Transcript Slide 1

‫بسم هللا الرحمن الرحيم‬
Primary Health Care
Basic Concepts
“A state of complete physical, mental and
social wellbeing and its not merely the
absence of disease or infirmity”
WHO 1946
Concepts of health care
• Provision of services by health personnel It
– Diagnosis
– Rehabilitation
Levels of Health Care
• Primary health care
• Secondary health care
• Tertiary health care
Levels of Health Care
Primary health care
• The “first” level of contact between
the individual and the health
• The closest to the people.
• Cover all people with essential
• Addresses the main health
problems in the community,
providing preventive and curative
• A majority of prevailing health
problems can be satisfactorily
• Provided by the primary health
Levels of Health Care
Secondary health care
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level
Tertiary health care
• Offers super-specialist care
• Provided by regional/central level institution.
PHC history
•PHC appeared as a concept since 1975 in the 25th
conference for WHO
•Health for All by the year 2000 (Assembly) -1977
•International Conference on Primary Health Care
(Alma – Ata) -1978
PHC history WHA 1977
• The 30th World Health Assembly Comes with new
• Social justice and equity are essential for health
• Recognition of the role of community
• The importance of the political will
• The relation between health and development
(health is essential for development and
development is essential for health)
Health for All
• The ideas concluded in the international
objective of Health for All
• Definition of HFA: Attainment by all peoples of
the highest level of health that permit them to
lead socially and economically productive life
Fundamental Principles for Health for
Health is fundamental human right and a worldwide social goal
Health is an integral part of development
The existing gross inequality in the health status of people is of common
concern to all countries and must be drastically reduced.
People have the right and the duty to participate individually and
collectively in the planning and implementation of their health care
Governments have a responsibility for the health of their people
Countries must become self-reliant in health matters.
Fuller and better use must be made of the world’s resources to promote
health and development.
Alma-Ata Conference (1978)
• proclaimed PHC
as way to
achieving HFA
Primary Health Care
• It is the 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
Primary Health Care
PHC 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
through their full participation and at a
cost that community and country can
afford to maintain at every stage of their
development in the spirit of self-reliance
and self-determination.
Alma Ata declaration, 1978
Principles of Primary Health Care
1.Equitable Distribution:
Health services should be available to each and every one in the
community – not depend on one’s capability to pay for the services
(rich & poor) Rural or urban
2 .Appropriate Technology:
Appropriate technology is one which is – scientifically sound, adapted to
local needs, acceptable to those who apply it and to those on whom
it is applied, within the resources which can be afforded by the
community and the nation.
Examples of appropriate technology are Oral rehydration therapy DOTS
and Immunization programme
Principles of Primary Health Care
3.Inter-Sectoral Coordination:
in addition to the health sector, all related sectors in
particular agriculture, animal , food, industry.
4.Community Participation:
While most of the efforts in providing health care come from
the Ministry of health, the system of primary health care
should be based on full participation and involvement of
the community in planning, implementation and
The Basic Requirements for Sound PHC
• Appropriate service is provided according to
essential human needs, priorities and
• Sufficient volume of care to meet the need
and demand of a community
• Adequate attention to all aspects of a medical
problem, including prevention, early
detection, diagnosis, treatment, follow up
measures, and rehabilitation.
• The cost should be within the means and
resources of the individual and the country.
• Geographic, economic, cultural accessibility
• Acceptability of care depends on a variety of
factors, including satisfactory communication
between health care providers and the
patients, whether the patients trust this care,
and whether the patients believe in the
confidentiality and privacy of information
shared with the providers.
• Availability of medical care means that care
can be obtained whenever people need it.
• Assessebility means that medical care can be
readily evaluated.
Main Elements of PHC
1. Health Education concerning prevailing
health problems and the methods of
preventing and controlling them;
2. Promotion of food supply and proper
3. An adequate supply of safe water and basic
Main Elements of PHC
4. Maternal and child health care, including
family planning
5. Immunization against the major infectious
6. Prevention and control of local endemic
7. Appropriate treatment of common diseases
and injuries
8. Provision of essential drugs
(secondary) elements of PHC
• Mental Health
• Care of elderly
• Occupational Health
• School Health
• Reproductive Health
• Adolescent Health
Elements of PHC (cont.)
Primary Health Care
Preventive services
Curative services
Outpatient clinic (referral)
General services
Care of vulnerable groups
Health education
Monitoring of environment
Prev.&control of endemic diseases
Maternal &child health s.
School health services
Geriatric health services
Occupational health services
Laboratory services
First aid and emergency
Primary Health Care - Benefits
• PHC focuses on keeping people healthy & addressing
illness early so as to increase probability of cure
• Individuals have access to appropriate care
• Services are matched to community needs
• Targeted services will have a positive impact on the
utilization of health and social services
• Healthy communities with healthy people contribute
to a stable economy
• PHC is Cost-effective
Why PHC is Cost-effective?
• Reduces the disease burden. Effectively addressing the
most common health needs (70% - 90% of health
• Produce economic savings. improving family health by
prevention, close services and sustainable follow up.
• Assure greater equity. Geographically, Financially, and
culturally accessible to local communities
• Efficient allocation of resources (Spending 1 US$ in
PHC saving 10 US$ to the government)
• Operationally sound ,cheap and simple knowhow.
• Fund raiser tool, attract the community to finance &
participate in provision of health services.
Comparison between Primary & Secondary
health care costs
Country & Maternal
health services
PHC level of service
provision cost (US$)
Secondary level of
service provision cost
Antenatal Care
2.21 $
4.18 $
Vaginal delivery
2.71 $
33.90 $
Antenatal Care
3.23 $
Vaginal delivery
10.22 $
24.03 $
Antenatal Care
3.17 $
5.25 $
Vaginal delivery
7.66 $
14.60 $
Problems that impede the implementation
of PHC in Sudan
1. The burden of communicable and non-communicable
diseases is rising which put more demand on PHC
2. Inequitable distribution of health care services
3. Shortage of qualified human resources.
4. Inadequate PHC level management capacity.
5. Absence of sustainable financial mechanism for PHC
6. The focus of government spending on hospitals leading
to an unbalanced health system. Most of the
government health expenditure is directed to the
secondary and tertiary hospitals
Population & Health Expenditure
(Inverted Pyramid)
5 % of
%80 of Health
15 %
15% of Health
80% of population
5 %Health