RIVERS STATE SCHOOL OF MIDWIFERY, PORT HARCOURT.

Course Title: Primary Health Care 1

Course Code: MID 114

Placement: First year First semester

Credit unit: 3

Learning objectives

At the end of this course, the student should be able to:

Explain the concept, rationale and principles of primary health care.

Discuss community structure and functions.

Discuss the strategies for community diagnosis and mobilization.

Explain the principles of information, education and communication (IEC) in community care.

Discuss the clinical skills used in Primary Health Care

INTRODUCTION TO PRIMARY HEALTH CARE
HISTORICAL PERSPECTIVES OF PRIMARY HEALTH CARE

Prior to 1978, existing health services globally, were failing to provide quality health care to the
people. Different ideas and alternatives could not establish a well-functioning health care system .

As a result of these, a joint international conference was held in the year 1978 in Alma-ata,
Kazakhstan, organized by the World Health Organization (WHO) and the United Nations
International Children’s Education Fund (UNICEF), commonly known as the Alma-Ata
conference. The conference jointly called for a revolutionary approach to health care.

During this conference, a declaration was made, called the Alma-ata declaration. This
declaration states that health is a basic human right, and that governments are responsible to
assure their citizens of the protection of these rights and also to develop appropriate strategies for
the fulfillment of this promise.

Gross inequalities exist in the health status of people in developed and developing countries and
even in people within a country; this has caused a common concern for those countries. The
conference called for the acceptance of WHO goal of ‘Health for All’ by 2000 AD.

The conference emphasized the rights and duties of people to participate in the planning and
implementation of their health care; and also advocates the use of scientifically, socially and
economically sounds technologies. Primary health care is then adopted as the appropriate method
in attaining these targets.

IN NIGERIA

Primary health care is a part of the three tier health care system in Nigeria, which are:

The primary,

Secondary and

Tertiary health care.

They are all funded by the local, state, and federal government respectively. It was formulated by
the 134 countries which were present at the Alma-ata international conference in Russia, on
September 12, 1978, organized by the world health organization. There was a national initiative
to overhaul the primary health care in the late 1980s, through the adoption of a new national
health policy. The federal government gave directives to the local government to have full
jurisdiction over the delivery of primary health care services. Federal Government through the
Federal Ministry of Health sets overall policy goals, co-ordinates activities, ensures quality,
training and implements sector programmes.

The federal, state and local governments respectively, are responsible for the financial aspect. It
is the first level contact of the individual and community in the national health system, thus
bringing health care as close as possible to where people live and work and contribute the first
element of a continuing health care process”. It is essentially aimed to promote health, to cure

diseases and to rehabilitate. Nigeria is one of the few countries in the developing world to have
systematically decentralized the delivery of basic health and education services to locally elected
governments.
Nigeria, being hailed as the giant of Africa, with an enormous population of over 217 million is
yet ranked among the poorest nations in the world. There is poor management of the health
sector and subsequently poor quality of service to the general populace. There is lack of needed
resources to function effectively, despite the presence of an extensive national health
infrastructure. Nigeria therefore moves to decentralize her health system by clarifying
responsibilities and service at each level, with the hope of a better result in management and co-
ordination.
Primary health care is the backbone of Nigeria health system; it plays a vital role in deployment
of all resources through appropriate channels in promoting, maintaining as well as improving
health. All these confirm the definition of primary health care:

DEFINITION

Primary health care is an 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 the community and country can
afford to maintain at every stage of their development in the spirit of self reliance and
determination. (World Health Organization)

It forms an integral part of both the country's health system of which it is the central function and
the main focus of the overall social and economic development of the community.
Being the first element of a continuing health care process, it means that patients have a direct
access to the appropriate source of care. It equally shows that it deals more with common,
affordable and well defined problem in a community setting.
The development of primary health care in Nigeria has immense improvement, yet it still shows
some major defects.

EXTRACTION OF SOME BASIC TERMS FROM THE DEFINITION:

Essential health care: Health services crucial to the health of the people, rendered at the lower
level of health care such as immunization, family planning, school health, health education,
environmental health, control of communicable diseases and referrals.

Scientifically sound: It should be scientifically acceptable and explainable.

Socially acceptable methods and technology: Intervention should consider local culture,
traditional values and beliefs.

Universally accessible: This states that primary health care should be situated in a place where
it can be accessible to all. It should be as close as possible to where people live and work, to
guarantee universal coverage.

CONCEPT OF PRIMARY HEALTH CARE

The word “health” means different things to different people, depending on the situation. If
somebody complains “I was worried about the health of my baby when he crawled in the sand”
this statement clearly indicates the woman is referring to the baby’s physical health. On the other
hand, when a phrase like this is heard “with all this increased workload and late night reading, l
wonder what the effects will be on his health. What likely comes to mind is the person’s mental
health.
The English word "health" comes from the Old English word hale, meaning "wholeness, being
whole, sound or well.

Definition of health by world health organization

According to the World Health Organization, “health is a state of complete physical, mental and
social well-being and not merely the absence of diseases or infirmities”.
This famous definition was created during a preamble to the constitution of the world health
organization as adopted by the international health conference, New York, on the 19-22 of June,
1946; it was later signed on the 22 of July, 1946 by the representatives of the 61 states and came
into force on 7 April 1948.

Criticism of the W. H .O definition of health

The Lancet contains an article which argues that “health is not a state of complete physical,
social and mental wellbeing”. Neither is it “merely the absence of diseases or infirmity”. The
article criticized that the WHO definition will not stand in an era of new understanding of disease
at molecular, individual and societal levels. (The Lancet, Volume 373, Issue 9666, Page 781, 7
March 2009).

What is wellness?

Wellness "is a state of optimal well-being that is oriented toward maximizing an individual's
potential. It is a life-long process of moving towards enhancing your physical,
intellectual, emotional, social, spiritual, and environmental well-being." The
University of East Carolina defines wellness as "the integration of mind, body and spirit.
Optimal wellness allows us to achieve our goals and find meaning and purpose in our lives.
Wellness is the ability to live life to the fullest and to maximize personal potential in a variety of
ways. Wellness involves continually learning and making changes to enhance your state of
wellness. We achieve true wellness when we balance the physical, emotional, intellectual, social,
occupational, spiritual, and environmental aspects of life.

Determinants of health
The health of individual people and their communities are affected by a variety of factors.
According to WHO, people’s health, whether good or bad, depends on their environment and
situation, what is happening around them and what has happened to them.
Most of the factors that determine our good or bad health are out of our control. Therefore,
praising or criticizing people for their good or bad health is wrong. According to W H O, the
determining factors include the following:
Socio-economic factors: The higher the socio-economic factors the higher the likelihood of an
individual to enjoy good health. This affects every member of the society including newborn
babies. According to a study done in South Korea, low socio-economic status is linked to heart
attack and risk for strokes.
Educational level: Higher level of education is associated with a greater self esteem. People
with lower level of education are most likely to experience more stress as compared to those with
higher level of education, they also stand a higher risk of experiencing poorer health.
Physical environment: Access to clean and safe water, pure environmental air, a healthy work
space and a safe and comfortable house can guarantee good health, as compared to their
counterparts with the opposite situation.
Job prospect and employment condition: Statistics show that those who are gainfully
employed enjoy better health care than those who are unemployed.
Support from people around you: Research shows that strong family support promotes health
and is preventive of future suicidal tendencies among young adults.
Culture: The custom and traditional practices of a people and how the family responds to them,
has an impact on their health negatively or positively. For example, female genital mutilation is a
cultural practice and its health effects are enormous to those who practice it.
Access and use of health services: The presence and use of quality health services by a people
determines their health status. Life expectancy is higher for people in developed countries who
have available quality medical services.
Genetic inheritance: The genetic make-up of some individuals, determine their response to
certain diseases and even their general health. Research shows that people’s gene play an
important role in how they respond to biological and psychological stress in their environment.
Lifestyle: The kind of food we eat, whether or not we drink alcohol and smoke, the kind of
activities in engage in all play vital roles on our health.
Gender: Men and women are prone to different kinds of diseases because of their make-up, and
these also affect their health differently. Certain reproductive health conditions peculiar to
women are not experienced by men.