NUR 102 CONCEPT OF PRIMARY HEALTH CARE The implementation of new knowledge and technology in terms of vertical pro gramme for eradication of disease did not achieve expected results’ and it wa s realized that there was a need for establishment of permanent health servic es in rural areas to deal with the day-to-day work in the control and prevention of diseases and promotion of health. It was realized that the world's priority he alth problems required development of new approaches for their solution. Hen ce the approach in health services was shifted from curative to a preventivea pproach; from urban to rural populations; from privileged to the underprivilege d; from unipurpose to multipurpose workers and from vertical mass campaign s toa system of integrated health services forming a component of overall so cial and economic development. Based on this, a shift in emphasis on health s ervices to Basic Health Services Approach was conceptualized in 1970. This c concept focused on increasing accessibility and availability of health services t o the rural populations of developing countries. It was conceived as first level care or first contact care. Now the concept of Basic Health Services paved the way for Primary Health Care; the ideas contained in Basic Health Services wer e further expanded to cover accessibility, availability, acceptability, affordabilit y and appropriateness of health services. In May 1977, the Thirtieth World He alth Assembly adopted a resolution in which it was decided that the main soc ial target of Governments and of the World Health Organization in coming de cades should be "Health for All" by the year 2000 AD. The basis of "Health for All" strategy is the Primary Health Care. In 1978, an international conference o “d : rT_ L n primary health care was held at Alma Ata in the then USSR jointly by WHOa nd UNICEF. This led to the concept of Primary Health Care. This concept of PH C was recommended by various health committees including Nigeria. This cle arly indicates that PHC concept has its roots in the initial stages of our nationa Ihealth care approach. Definition of primary health care Primary Health Care is defined in Alma-Ata Declaration (1978). The Alma Ata Declaration states: Primary Health Care is the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community thro ugh their full participation and at a cost that the community and country cana fford to maintain at every state of their development in the spirit of self-relianc e and self-determination. If you look at the definition, you will find that it involves accessibility, which m eans, continuing and organized supply of care which is geographically, financi ally, culturally within easy reach of the whole community. Acceptability implie s that care has to be appropriate and adequate in quality and quantity to satisf y the health needs of people and has to be provided by methods acceptable t o them within their socio-cultural norms; Affordable implies that whatever the methods of payment used, the services should be affordable by community a nd country; Appropriate technology which means using appropriate methods, techniques and locally available supplies and equipment which together with t he people using them can contribute significantly to solving a health problem. Primary health care is based on socially accepted methods which the country “d 2 rT_ L can afford. Thus self-reliance and self-determination are emphasized. Thus w e can say primary health care is a practical approach to make essential health care universally accessible to individuals, families and community in an accept able and affordable way and with their full participation. The significance of P HC is to have contract with members of the community for providing continuin g health care in the light of national health system. PHC focuses on promotiv e, preventive, curative, rehabilitative and emergency care to meet the main he alth problems in the community, giving special attention to the vulnerable grou ps such as mother and child Element of Primary Health Care The eight essential elements or components of Primary Health Care as outlin ed in the Alma-Ata Declaration are: & Education concerning prevailing health problems and the methods of preven ting and controlling them; Promotion of food supply and proper nutrition; 8 An adequate supply of safe water and basic sanitation; Matemal and child health care including family planning; Immunization again st major infectious diseases; & Prevention and control of locally endemic disease; Appropriate treatment of common diseases and injuries. Provision of essential drugs. “] ,Dental & Mental Health are now added Principles of primary health care The five basic principles which provide the framework of the primary health ca re are as follows: i Equitable distribution of resources ii, Manpower development iii, Community involvement or participation iv. Appropriate technology v. Intersectoral coordination i. Equitable distribution of resources: As you know, the attainment of a high le vel of health is the fundamental right of an individual or you can also say that all human beings have an equal right to health. You will be interested to know how people can ensure this right. The answer is that all the people of the worl d/country should be provided with equal opportunities to develop health to the fullest and maintain it. So we can say that equitable distribution means that h “d 4 rT_ L ealth services must be shared equally by all people irrespective of their ability to pay; and all the people -rich or poor, rural or urban -must have access to hea Ith services. If we look at health statistics, you will find that the health situation as indicate d by health status indicators, e.g. infant mortality rate (IMR), maternal mortalit y rate (MMR), birth rate (BR), death rate (DR), etc. is lower in urban areas than in rural areas. Why this difference? Itis because health services are mainly co ncentrated in cities and towns, thus resulting in inequality of care for rural peo ple. These statistics reflect how health-related resources are distributed with t he countries - including access to health services, education and income-earni fg opportunities. This is called social injustice. ‘The inability to receive health care services by majority of rural people and tho se living in urban slums is inaccessibility. The aim of PHC is to bridge this gap by shifting this concentrated health care system from cities or urban areas (w here three quarters of health budget is spent) to the rural areas (where three quarters of the people live) and bring the services as near as possible to the m. The other feature of health equity in society is health status of women and th e disparity in health between genders which indicates that women suffer mor e from health problems than men. This is a critical indication of health inequali ty. What can you, as a health care provider do? You can only provide care toa n individual, diseased or healthy, irrespective of any disparity; but in general, th ese facts call for explicit policies and strategies to reduce inequalities in healt h. “| s i_ L ii. Manpower development: The manpower development in the context of he alth includes both professional and auxiliary health personnel, members of co mmunity and supporting staff. Primary health care, aims at mobilizing the hu man potential of the entire community by making use’ of all available resource s. This can only be achieved if the individuals and families accept greater resp onsibility for their health. The requirement of health manpower will vary according to the varying needs of groups of the population and desired outputs. Primary health care focuses on: Education and training of health workers to perform functions relevan t to countries health problems © Reorientation of health personnel © Planning health manpower according to the needs of health system, i n terms of the right kind of manpower, the right number, at the right ti me and in the right place. iii, Community participation: Community participation is the process by which individuals, families and communities assume the responsibility in promoting t heir own health and welfare. By their own health decisions, they develop the c apacity to contribute to their own and the community's development. Realizin g the fact that a community can become the agent of its own development, a continuous effort should be made towards the involvement of the local comm unity in planning, implementation and maintenance of health services. The term community involvement in health describes a process in which partn “| ‘ i_ L ership is established between government and local communities in planning and implementation of health activities. It aims at building local self-reliance a nd gaining social control over primary health care infrastructure and technolog y. For example, one such approach which is followed in our country (Nigeria) is training of village health workers and aides. They are selected by the local co mmunity and are trained locally in the delivery of primary health care and are i nvolved in planning the care for the community. This concept is an essential fe ature of PHC. The individuals in the community know their own situation bette rand are motivated to solve their common problems. Thus it can be stated th at involvement of community in health matters will require attainment of capa city by individuals to appraise a situation, weigh the various possibilities ande stimate what can be their own contribution. Your contribution in community p articipation, as a member of the health system, is to motivate the community to learn and solve their own health problems, explain, advise and provide clear information about favourable and adverse consequences of the health interve ntions proposed as well as their relative cost. Areas in which individuals, families and communities can participate are: { Involvement of the community in assessment of the situation, Definition of the problem and setting of priorities. Planning of the primary health care activities and subsequently cooperating fF ully when these activities are carried out iv. Appropriate technology: Appropriate technology means the technology tha “d ; rT_ L tis scientifically or technically sound, adaptable to local needs, culturally acce ptable (i.e. acceptable to those who apply it and for whom it is used) and finan cially feasible. This implies that technology should be in keeping with the local culture. It mus tbe capable of being adapted and further developed, if necessary. In addition, it should be easily understood and applicable by the community. The Health for all target requires first and foremost scientifically sound health technology that people can understand and accept and which the now expert can apply. It also implies use of cheaper, scientifically valid, acceptable and av ailable equipment, procedures and techniques rather than those costlier andn. on affordable and non accessible to the community. For example, oral rehydra tion fluid, locally prepared weaning food and stand pipes rather than house to house connection, cooperative food stores. It is socially, economically and professionally acceptable to take the technolog y closer to the people, consumer, wherever possible. For example, making reh ydration salts for babies available to mothers in every home is likely to be mor e useful than expecting the mothers to take the baby to the special center. We cannot afford to continue the use of sophisticated technology which is app ropriate for meeting the local health needs of people. For example, we know t hat expensive hospitals which are inappropriate to local needs are being built. These absorb a major part of the national budget, thereby affecting the impro vernent of general health services. The concept of appropriate technology can further be explained by taking the example of ORT (oral rehydration therapy). The ORT packets, for diarrhoea, prescribed by WHO cannot be made available to each home; so the community is taught how to prepare sugar and salt solut “d 5 rT_ L ion to combat dehydration in a child with diarrhoea. With these concepts in mi nd, we shall discuss the principles of intersectoral coordination. v. Intersectoral coordination: We now come to the principle which focuses on the concept that health of an individual, family and community is affected by o ther sectors in addition to health sector. Let us now try to learn more about thi s principle. It is now realized that health cannot be attained and/or primary he alth care PHC) cannot be provided by the health sector alone. PHC requires th e support of other sectors; these sectors serve as entry points for the develop ments and implementation of PHC. In our country the sectors responsible for economic development, antipoverty measures, food production, water purifica tion, sanitation, housing, environmental protection and education all contribute to health. Development of PHC will rest on proper coordination at all levels bet ween the health and all sectors concerned. Declaration of Alma-Ata states that Primary Health Care involves in addition to the health sector all related service sand aspects of national and community development; in particular, agricultur e, animal husbandry, food, industry, education. Housing, public works, commu nication and other sectors," WHO (1978, HFA Series No. 1).