Primary Health Care - howMed Lectures -Medical Lectures and 初級(jí)衛(wèi)生保健醫(yī)學(xué)講座講座- howmed

PRIMARY

HEALTH

CAREByDr

Naseer

Alam

TariqHealthHealth

is

a

fundamental

human

rightState

responsibility

for

the

health

of

itspeopleNational

Govt

all

over

the

world

arestriving

to

expand

and

improve

theirhealth

care

servicesThe

current

situation

isUrban

orientedMostly

curative

in

natureAccessible

to

asmall

part

of

populationHealthHealth

is

a

state

of

complete

physical,mental

and

social

wellbeing

and

notmerely

absence

of

disease

orinfirmity(WHO

Definition

of

Health

1948)Primary

Health

CareAt

the

international

level,

the

UniversalDeclaration

of

HumanRights

established

abreakthrough

in

1948,

by

stating

in

Article

25:“Everyone

has

the

right

to

a

standard

ofliving

adequate

for

the

health

andwellbeing

of

himself

and

his

family”The

preamble

to

the

WHO

Constitution

alsoaffirms

that

it

is

one

of

the

fundamental

rightsof

every

human

being

to

enjoy

“The

highestattainable

standard

of

health”Primary

Health

Care

Increasing

importance

given

to

socialjustice

and

equity,

recognition

of

thecrucial

role

of

communityparticipation,

changing

ideas

aboutthe

nature

of

health

anddevelopment,

the

importance

ofpolitical

will

called

for

newapproaches

to

make

medicine

in

theservice

of

humanity

more

effective.Primary

Health

CareAgainst

the

above

background,

the

30th

Worldhealth

Assembly

resolved

in

May

1977

atAlmata

,

that“the

main

social

target

of

governments

andWHO

in

the

coming

decades

should

beThe

attainment

by

all

citizens

of

the

world

bythe

year

2000

of

a

level

of

health

that

willpermit

them

to

lead

a

socially

andeconomically

productive

life”This

culminated

in

the

international

objectiveof

HEALTH

FOR

ALL

by

the

year

2000

as

thesocial

goal

of

all

governments.Primary

Health

CareThe

joint

WHO

–

UNICEF

internationalconference

in

1978

at

Alma

–

Ata

(USSR)the

governments

of

134

countries

andmany

voluntary

agencies

called

for

arevolutionary

approach

to

health

care.Declaring

that

“The

existing

grossinequality

in

the

health

status

of

peopleparticularly

between

developed

anddeveloping

countries

as

well

as

withincountries

is

politically,

socially

andeconomically

unacceptable”Primary

Health

CareHealth

for

all

means

that

health

is

to

be

broughtwithin

the

reach

of

every

one

in

a

givencommunity.It

implies

the

removal

of

obstacles

to

health

–that

is

to

say

the

elimination

ofMalnutritionIgnoranceDiseaseContaminated

water

supplyUnhygienic

housing

etcIt

depends

oncontinued

progress

in

medicineand

public

health.Alma

Ata

Declaration

called

on

allgovernments

to

formulate

national

policies,strategies

and

plans

of

action

to

launchand

sustain

primary

health

care

as

part

ofa

national

health

system.It

is

left

to

each

country

to

innovate,according

to

its

own

circumstances

toprovide

primary

health

careThis

was

followed

by

the

formulation

andadoption

of

the

Global

Strategy

for

Healthfor

all

by

the

34th

WorldHealthAssemblyin

1981.Primary

Health

care

got

off

to

a

good

startin

many

countries

with

the

theme

“Healthfor

All

by

2000

AD”Primary

Health

Care

Primary

Health

Care

is

a

newapproach

to

health

care,

whichintegrates

at

the

community

level

allthe

factors

required

for

improvingthe

health

status

of

the

population.Concept

of

PHCPHC

is

for

all

specially

the

needyRegardless

of

social

and

economic

status

everyindividual

in

the

nation

must

have

access

to

goodhealth

careThe

services

should

be

acceptable

to

thecommunity

and

there

must

be

active

involvementof

the

communityThe

health

services

must

be

effective,

preventive,promotive

and

curativeThe

services

should

form

an

integral

part

of

thecountry’s

health

systemThe

programme

must

be

efficient,

multi-

sectorialbecause

health

does

not

exit

in

isolationPrimary

Health

Care

Essential

Health

care

based

onpractical,

scientifically

sound,

andsocially

acceptable

methods

andtechnology

made

universallyaccessible

to

individuals

and

familiesin

the

community

through

their

fullparticipation

and

at

a

cost

that

thecountry

and

community

can

affordLevels

of

Health

CareLevels

of

Health

Care3

level

of

health

care

serviceLevels

of

Health

Care3

level

of

health

care

servicePrimary

care

levelSecondary

care

levelTertiary

care

levelLevels

of

Health

CarePrimary

care

levelFirst

level

of

contact

of

individual,

familand

community

with

health

systemMost

effective

and

close

to

the

peoplePHCBHU,

RHC,

THQClinicsRMOGPLevels

of

Health

CareSecondary

care

levelHigher

level

of

careMore

complex

problem

are

dealt

withDHQTHQHealth

centersHospLevels

of

Health

CareTertiary

care

levelSpecialized

health

careSpecific

facilitiesSpecialized

health

workersTeaching

hosp,Regional

hospCentral

hospSpecializes

hospAFICAFIDNICVDPrimary

Health

CarePHC

is

essential

health

care

madeuniversally

accessible

to

individualsand

families

in

the

community

bymeans

acceptable

to

them,throughtheir

full

participation

and

at

a

costthat

the

community

and

country

canaffordPRINCIPLES

OFPRIMARY

HEALTH

CAREPRINCIPLES

OF

PRIMARY

HEALTH

CAREEquityCommunity

ParticipationIntersectoral

CoordinationAppropriate

TechnologyEquity/EquitableDistributionThe

first

key

principle

in

primary

healthcare strategy

is

equity

or

equitabledistribution

of

health

servicesHealth

services

must

be

shared

equallyby

all

people

irrespective

of

their

ability

tpay

and

all(

rich

or

poor, urban

orrural)

must

have

access to

healthserviceshealth

services

are

mainly

in

townsInaccessibility

to

majority

ofpopulationSocial

injusticeAvailability

-Insurance/NHSCommunity

ParticipationOverall

responsibility

is

of

the

StateThe

involvement

of

individuals,families,

and

communities

in

promotionwelfare

is

anprimary

healthof

their

own

health

andessential

ingredient

ofcare

PHC

coverage

cannot

be

achievedwithout

the

involvement

of

communityin

planning,

implementation

andmaintenance

of

health

servicesPolio.

FPIntersectoral

Coordination?DPeHcClairnavtoilovnesofinAlamdadi–tiAotna

tsotattheeshtehaaltthsector

all

related

sectors

and

aspects

ofnational

and

communityin

particular

education,animal

husbandry,

food,development,agriculture,industry,public

works,education,

housing,communication

To

achieve

cooperation

planning

atcountry

level

is

required

to

involve

allsectorsAppropriate

TechnologyTechnology

that

is

scientificallysound,

adaptable

to

the

local

needs,and

acceptable

to

those

who

apply

itand

those

for

whom

it

is

used

and

canbe

maintained

by

the

peoplethemselves

with

the

resources

of

thecommunity

and

country

can

affordluxurious

hospitals,

costly

equipments80:20Essential

Component

/

ElementsEssential

Component

/

Elements1.Education

concerning

prevailing

healthproblems

and

themethodsof

identifying,preventing

and

controlling

them2.Promotion

of

food

supply

and

propernutrition,water

and

basican

adequate

supply

of

safesanitation3.Maternal

and

child

health

care

includingfamily

planning4.Immunization

against

major

infectiousdiseasesEssential

component

/

Elements5.Prevention

and

control

of

locallyendemic

diseases6.

Treatment

of

common

diseases

andinjuries7.Promotion

of

mental

health8.

Provision

of

essential

drugsMillennium

Development

Goals

MDG,s

place

health

at

the

heart

ofdevelopment

and

representcommitments

by

governmentsthroughout

the

world

to

reducepoverty

and

hunger

and

to

tackle

illhealthMillennium

Development

GoalsEradicate

extreme

poverty

and

hungerAchieve

universal

primary

educationPromote

gender

equityImprove

maternal

healthReduce

child

mortalityCombat

HIV/AIDS,

malaria,

andothercommunicable

diseasesEnsure

environmental

sustainabilityDevelop

global

partnership

fordevelopmentPrimary

Health

Care

in

PakistanBasic

Health

Unit

(BHU)Total

BHU’s

5374BHU

serve

a

population

of

5,000-10,000Services

provided

at

BHU

are—MCH

services,childcare,

immunization,

diarrheal

diseases,malarial

control,

child

spacing,

mental

and

schoolhealth

serviceRural

Health

Centre

(RHC)Total

No

5955-10

BHU

are

linked

with

RHC25

beds,

laboratory,

X-ray,

minor

surgery,dentalDispensariesMCH

Centers4842909Primary

Health

Care

in

PakistanTehsil

Hospital50-100

bedded

hosplaboratory,

X-ray,

surgery

,dental,

specDistrict

Headquarters

hospital100-200 bedded

hosplaboratory,

X-ray,

surgery

,dental,

all

specPrimary

Health

Care

in

PakistanH