, give priority to most in
need and disadvantaged groups.
 Decentralization

• Decentralization

– Sharing & transferring power & decision making

away from center to periphery.
– Bring decision closer to the community
 Focus on prevention
• Since many health problems are
communicable & preventable
– Prevention is easier & better than cure.
 Elements/Components of PHC
• There are 8 elements of Primary Health Care.
• These 8 elements are also known as ‘essential health care’. They are:
 Why is Primary Health Care Important?

• Primary Health Care focuses more on quality health

service and cost-effectiveness.
• Primary Health Care focuses on “Health for all”.
• Primary Health Care integrates preventive,
promotive, curative, rehabilitative and palliative
health care services.
• Primary Health Care encourages new connection
and community participation.
• It includes services that are readily accessible and
available to the community.
• Primary Health Care can be easily accessible by all
as it includes services that are simple and efficient
with respect to cost, techniques and organization.
• Primary Health Care promotes equity and equality.
• Primary Health Care improves safety, performance,
and accountability.
• Primary Health Care advocates on health
promotion and focuses on prevention, screening
and early intervention of health disparities.
• Primary Health Care is also perceived as an integral
part of country’s socio-economic development.
• It addresses the expansive determining factor of health and
ensures whole person care for health demands during the
course of the natural life.
 Challenges for Implementation of PHC

• Poor staffing and shortage of health personnel

• Inadequate technology and equipment
• Poor condition of infrastructure/infrastructure gap, especially in the
rural areas
• Concentrated focus on curative health services rather than preventive
and promotive health care services.
• Challenging geographic distribution
• Poor quality of health care services
• Lack of financial support in health care programs
• Lack of community participation
• Poor distribution of health workers/health workers concentrated on the
urban areas.
• Lack of intersectoral collaboration
Mitigation Measures for Ensuring Effective PHC

• Encouraging community participation through

rapport building, effective communication and
sharing objectives and benefits of PHC.
• Developing quality assurance mechanisms through
the development of various indicators and
standards.
• Development of clinical guidelines including the
implementation of essential drugs list.
• Allocating resources as per the need of the central,
provincial/state and local level.
• Develop a planning process to define objectives
and set targets by giving priority on those families
and communities most at risk.
• Promoting problem-orientated research in health
management system.
• Creating pathways to give health higher priority on
the agenda of district development and
collaboration of health departments to perform its
role in health activities.
• Develop guidelines and framework that specify the
roles and responsibilities of the provincial states.
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