Update on PHC (24 August 2019)
Analysis of the advancement of Primary Health Care to date:
From primary health care to universal health coverage – one step forward two steps back, a comment in the Lancet by David Sanders et al illuminates the advancement of PHC since 1978. Authors emphasise that the PHC should be an umbrella under which UHC should reside. More than forty years on, we have failed to implement the principles of PHC declaration in Alma Ata to achieve universal health coverage.
Read ... PHC to UHC
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Primary Health Care
Primary healthcare (PHC) refers to "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. 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".
This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all. The Alma-Ata Conference mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. There were many factors that inspired PHC; a prominent example is the Barefoot doctors of China.
The ultimate goal of primary healthcare is the attainment of better health services for all. It is for this reason that World Health Organization (WHO), has identified five key elements to achieving this goal:
https://en.wikipedia.org/wiki/Primary_healthcare (accessed on 28 April 2018)
It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health and an important part of a country’s development should be the strengthening of primary health-care services. In many countries strengthening of primary health care has resulted in an increase of vaccination rates and safe motherhood care, resulting in a lowering of avoidable infant and maternal mortality, for example in Egypt and Sri Lanka.
Description of PHC and how it is important that governments take this approach at country level and implement it responsibly is clear. However, for PHC workers at grass-root levels, health service delivery can be summarized under “Eight Components of PHC”. Delivery of these eight components of PHC in all Primary Health Centers under the District Health Service management can make a significant difference to the health of the communities served.
Eight Components of Primary Health Care (graphical illustration at the top):
These attributes to PHC seem obvious and have been promoted ever since the inception of the PHC in 1979. When one looks at the implantation of these components comprehensively at primary health care level, there is disappointment. First of all these components are again separated from one another and vertical programmes are encouraged, even forced. Take for example of immunisation programmes – single minded teams from outside go to rural areas to cover all children and celebrate 85% or greater coverage. A different group of people go again to provide antenatal or under-5 care. These vertical programmes barely have any resemblance with comprehensive PHC and its components.
The only way to achieve health for all in a primary health centre catchment area is to empower the health centre team to provide all aspects of primary health care. District and regional support is required to strengthen this team in enabling them to provide better care to all living in the community.
It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health and an important part of a country’s development should be the strengthening of primary health-care services. In many countries strengthening of primary health care has resulted in an increase of vaccination rates and safe motherhood care, resulting in a lowering of avoidable infant and maternal mortality, for example in Egypt and Sri Lanka.
Maternal and child health (MCH) is at the forefront. Comprehensive delivery of MCH relies heavily on all the remaining seven components. (continued on Maternal & Child Health page)
Analysis of the advancement of Primary Health Care to date:
From primary health care to universal health coverage – one step forward two steps back, a comment in the Lancet by David Sanders et al illuminates the advancement of PHC since 1978. Authors emphasise that the PHC should be an umbrella under which UHC should reside. More than forty years on, we have failed to implement the principles of PHC declaration in Alma Ata to achieve universal health coverage.
Read ... PHC to UHC
______________
Primary Health Care
Primary healthcare (PHC) refers to "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. 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".
This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata, Kazakhstan in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all. The Alma-Ata Conference mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. There were many factors that inspired PHC; a prominent example is the Barefoot doctors of China.
The ultimate goal of primary healthcare is the attainment of better health services for all. It is for this reason that World Health Organization (WHO), has identified five key elements to achieving this goal:
- Reducing exclusion and social disparities in health (universal coverage reforms);
- Organizing health services around people's needs and expectations (service delivery reforms);
- Integrating health into all sectors (public policy reforms);
- Pursuing collaborative models of policy dialogue (leadership reforms); and
- Increasing stakeholder participation.
- Equitable distribution of health care – according to this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class.
- Community participation – in order to make the fullest use of local, national and other available resources. Community participation was considered sustainable due to its grass roots nature and emphasis on self-sufficiency, as opposed to targeted (or vertical) approaches dependent on international development assistance.
- Health workforce development – comprehensive healthcare relies on adequate number and distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at the local and referral levels.
- Use of appropriate technology – medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community. Examples of appropriate technology include refrigerators for vaccine cold storage. Less appropriate could include, in many settings, body scanners or heart-lung machines, which benefit only a small minority concentrated in urban areas. They are generally not accessible to the poor, but draw a large share of resources.
- Multi-sectional approach – recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local governments, voluntary organizations, etc.).
https://en.wikipedia.org/wiki/Primary_healthcare (accessed on 28 April 2018)
It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health and an important part of a country’s development should be the strengthening of primary health-care services. In many countries strengthening of primary health care has resulted in an increase of vaccination rates and safe motherhood care, resulting in a lowering of avoidable infant and maternal mortality, for example in Egypt and Sri Lanka.
Description of PHC and how it is important that governments take this approach at country level and implement it responsibly is clear. However, for PHC workers at grass-root levels, health service delivery can be summarized under “Eight Components of PHC”. Delivery of these eight components of PHC in all Primary Health Centers under the District Health Service management can make a significant difference to the health of the communities served.
Eight Components of Primary Health Care (graphical illustration at the top):
- Maternal and child health
- Food supply and proper nutrition
- Immunizations
- Health Education
- Provision of essential drugs
- Communicable disease control
- Treatment of common illnesses
- Safe water and basic sanitation
These attributes to PHC seem obvious and have been promoted ever since the inception of the PHC in 1979. When one looks at the implantation of these components comprehensively at primary health care level, there is disappointment. First of all these components are again separated from one another and vertical programmes are encouraged, even forced. Take for example of immunisation programmes – single minded teams from outside go to rural areas to cover all children and celebrate 85% or greater coverage. A different group of people go again to provide antenatal or under-5 care. These vertical programmes barely have any resemblance with comprehensive PHC and its components.
The only way to achieve health for all in a primary health centre catchment area is to empower the health centre team to provide all aspects of primary health care. District and regional support is required to strengthen this team in enabling them to provide better care to all living in the community.
It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health and an important part of a country’s development should be the strengthening of primary health-care services. In many countries strengthening of primary health care has resulted in an increase of vaccination rates and safe motherhood care, resulting in a lowering of avoidable infant and maternal mortality, for example in Egypt and Sri Lanka.
Maternal and child health (MCH) is at the forefront. Comprehensive delivery of MCH relies heavily on all the remaining seven components. (continued on Maternal & Child Health page)
