1 of 31

Introduction, Alma Ata Declaration, Concepts and principles and Components of PHC

Sunday Asuke

Community Medicine and Primary Health Care

Bingham University

​

2 of 31

Outline

  • Major elements in the 70s
  • BHSS in Nigeria
  • Alma Ata in Russia
  • Principles of PHC
  • Components of PHC
  • Challenges of PHC

​

​

2

2/6/2019

3 of 31

Preamble

  • “Primary Care”- 1920 in England.Lord Dawson reported on “First Contact Medical Care and the Promotion of Primary Health Centre”.
  • In 1962, the term was used in Britain to denote General Practice
  • Prior to Alma Ata, nations had one system or the other of health care delivery
  • Nigeria had BHSS in the 70’s

​

​

3

2/6/2019

4 of 31

Major events worldwide in the 70s

  • Declaration of Health for All (HFA) by the WHO Health Assembly in 1977

​

  • Adoption in Alma-Ata in 1978 of the PHC approach as the strategy by which the ultimate objective of HFA would be attained

4

2/6/2019

5 of 31

BHSS in Nigeria

  • Objectives:
  • Increase access to appropriate health services by the end of 1975-1980
  • Prevention and health promotion services to be integrated with curative services
  • Basic Health Units to achieve integration
  • Develop new cadre of primary health care workers to man the health facilities to be constructed

5

2/6/2019

6 of 31

BHSS in Nigeria - 2

  • Implementation:
  • 1 BHU with Four categories of HF
  • 1 comprehensive HF at apex – 50,000 pop.
  • 4 PHC centers – 10,000 pop. each
  • 20 health clinics – 2,000 pop. each
  • 5 mobile clinics – 40,000 pop. each
  • States refused to comply because it meant constructing 25 HF in 1LGA
  • After about N200 million at the end of 1983, most of the facilities remained uncompleted all over the country

6

2/6/2019

7 of 31

Reasons for failure of BHSS - 3

  • Reliance on unsustainable structures and equipment
  • Little community participation and inter-sectoral collaboration
  • Selection based on political expediency
  • The training of health personnel were also institutional based
  • Workers integration problems
  • Same reason for preference of urban posting persists

7

2/6/2019

8 of 31

REASONS FOR A NEW APPROACH

  • Gross inequalities exists b/w developed and developing countries and also within countries – leading to inequity
  • High cost of technology
  • Access problems
  • People have a right to participate individually and collectively in their own health care
  • Sustainability of many health interventions in doubt
  • Univalent programs which never translated into a healthy population

8

2/6/2019

9 of 31

Alma Ata USSR 1978 (12/9/78), defined PHC as

  • Essential Health Care based on
  • Practical, Scientifically sound, and Socially acceptable methods and Technology
  • made universally accessible to individuals and families in the community
  • 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”

9

2/6/2019

10 of 31

Definition 2

  • An integral part of both the country’s health system
  • The central function and main process
  • Overall social and economic development of the country.
  • First level of contact of individuals, the family and the community with the National Health System,
  • Bringing health-care as close as possible to where people live and work
  • and constitutes health care process.

10

2/6/2019

11 of 31

Universal principles of Primary Health Care

  • Equitable distribution
  • Essential healthcare
  • Community participation
  • Use of appropriate technology
  • Self reliance
  • Inter-sectoral collaboration

​

​

11

2/6/2019

12 of 31

Community participation

  • Generally speaking, this concept borders on Beauchamp and Childress’es four principles of respect for autonomy, beneficience, non-maleficience and justice
  • Five components namely:
  • Sharing project costs
  • Sharing project efficiency
  • Increasing project effectiveness
  • Increasing beneficiary capacity
  • Increasing community empowerment.

12

2/6/2019

13 of 31

Appropriate technology

  • Use technology appropriate for level of development and setting
  • Release resources from high technology, apply simple technology that meet needs of majority
  • Shift resources from expensive curative institutions and training of specialist health workers to preventive care and treatment of prevalent diseases

13

2/6/2019

14 of 31

Appropriate technology in therapy

Examples

  • Use of SSS and ORT in the management of diarrhea (Bangladesh Rural Advancement Committee 80 -86 undertook to teach all rural mothers in use of ORS; found to significantly reduce mortality from diarrhea)

14

2/6/2019

15 of 31

Appropriate technology in preventive care

  • Growth monitoring : use of Shakir trip to measure MAC; simple weighing scales ( hanging scales) for use at community level
  • Construction of simple VIP latrines etc
  • ORS and scales reduce cost and offer opportunities for educating mothers, thus educational benefits

15

2/6/2019

16 of 31

Appropriate technology: human resources

  • Shift from training specialist health workers to training lower cadre workers like CHO, CHEWs and CBHW to expand coverage and provide appropriate care to targeted communities

16

2/6/2019

17 of 31

Inter-sectoral collaboration

  • Health and development interrelated
  • New development paradigm recognized investment in man as subject and object of development
  • Definition of causes of poor health expanded to include socio-economic environment

​

17

2/6/2019

18 of 31

Determinants of health

  • Education, agriculture, water, sanitation, housing
  • Work, environment and employment
  • Social organizational network, living conditions, family size
  • Age, sex. Gender, genetics, lifestyle
  • Health care: resources, organization and management, delivery (accessibility, quality and utilization)
  • Socioeconomic development

18

2/6/2019

19 of 31

Importance of other sectors

  • Improvement in health result mainly from activities from other sectors
  • A third of the global population has no access to water and sanitation
  • Essential elements of PHC

​

​

19

2/6/2019

20 of 31

Components of Primary Health Care

  • Health Education and promotion
  • Immunization against major infectious diseases
  • Prevention and control of locally endemic and epidemic diseases
  • Adequate supply of good water and basic sanitation
  • Promotion of food supply and proper nutrition

​

20

2/6/2019

21 of 31

Components of PHC 2

  • Maternal and child health care including family planning
  • Appropriate treatment of common diseases and injuries
  • Provision of essential drugs and revolving system.
  • Dental health care
  • Mental health care
  • Primary eye care

21

2/6/2019

22 of 31

Misconceptions about PHC

  • PHC is only of relevance to poor developing countries which cannot afford modern medical care.
  • PHC is second best medicine acceptable only to the rural poor and urban slum dwellers.
  • PHC is a stopgap solution to be replaced by something better at a latter stage and
  • PHC is a separate stand-alone service isolated from the main health care system.

​

22

2/6/2019

23 of 31

Implementation of PHC in Nigeria

  • 1985-1992: PHC Renaissance
  • From 1986: Process of reorientation of health services towards PHC approach
  • Stepwise implementation with 52 LGAs at inception
  • In August 1987, the federal government launched its Primary Health Care plan
  • Bamako initiative was introduced in 1988
  • 1993-1999: Period of low PHC activity

​

23

2/6/2019

24 of 31

Current status of PHC in Nigeria

  • Ward Health System: represents the current national strategy for the delivery of PHC services.
  • Utilises the electoral ward from which a representative councillor is elected as the basic operational unit
  • Aims of WHS:
  • To promote full & active community participation at the grass root level
  • To improve access to quality health care and ensure equity
  • To promote local initiatives and encourage poverty alleviation activities in the ward
  • To reinforce political commitment at grass root level
  • To reduce morbidity and mortality especially amongst women and children under five years

24

2/6/2019

25 of 31

Committees at PHC level

  • LG PHC Management Committee

​

  • PHC Technical Committee

​

  • Ward Development Committee

​

  • Village Development Committee

25

2/6/2019

26 of 31

Health Manpower at the PHC

  • Medical Officer of Health
  • Community Health Officer ± midwifery skills
  • Public Health Nurse
  • CHEW
  • JCHEW
  • EHO
  • Pharmacy technicians
  • Others: lab technician, ?Health attendant and support staff
  • ??? Health assistants

26

2/6/2019

27 of 31

Medical Officer of Health

  • 1856: the Association of Metropolitan Medical Officers of Health.
  • Ladipo Oluwole
  • 2007: Association of Medical Officers of Health in Nigeria
  • Managerial functions
  • Technical functions
  • Clinical functions

​

27

2/6/2019

28 of 31

Functions of the MoH 2

  • Identify health needs of the population & measures needed to address them
  • Develop health plans
  • Draw up health budget
  • Coordinate and monitor implementation of interventions
  • Ensure standards of care are maintained through effective supervision
  • Supervise health workers

​

  • Identify training needs of staff
  • Ensure support for health activities, especially at community level
  • Resource management – financial , logistics, transport , personnel , facilities ,information
  • Collect, collate and analyze relevant health information
  • Write report

​

28

2/6/2019

29 of 31

Challenges of PHC implementation

  • Poor political goodwill
  • Lack of sincerity
  • 3 tier-responsibility
  • Allocative inefficiencies
  • Managerial inefficiencies
  • Branding issues
  • Lack of human resource planning
  • Mediocrity
  • Gaps in recruitment of skilled manpower
  • Developmental inequalities

29

2/6/2019

30 of 31

30

2/6/2019

Primary Health Care

Primary Care

PHC spans the entire health system forming an integral part of the country’s HS of which it is the central function and main focus and sustained by a functional referral system

PC refers to the point at which an individual normally makes his first contact with the health services. It is an integral component of the HS

PHC adopts the essentials elements of the new approach i.e. the basic principles of community participation, social justice, equity etc

PC is vertical program and does not involve the essential elements or principles of the PHC

PHC is multi-sectoral in dimension and involves in addition to the health sector all related sectors and aspects of community development in particular agriculture, food, education, housing, public work, water

PC as a vertical program involves only health workers / health providers

The relationship in PHC is bottom top approach, here communities decide the content of the health program

In PC the relationship is top-bottom approach

PHC addresses main health problems; promotive, preventive, curative and rehabilitative services

PC addresses the general health problems and illnesses of the people

PHC is a global thinking of policy making about health care, an innovative public health strategy aimed at achieving health for all

PC is the traditional care which evolves from the old system, offered by the general practitioner / family doctors aimed at treating and curing illnesses

31 of 31

THANK YOU FOR LISTENING

31

2/6/2019