UNIT-3

Primary Health
Care
Prepare By:
Sushila Pokharel
 Contents(8 Hrs)
• Concept of primary health care

– Historical perspective of bringing primary health care

– The Alma Ata declaration and definition of primary health care

– Elements and principles of primary health care

• Target for health for all by 2000 AD and beyond 2000

• Primary health care approach in current health plan and second

long term health plan

• Role and responsibilities of nurse in primary health care

 Concept of Primary Health Care
 In 1977 the world health assembly established a goal
”health for all by 2000” which was adopted by many
countries through the world.

 In 1978, Alma-Ata declaration was made at

USSR(Union of Soviet Socialist Republics) which was
conducted by WHO, UNICEF and the governments of
134 countries and many voluntary agencies.
 The conference documents detail the principles
which must be considered to establish PHC in
order to provide, in the words of WHO “ health
care for all by the year 2000 A.D”.
 It is then, the concept of PHC becomes the
strategy to achieve the goal of health for all by
2000.
 Health for all does not mean that since the year 2000,
doctors and nurses will provide medical care for
everybody in the world for all their existing ailments; nor
does it mean that from the year 2000 nobody will be sick
or disabled.
 But it does mean that there will be an even distribution
among the population of whatever resources for health
are available so that people will use the available
approaches for better health.
 PHC is a new approach to health care, which
integrates at the community level all the factors
required for improving the health status of the
population. Primary health care is available to the
people at the first level of health care.
 It is based on the principle of equity, wider coverage,
individual and community involvement and
intersectoral co-ordination that is all people should
have an opportunity.
• While it integrates promotive, preventive and
curative services it is also conceived as an integral
part of the country’s plan for socio-economic
development.

• The Alma Ata Declaration has called on all

government to formulate national policies,
strategies and plan of action to launch and sustain
PHC as a part of a national health system.
• In Nepal, PHC system has implemented since 1980
and has given more stress after the democracy (2046).

• The national health policy was adopted in 1991 (2048

B.S.) to bring improvement in the health condition of
the people of Nepal.
• The primary objectives of National Health
Policy (NHP) were to extend the primary
health care system to the rural population so
that they benefit from modern medical
facilities and trained health care providers.
Primary Health Care
• The first level of care and usually the first point of
contact that people have with the health care
system.
• PHC supports individuals and families to make the
best decisions for their health.
• The scope of primary care includes the
diagnosis, treatment and management of
health problems; prevention and health
promotion; and ongoing support, with family
and community intervention where needed.”
• It includes advice on health promotion and
disease prevention, health assessments,
diagnosis and treatment of episodic and
chronic conditions and supportive and
rehabilitative care.
• Primary Health Care is defined as a set of
universally accessible first-level services that
promote health, prevent disease, and provide
diagnostic, curative, rehabilitative, supportive
and palliative services.
 Alma -Ata declaration
 The international conference on primary health care,
meeting in Alma Ata in September, 1978 made
following declaration:
1. Health is a fundamental human right and that
attainment of the highest possible level of health is the
most important worldwide social goal.
2. The existing gross inequality in the health
status of the people between developed and
developing countries as well as within
countries is politically, socially and
economically unacceptable and is, therefore,
of common concern to all countries.
3.The promotion and protection of the health of people
is essential to sustained economic and social
development and contributes to a better quality of life
and to world peace.

4.The people have the right and duty to participate

individually and collectively in the planning and
implementation of their health care.
5. The main social target of government, international
organizations and whole world community should be
attainment of health for all by year 2000.
6. Primary health care is essential health care based
on practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individual and families in
community through their full participation and at
cost that the community and country can afford to
maintain at every stage of the development in the
spirit of self reliance and self determination.
8.All government should formulate national policies,
strategies and plan of action to launch and sustain
primary health care.

9. All countries should cooperate in a spirit of partnership

and sustain primary health care as part of a
comprehensive national health system and in
coordination with other sectors.
10. An acceptable level of health for all the
people of the world by the year 2000 can be
attained through a fuller and better use of
world’s resources, considerable part of which
is now spent on military conflicts.
 Definition
• The Alma Ata conference 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.”
 Elements of PHC
i. Education concerning prevailing health
problems and the methods of preventing and
controlling them
ii. Promotion of food supply and nutrition
iii. Basic sanitation and safe water
iv. Maternal and child health/ family planning
v. Immunization against major infectious diseases
vi. Prevention and control of endemic diseases
vii. Treatment of common diseases and injuries
viii.Provision of essential drugs
ix. Mental health
x. Dental health
 i. Education concerning prevailing health
problems and the methods of preventing and
controlling them.

 Health education is an integral part of all health

services and hence all health personnel, including
nurses are responsible for educating people as to
how they can improve their own health.
• Health education on the prevailing health
problems on certain community (as in context of
developing countries, diarrhea, dysentery, upper
respiratory tract infection, leprosy, tuberculosis,
as in develop country HIV/AIDS, child abuse,
sexual abuse, drug addiction, heart disease etc.)
should be given with main focus on preventive
aspect and ways of control it.
ii. An adequate supply of safe water and basic
sanitation.

• Adequate safe water supply and clean and proper

disposal of wastes are essential for the health and
well being of the community as well as people.
• Until there is an adequate access to safe water and
basic sanitation health status of the community can
not be achieved and water borne diseases will be still
prevalent.
• The community health nurse should teach the community
about the method of water purification, not contaminating
river and wells, identify the source of clean water,
encourage people to construct household and community
latrines, make provision for composting facilities and septic
tank where drainage system is poor.

• The CHN is also responsible for the coordination with

other sector for providing safe water and maintenance of
good sanitation for the community.
 iii. Promotion of food supply and nutrition

 There is a direct relation between nutrition and health.

 Nutrition is necessary for growth and development,

protection from infection and prevention from
specific deficiency.
 In developing countries nutritional deficiency disease
are prevalent causing mortality, morbidity and
disability in children.
• Protein-calorie malnutrition, vitamin A
deficiencies which increase susceptibility to
various infections eg. xeropthalmia, night
blindness, dry skin, iodine deficiency disease
etc are common.
• In such community its our responsibility to give
health teaching regarding nutrition, use of iodized
salt, suitable measure should be taken for
treatment and control of diarrheal disease,
intestinal parasites.
• Measure should be taken to improve personal
hygiene, environmental sanitation and we can also
assist to grow various types of food in their
kitchen garden, preparation of supplementary
food, preparation of food with balanced diet and
selection of food in sufficient quality and quantity.
 iv. Maternal and child health/ family
planning
• Maternal and child health are the important indicator of the
country development.
• Maternal mortality rate is high in developing countries
including Nepal.
• So to reduce maternal and child mortality and morbidity we
have to carry out maternal and child health care, which
include antenatal, intra natal, and postnatal care, new born
and infant care, provision of family planning etc.
 v. Immunization against major infectious
diseases
• Immunization is important for the prevention of
communicable disease.
• Certain disease such as measles, diptheria, pertusis,
tetanus, hepatitis, tuberculosis, poliomyelitis causes
many cases of illness, disability and death each year.
• These disease are easily be prevented by active
immunization.
• So that we have to motivate families to have
their children fully immunized and also health
post should receive enough supply of
immunization regularly and cold chain should
be maintained.
vi. Prevention and control of locally
endemic diseases

• Endemic disease are those diseases that often occur in

certain geographical area, country or a class of people.

• These diseases might include diarrhea, common cold,

tuberculosis, malaria, kalazar, goiter etc.

• The community should therefore be taught about

preventive measure by providing information on mode
of transmission and cause.
• In addition to preventive measure, we should
teach community about the way to deal if
disease occurs.
• In disease control and prevention, nursing teams
collect and record data, provide care to ill,
provide medication on time, give health
education, visit and follow-up the cases and
conduct surveillance in risk population.
 vii. Treatment of common diseases and
injuries
 Treatment of minor ailments and first Aid measures

may be taken at village level.

 Treatment of common diseases and injuries are to be

provided at the subcenter and primary health centers

and appropriate referral services are to be organized.
 The emergency treatment and primary care provided

by nurse help to reduce morbidity and mortality.

viii. Provision of essential drugs

 Essential drugs are those drugs that are of proven

value, good quality, and cheap; that can be used to
treat the majority of diseases in the country.
 The national drug scheme of Nepal has established an
essential drug programme and has compiled a list of
200+ drugs that are essential for Nepal.
• All health care organization should be equipped
with emergency drugs to tackle the situation and
health personnel including the nurse should be
aware about the supply of essential drugs.
• Nepal Drug Limited has been entrusted with
manufacturing these drugs so that Nepal may
eventually be self-sufficient in the production of
essential drugs.
 ix. Mental health
 Mental health is the “state of successful performance of
mental function, resulting in productive activities,
fulfilling relationships with other people and the ability
to adapt to change and to cope with adversity.”
 If a person is mentally disturbed he/she cannot do any
things. So, the CHN should teach about stress
management, prevention of mental illness and proper
management of mentally disturbed people.
 Number of mental illness is increasing day to day.
Modern life can be extremely stressful and may
provoke mental illness.

 So PHC should concentrate on the mental problem

which prevails in the community with assistance
from and collaboration with many other groups.
 x. Dental health

 The objective of dental health services is the

prevention of dental disease of all kinds, as well as the
treatment of dental disorders.
 Nepalese people are suffering from various dental
problems so the PHC nurse should conduct school
dental program and provide health education on oral
care, treatment about oral and tooth disorders.
 The dental health is added in PHC component
with the sense of complete health.
 “ELEMENTS” of PHC

E= Education about health E= Essential drugs provision

problems and their control. N= Nutrition

L= Local disease control T= Treatment of common

E= EPI (Expanded Program diseases

on Immunization) S= Safe drinking water and

M= Maternal and Child Health sanitation

M & D= Mental health and
based family planning dental health
Five basic principles of primary
Health Care
1. Accessibility of health services to all
population
• The term “accessibility” refers to the health care
system that can be reached and used by all
people.
• This means that health posts must be located in
places where people can go easily.
• It also means that health care must be available to all
people regardless of their age, sex, religion, caste, level
of income, level of education, or place of residence.

• This means equitable distribution of health services i.e.

health services must be shared equally by all people
irrespective of their ability to pay and all must have
access to health services.

• Accessibility also refers to the availability of drugs and

other supplies at health posts and hospitals.
• In other words, it implies equal distribution of
resources , providing these items to rural areas
is expensive and difficult because of lack of
accessibility of roads and airports.
• These supplies have to be carried to the health
posts by mules, horses or porters.
• Certain drugs need refrigeration, which is also
not available in many areas of the country.
• Accessibility implies the continuation and organized
supply of care that is geographically, financially,
culturally and functionally within easy reach of the
whole community.
• Geographical accessibility means that the distance
travel time and means of transportation are acceptable
to the people.
• Financial accessibility means that whatever the
method of payment is used, the services can be
afforded by the community and the country.
• Culturally accessible means that the technical
and managerial methods used are in keeping
with the cultural pattern of the community.
• Functional accessibility means that the right
kind of care is available on a continuing basis
to these who need it, whenever they need it
and the is provided by the health team required
for its proper delivery.
2.Maximum individual and community
involvement in planning and
implementation of health services
• According to WHO and UNICEF community
participation is “the process by which individuals
and families assume responsibility for their own
health and welfare and for those of the
community, and develop the capacity to contribute
to their and the community’s development.
• To have full community participation, the
community people must be involved in all
aspects of the project.
• There must be a continuing effort to secure
meaningful involvement of the community in the
planning, implementation and maintenance of
health services, besides maximum reliance on
local resources such as manpower, money and
materials.
• Such a project succeeds only when the
community takes full responsibility for every part
of the process.
 3. Emphasis on services that are preventive
and promotive rather than curative

• Preventive and promotive health services teach

people to remain clean and prevent disease from
occurring.
• Diseases can result from drinking contaminated
water, poor hygiene and sanitation, many people
living together in a small house inhaling smoke
from cigarettes or chulos.
• Preventive and promotive services include
providing clean water to communities, sanitation
facilities such as toilets, adequate housing,
isolation of ill people from other family
members, availability of adequate amount of
nutritious food and vaccination programmes.
• Curative services should be provided together
with preventive and promotive services.
• The nurse sometimes needs to treat the illness
and teach patients and their families how to
prevent the illness from reoccurring.
• The community has to be reminded that
curative services are expensive for the sick as
well as for the community.
• Hence preventive and promotive services are
found to be cheaper in the long run and easier to
provide than curative services.
• But not all the promotional services are cheap
eg water supply, housing etc are not only
expensive but sometimes difficult to meet them.
4. Use of appropriate technology

• Appropriate technology has been defined as

“technology that is scientifically sound, adaptable to
local needs and acceptable to those who apply it and
those for whom it is used and that can be maintained
by the people themselves in keeping with the
principle of self reliance with the resources the
community and country can afford.”
• The principle includes appropriate methods and
technology to implement all the elements of PHC.
• For eg. Building a health post by using locally
available materials such as bricks and wood rather
than importing expensive cement and other supplies
that the community can afford, or using an existing
building instead of constructing a new one.
• Appropriate technology means having basic and
easily repairable equipment rather than having
an expensive one that needs special training and
has complex part to repair.
• People are more likely to build toilets if they are
taught how to make them with locally available
materials like stone, wood, or bamboo.
• Appropriate methods and technology also
mean teaching people appropriate health care
methods that are easily available, and easy to
understand and use.
5. Integration of health development
with overall social and economic
development

• Improvement in health cannot take place

without improving the social and economic
status of the people.
• Integration with social and economic
development implies a multi sectoral approach
to health.
• People need land to grow food, or they need jobs
that pay them enough money to buy food for their
families. Increasing the level of education and
improving the status of women in society also
improve the health of people.
• Different ministries and agencies need to work
together to improve all aspects of the country.
• For eg. Water supply engineer builds a tube well in
a village, a nurse or a health worker teaches
people how to keep the water clean once it is taken
from the well.
• A nurse who knows the needs of the community
where she works, can help the local development
officer and the community to work together and
plan appropriate programs that will benefit the
community.
Role of the nurse in Primary health care

• In the beginning nurses worked in the hospital only

and cared for ill patients under the supervision of
physicians.
• Now the role of nurses expanded and works in
community independently. Nurses must perform the
following roles while providing primary health care.
Health care provider
• The most familiar role of the nurse is that of care
provider. It means that the nurse ensures that health
services are provided not just to individual and
families, but also to groups and population.
• The community health nurse provides service along
the entire range of the health continuum but
especially emphasizes promotion of health and
prevention of illness.
• Nursing service includes seeking out clients at
risk for poor health to offer preventive and
health promoting services, rather than waiting
for them to come for help after problems arise.
Educator
• A second important role of the community health nurse
is that of educator or health educator. The educator role
is especially useful in promoting the public’s health. As
an educator role the nurse performs both in the hospital
and in the community.

• As educators, the nurses seek to facilitate client

learning. Information is shared with clients both
formally and informally.
• Formal classes may be held to increase
people’s understanding of health and health
care. The emphasis throughout the health
teaching process continues to be placed on
illness prevention and health promotion.
Manager role

• As a manager, the nurse exercises administrative

direction toward the accomplishment of specified

goals by assessing clients’ needs, planning and

organizing to meet those needs, directing and

leading to achieve results and controlling and

evaluating the progress to ensure that goals are met.

• The nurse serves as a manager when

overseeing client care as case manager,

supervising auxiliary staff, managing case

load, running clinics or conducting community

health needs assessment.

Researcher

• In the researcher role, nurses engage in systematic

investigation, collection and analysis of data for
solving problem and enhancing community health
practice.
• Research is an investigation process in which all
nurses can become involved in asking questions and
looking for solutions.
Coordinator
• Nurse seldom practice in isolation. They must work with
many people including clients, other nurses, physicians,
teachers, social workers, physical therapist, nutritionist,
occupational therapist, psychologist, epidemiologist, etc.

• Coordination means bringing people and activities

together so that they functioning harmony while
pursuing desired objectives
 Change agent role
• As a change agent, the nurse guides in decision making,
stimulate interest in health promotion, influence health
policy. Nurse makes the people adopt the healthy idea
through different performance, education, skills, attitudes
etc.
• Change is very difficult for most people to accept, many
times it can be expensive and also involves taking a risk
because the change might not be appropriate and it might
not work.
• The nurse needs to encourage those changes
that are in the best interest of the people and
involve the least amount of risks to the poor
people of her community.
Evaluator

• The purpose of evaluation is to assess the

achievement of stated objectives of a programme, its
adequacy, its efficiency and its acceptance by all.
• The nurse must compare and judge performance and
outcomes against previously set goals and standards.
Supervisor

• Supervision is an interaction between a leader

and follower .
• So to help the coworker and community
people to do their job skillfully, effectively to
improve quality of health and evaluate the
performance.
 Motivator
• A nurse motivates the community people to find their
health needs, increase interest to adopt healthy life style
and increase awareness regarding health, sanitation,
hygiene etc.
• Until the people are interested and become aware of their
needs, they will not consume the health service provided
to them. So the nurse increases awareness and motivates
them to promote and maintain their own health.
 Counselor

• PHC nurse counsels the people as per their

needs, e.g. she provides counseling service on
family planning, immunization, use of safe
water, choice to treatment pattern, mental health,
drug and alcohol abuse, rehabilitation etc.
• She can also provide counseling service on social
and other problems related to health.
 Facilitator

• Nurses helps people to facilitate or provide

opportunity to know many things as healthy facility,
education sector, source of other facilities, source of
income, etc.
• So the nurse convey the message to people and also
act as facilitator to achieve needed information.
Target for health for all by 2000 and
beyond 2000
• Health for all is defined as the attainment of a level
of health that will enable every individual to lead a
socially and economically productive life. Health
for all is a holistic concept calling for efforts in
agriculture, industry education, housing and
communication, just as much as in medicine and
public health.
 What we aimed at to be
achieved by 2000….
Topics Goals by 2000 What we
achieved
IMR per 1000 live reduce from 107 to 45 64 per 1000
births
Population growth rate reduce from 2.66 to less than 2 2.11%
percent
Life expectancy at increase from 51 to 65 years 62.33
birth both for men and women
Health Worker to One health worker for every 1 doctor: 18,439
Population 3000 of the population people
ratio One trained nurse 1 nurse : 4987
for every 600 people
population (2003)
One community
health volunteer for
every 500
 Then came “ Millennium
Development Goal”

• At the millennium summit of September 2000, the

member state of UN adopted the millennium declaration

aims to bring peace, security and development to all the

people. The Millennium Development Goals (MDGs)

are 8 goals that UN Member States have agreed to try to

achieve by the year 2015.

• The MDGs are derived from this Declaration.

• Each MDG has targets set for 2015 and
indicators to monitor progress. Several of
these relate directly to health.
 Millennium Development Goal

September
2000

8 Goals with
3
Health
To be 189
Goals
Achieved by member
2015 states
 Millennium Development Goals
Aims
- To bring peace, security & development to all people.

- 8 goals, 18 targets & 48 indicators were mentioned.

Goals
Goal 1- Eradicate extreme poverty & hunger
Goal 2- Achieve universal primary education
Goal 3- Promote gender equality & empower women
Goal 4- Reduce child mortality
Goal 5- Improve maternal health
Goal 6- Combat HIV/AIDS, Malaria & other diseases
Goal 7- Ensure environmental sustainability
Goal 8- Develop a global partnership for development
 Sustainable
Development goal
The Sustainable Development goal is a set of
international development goals from 2016 to 2030,
which was adopted by the UN Sustainable Development
Summit held in September 2015 building on the success
of Millennium Development Goals (MDGs).
 The 2030 Agenda listed “Sustainable Development
Goals” consisting of 17 goals and 169 targets in order
to eradicate poverty and realize a sustainable world.
The SDGs are universal goals applicable, not only to
developing countries but also developed countries,
and pledge “Leave no one behind.” through the
implementation process.
• Goal 1. End poverty in all its forms everywhere

• Goal 2. End hunger, achieve food security and improved

nutrition and promote sustainable agriculture.

• Goal 3. Ensure healthy lives and promote well-being

for all at all ages

• Goal 4. Ensure inclusive and equitable quality education

and promote lifelong learning opportunities for all
• Goal 5. Achieve gender equality and empower
all women and girls
• Goal 6. Ensure availability and sustainable
management of water and sanitation for all.
• Goal 7. Ensure access to affordable, reliable,
sustainable and modern energy for all.
• Goal 8. Promote sustained, inclusive and sustainable
economic growth, full and productive employment and
decent work for all.

• Goal 9. Build resilient infrastructure, promote inclusive

and sustainable industrialization and foster innovation

• Goal 10. Reduce inequality within and among countries.

• Goal 11. Make cities and human settlements inclusive,

safe, resilient and sustainable.
• Goal 12. Ensure sustainable consumption and production patterns

• Goal 13. Take urgent action to combat climate change and its

impacts

• Goal 14. Conserve and sustainably use the oceans, seas and

marine resources for sustainable development

• Goal 15. Protect, restore and promote sustainable use of

terrestrial(Global) ecosystems, sustainably manage forests,

combat desertification, and halt and reverse land degradation and

halt biodiversity loss

• Goal 16. Promote peaceful and inclusive societies for
sustainable development, provide access to justice for
all and build effective, accountable and inclusive
institutions at all levels

• Goal 17. Strengthen the means of implementation and

revitalize the Global Partnership for Sustainable
Development
Goal 1: End poverty in all its forms
everywhere
 SDG 1: End poverty in all its forms
everywhere
• Target 1.1 By 2030, eradicate extreme poverty for all
people everywhere, currently measured as people living
on less than $1.25 a day
• Target 1.2 By 2030, reduce at least by half the
proportion of men, women and children of all ages living
in poverty in all its dimensions according to national
definitions
• Target 1.3 Implement nationally appropriate social
protection systems and measures for all, including floors,
and by 2030 achieve substantial coverage of the poor and
the vulnerable
• Target 1.4 By 2030, ensure that all men and women, in
particular the poor and the vulnerable, have equal
rights to economic resources, as well as access to basic
services, ownership and control over land and other
forms of property, inheritance, natural resources,
appropriate new technology and financial services,
including microfinance.

• Target 1.5 By 2030, build the resilience of the poor

and those in vulnerable situations and reduce their
exposure and vulnerability to climate-related extreme
events and other economic, social and environmental
shocks and disasters
Goal 2: End hunger, achieve food security and
improved nutrition and promote sustainable
agriculture
SDG 2: End hunger, achieve food security and
improved
nutrition and promote sustainable agriculture
• Target 2.1 By 2030, end hunger and ensure access by
all people, in particular the poor and people in
vulnerable situations, including infants, to safe,
nutritious and sufficient food all year round.

• Target 2.2 By 2030, end all forms of malnutrition,

including achieving, by 2025, the internationally
agreed targets on stunting and wasting in children
under 5 years of age, and addressing the nutritional
needs of adolescent girls, pregnant and lactating
women and older persons
• Target 2.3 By 2030, double the agricultural productivity and
incomes of small-scale food producers, in particular women,
indigenous peoples, family farmers, pastoralists and fishers,
including through secure and equal access to land, other
productive resources and inputs, knowledge, financial
services, markets and opportunities for value addition and
non-farm employment.

• Target 2.4 By 2030, ensure sustainable food production

systems and implement resilient agricultural practices that
increase productivity and production that help maintain
ecosystems; that strengthen capacity for adaptation to climate
change, extreme weather, drought, flooding and other
disasters and that progressively improve land and soil quality
 Contd.
• Target 2.5 By 2020, maintain the genetic diversity
of seeds, cultivated plants and farmed and
domesticated animals and their related wild
species, including through soundly managed and
diversified seed and plant banks at the national,
regional and international levels, and ensure access
to and fair and equitable sharing of benefits arising
from the utilization of genetic resources and
associated traditional knowledge, as internationally
agreed
Goal 3: Ensure healthy lives and
promote well- being for all at all
ages
• Target 3.1 By 2030, reduce the global maternal
mortality ratio to less than 70 per 100,000 live
births.

• Target 3.2 By 2030, end preventable deaths of

newborns and children under 5 years of age.

• Target 3.3 By 2030, end the epidemics of

AIDS, tuberculosis, malaria and neglected
tropical diseases, and combat hepatitis, water-
borne diseases and other communicable diseases
• Target 3.4 By 2030,reduce by one third premature
mortality from non-communicable diseases
(NCDs) through prevention and treatment and
promote mental health and well being.

• Target 3.5 Strengthen the prevention and

treatment of substance abuse, including narcotic
drug abuse and harmful use of alcohol.

• Target 3.6 By 2020, halve the number of global

deaths and injuries from road traffic accidents
• Target 3.7 By 2030, ensure universal access to sexual
and reproductive health-care services, including for
family planning, information and education, and the
integration of reproductive health into national
strategies and program.
• Target 3.8 Achieve universal health coverage,
including financial risk protection, access to quality
essential health-care services and access to safe,
effective, quality and affordable essential medicines
and vaccines for all.
• Target 3.9 By 2030, substantially reduce the number
of deaths and illnesses from hazardous chemicals and
air, water and soil pollution and contamination
Goal 4: Ensure inclusive and
quality education for all and
promote lifelong learning
• Target 4.1 By 2030, ensure that all girls and
boys complete free, equitable and quality
primary and secondary education leading to
relevant and effective learning outcomes.

• Target 4.2 By 2030, ensure that all girls and

boys have access to quality early childhood
development, care and pre-primary
education so that they are ready for primary
education
• Target 4.3 By 2030, ensure equal access for all
women and men to affordable and quality
technical, vocational and tertiary education,
including university.

• Target 4.4 By 2030, increase by 75 percent the

number of youth and adults who have relevant
skills, including technical and vocational skills,
for employment, decent jobs and entrepreneurship
• Target 4.5 By 2030, eliminate gender disparities in
education and ensure equal access to all levels of
education and vocational training for the vulnerable,
including persons with disabilities, indigenous peoples and
children in vulnerable situations
• Target 4.6 By 2030, ensure that all youth and at least 95
percent of adults, both men and women, achieve literacy
and numeracy
• Target 4.7 By 2030, ensure that all learners acquire the
knowledge and skills needed to promote sustainable
development, including, among others, through education
for sustainable development and sustainable lifestyles,
human rights, gender equality, promotion of a culture of
peace and non-violence, global citizenship and appreciation
of cultural diversity and of culture’s contribution to
sustainable development
Goal 5: Achieve gender equality
and empower all women and
girls
• Target 5.1 End all forms of discrimination
against all women and girls everywhere.

• Target 5.2 Eliminate all forms of violence

against all women and girls in the public and
private spheres, including trafficking and
sexual and other types of exploitation.

• Target 5.3 Eliminate all harmful practices,

such as child, early and forced marriage and
female genital mutilation
• Target 5.4 Recognize and value unpaid care and
domestic work through the provision of public services,
infrastructure and social protection policies and the
promotion of shared responsibility within the household
and family as nationally appropriate
• Target 5.5 Ensure women’s full and effective
participation and equal opportunities for leadership at all
levels of decision-making in political, economic and
public life
• Target 5.6 Ensure universal access to sexual and
reproductive health and reproductive rights as agreed in
accordance with the Programme of Action of the
International Conference on Population and
Development and the Beijing Platform for Action and
the outcome documents of its review conferences
 Goal 6: Ensure access to water and
sanitation for all

21 March, 2016
• Target 6.1 By 2030, achieve universal and equitable
access to safe and affordable drinking water.

• Target 6.2 By 2030, achieve access to adequate and

equitable sanitation and hygiene for all and end open
defecation, paying special attention to the needs of
women and girls and those in vulnerable situations for all.

• Target 6.3 By 2030, improve water quality by reducing

pollution, eliminating dumping and minimizing release of
hazardous chemicals and materials, halving the
proportion of untreated waste water and increasing
recycling and safe reuse
• Target 6.4 By 2030, substantially increase water-use
efficiency across all sectors and ensure sustainable
withdrawals and supply of freshwater to address water
scarcity and substantially reduce the number of people
suffering from water scarcity
• Target 6.5 By 2030, implement integrated water
resources management at all levels, including through
trans boundary cooperation as appropriate
• Target 6.6 By 2020, protect and restore water-related
ecosystems, including mountains, forests, wetlands,
rivers, aquifers and lakes
Goal 7: Ensure access to affordable,
reliable, sustainable and modern
energy for all
Goal 8: Promote inclusive and sustainable economic
growth, employment and decent work for all
• Target 8.1 Sustain per capita economic growth
in accordance with national circumstances
and, in particular, at least 7 percent gross
domestic product growth per annum in the
least developed countries
• Target 8.2 Achieve higher levels of economic
productivity through diversification,
technological upgrading and innovation,
including through a focus on high-value-added
and labour-intensive sectors
• Target 8.3 Promote development-oriented policies that
support productive activities, decent job creation,
entrepreneurship, creativity and innovation, and
encourage the formalization and growth of micro-,
small- and medium-sized enterprises, including through
access to financial services.

• Target 8.4 Improve progressively, through 2030, global

resource efficiency in consumption and production and
endeavour to decouple economic growth from
environmental degradation, in accordance with the 10-
year framework of programmes on sustainable
consumption and production, with developed countries
taking the lead
• Target 8.5 By 2030, achieve full and productive
employment and decent work for all women and men,
including for young people and persons with
disabilities, and equal pay for work of equal value

• Target 8.6 By 2020, substantially reduce the proportion

of youth not in employment, education or training

• Target 8.7 Take immediate and effective measures to

secure the prohibition and elimination of the worst
forms of child labour, eradicate forced labour and, by
2025, end child labour in all its forms, including the
recruitment and use of child soldiers
• Target 8.8 Protect labour rights and promote safe
and secure working environments for all workers,
including migrant workers, in particular women
migrants, and those in precarious employment.

• Target 8.9 By 2030, devise and implement policies

to promote sustainable tourism that creates jobs
and promotes local culture and products.

• Target 8.10 Strengthen the capacity of domestic

financial institutions to encourage and expand
access to banking, insurance and financial services
for all
 Goal 9: Build resilient infrastructure, promote
sustainable industrialization and foster innovation
Goal 10: Reduce inequality within
and among countries
Goal 11: Make cities inclusive, safe, resilient and
sustainable
 Goal 12: Ensure sustainable
consumption and production
patterns
Goal 13: Take urgent action to
combat climate change and its
impacts
Goal 14: Conserve and sustainably
use the oceans, seas and marine
resources
• Target 14.1 By 2025, prevent and
significantly reduce marine pollution of all
kinds, in particular from land based activities,
including marine debris and nutrient pollution.

• Target 14.2 By 2020, sustainably manage and

protect marine and coastal ecosystems to avoid
significant adverse impacts, including by
strengthening their resilience, and take action
for their restoration in order to achieve healthy
and productive oceans
• Target 14.3 Minimize and address the impacts
of ocean acidification, including through
enhanced scientific cooperation at all levels.
• Target 14.4 By 2020, effectively regulate harvesting
and end overfishing, illegal, unreported and unregulated
fishing and destructive fishing practices and implement
science-based management plans, in order to restore
fish stocks in the shortest time feasible, at least to levels
that can produce maximum sustainable yield as
determined by their biological characteristics.

• Target 14.5 By 2020, conserve at least 10 percent of

coastal and marine areas, consistent with national and
international law and based on the best available
scientific information
 Contd.
• Target 14.6 By 2020, prohibit certain forms of fisheries
subsidies which contribute to overcapacity and overfishing,
eliminate subsidies that contribute to illegal, unreported and
unregulated fishing and refrain from introducing new such
subsidies, recognizing that appropriate and effective special and
differential treatment for developing and least developed
countries should be an integral part of the World Trade
Organization fisheries subsidies negotiation.

• Target 14.7 By 2030, increase the economic benefits to small

island developing states and least developed countries from the
sustainable use of marine resources, including through
sustainable management of fisheries, aquaculture and tourism
Goal 15: Sustainably manage forests, combat desertification,
halt and reverse land degradation, halt biodiversity loss
• Target 15.1 By 2020, ensure the conservation,
restoration and sustainable use of terrestrial and inland
freshwater ecosystems and their services, in particular
forests, wetlands, mountains and dry lands, in line with
obligations under international agreements
• Target 15.2 By 2020, promote the implementation of
sustainable management of all types of forests, halt
deforestation, restore degraded forests and increase
afforestation and reforestation
• Target 15.3 By 2020, combat desertification, restore
degraded land and soil, including land affected by
desertification, drought and foods, and strive to achieve a
land-degradation-neutral world
• Target 15.4 By 2030, ensure the conservation of mountain
ecosystems, including their biodiversity, in order to
enhance their capacity to provide benefits that are essential
for sustainable development
• Target 15.5 Take urgent and significant action to reduce
the degradation of natural habitats, halt the loss of
biodiversity and, by 2020, protect and prevent the
extinction of threatened species
• Target 15.6 Ensure fair and equitable sharing of the
benefits arising from the utilization of genetic resources
and promote appropriate access to such resources
 Contd.
• Target 15.7 Take urgent action to end poaching and
trafficking of protected species of flora and fauna and
address both the demand and supply sides of illegal
wildlife products
• Target 15.8 By 2020, introduce measures to prevent the
introduction and significantly reduce the impact of
invasive alien species on land and water ecosystems and
control or eradicate the priority species
• Target 15.9 By 2020, integrate ecosystem and biodiversity
values into national and local planning, development
processes, poverty reduction strategies and accounts
Goal 16: Promote just, peaceful and
inclusive societies
Goal 17: Revitalize the global
partnership for sustainable
development
• Target 17.1 Strengthen domestic resource
mobilization, including through international support
to developing countries, to improve domestic capacity
for tax and other revenue collection
• Target 17.2 Developed countries to implement fully
their official development assistance commitments,
including to provide 0.7 percent of gross national
income in official development assistance to
developing countries, of which 0.15 to 0.20 percent
should be provided to least developed countries
• Target 17.3 Mobilize additional financial resources
for developing countries from multiple sources
• Target 17.4 Assist developing countries in attaining long-
term debt sustainability through coordinated policies
aimed at fostering debt financing, debt relief and debt
restructuring, as appropriate, and address the external debt
of highly indebted poor countries to reduce debt distress
• Target 17.5 Adopt and implement investment promotion
regimes for least developed countries
• Target 17.6 Enhance North-South, South-South and
triangular regional and international cooperation on and
access to science, technology and innovation and enhance
knowledge sharing on mutually agreed terms, including
through improved coordination among existing
mechanisms, in particular at the United Nations level, and
through a global technology facilitation mechanism when
agreed upon
• Target 17.7 Promote the development,
transfer, dissemination and diffusion of
environmentally sound technologies to
developing countries on favourable terms,
including on concessional and preferential
terms, as mutually agreed
• Target 17.8 Fully operationalize the
technology bank and science, technology and
innovation capacity-building mechanism for
least developed countries by 2017 and enhance
the use of enabling technology, in particular
information and communications technology
• Target 17.9 Enhance international support for
implementing effective and targeted capacity-building in
developing countries to support national plans to
implement all the sustainable development goals,
including through North-South, South-South and
triangular cooperation
• Target 17.10 Promote a universal, rules-based, open, non-
discriminatory and equitable multilateral trading system
under the World Trade Organization, including through
the conclusion of negotiations under its Doha
Development Agenda
• Target 17.11 Significantly increase the exports of
developing countries, in particular with a view to doubling
the least developed countries’ share of global exports by
2020
• Target 17.12 Realize timely implementation of duty-
free and quota-free market access on a lasting basis for
all least developed countries, consistent with World
Trade Organization decisions, including by ensuring
that preferential rules of origin applicable to imports
from least developed countries are transparent and
simple, and contribute to facilitating market access
• Target 17.13 Enhance global macroeconomic stability,
including through policy coordination and policy
• coherence
• Target 17.14 Enhance policy coherence for
sustainable development
• Target 17.15 Respect each country’s policy space and
leadership to establish and implement policies for
poverty eradication and sustainable development
• Target 17.16 Enhance the global partnership for
sustainable development, complemented by multi-
stakeholder partnerships that mobilize and share
knowledge, expertise, technology and financial
resources, to support the achievement of the
sustainable development goals in all countries, in
particular developing countries
• Target 17.17 Encourage and promote effective
public, public-private and civil society partnerships,
building on the experience and resourcing strategies
of partnerships
• Target 17.18 By 2020, enhance capacity-building
support to developing countries, including for least
developed countries and small island developing states,
to increase significantly the availability of high-quality,
timely and reliable data disaggregated by income,
gender, age, race, ethnicity, migratory status, disability,
geographic location and other characteristics relevant
in national contexts
• Target 17.19 By 2030, build on existing initiatives to
develop measurements of progress on sustainable
development that complement gross domestic product,
and support statistical capacity-building in developing
countries
PHC approach in current National Health
Plan and second long term health plan

The National Health Policy was adopted in

1991 to bring about improvement in the health
condition of the people of Nepal.
The primary objective of the National Health
Policy is to extend the primary health care
system to the rural population so that they
benefit from modern medical facilities and the
services from trend health care providers.
NationalContd…
Health Policy
As the existing health policy 2048 (1991) was insufficient to
ensure citizen’s right to quality health care through appropriate
response new national health policy had to be promulgated in
2071 (2014).
A complete revision of the NHP 2048 has been introduced to
promote, preserve, improve and rehabilitate the people by
preserving the earlier achievement, appropriately addressing the
existing and newly emerging challenges and by optimally
mobilizing all necessary resources through a publicly accountable
efficient management.
 National Health Policy

• The Constitution of Nepal has established basic

health care as a fundamental right of its citizens. As
country has moved to federal governance system, it is
the responsibility of the state to ensure the access of
quality health services for all citizens based on
contextual norms of federal system.
• This National Health policy, 2019 has been formulated
on the basis of the lists of exclusive and concurrent
powers and functions of federal, state and local levels as
per the constitution; the policies and programmes of the
Government of Nepal; the international commitments
made by Nepal at different times; and the problems,
challenges, available resources and evidences in the
health sector. This national health policy has overall 25
policies and 146 strategies to improve the health sector.
Vision
• Healthy, alert and conscious citizens oriented to
happy life.

Mission
• To ensure fundamental health rights of citizens
through optimum and effective use of resources,
collaboration and participations.
Goal
• To develop and expand a health system for all citizens
in the federal structure based on social justice and
good governance and ensure access to and utilization
of quality health services.
 Objectives

• To create opportunities for all citizens to use their

constitutional rights to health.
• To develop, expand and improve all types of health
systems as per the federal structure.
• To improve the quality of health services delivered by
health institutions of all levels and to ensure easy
access to those services.
• To strengthen social health protection system by
integrating the most marginalized sections.

• To promote multi-sectoral partnership and

collaboration between governmental, non-
governmental and private sectors and to promote
community involvement, and

• To transform the health sector from profit-orientation

to service-orientation.
 Policies
1. Free basic health services shall be ensured from
health institutions of all levels as specified.

2. Specialized services shall be made easily accessible

through health insurance.

3. Access to basic emergency health services shall be

ensured for all citizens.
4. Health system shall be restructured, improved,
developed and expanded at federal, state and local
levels as per the federal structure.

5. In accordance with the concept of universal health

coverage, promotional, preventive, curative,
rehabilitative and palliative services shall be
developed and expanded in an integrated manner.
6. Collaboration and partnerships among
governmental, non-governmental and private
sectors shall be promoted, managed and regulated
in the health sector and private, internal and
external investments in health education, services
and researches shall be encouraged and protected.

7. Ayurveda, naturopathy, Yoga and homeopathy shall

be developed and expanded in an integrated way;
8. In order to make health services accessible, effective
and qualitative, skilled health human resources shall
be developed and expanded according to the size of
population, topography and federal structure, hence
managing health services.

9. Structures of Health Professional Councils shall be

developed, expanded and improved to make health
services provided by individuals and institutions
effective, accountable and qualitative.
10. Domestic production of quality drugs and
technological health materials shall be promoted
and their access and proper utilization shall be
ensured through regulation and management of
efficient production, supply, storage and
distribution.

11. Integrated preparedness and response measures

shall be adopted to combat communicable diseases,
insect-borne and animal-borne diseases, problems
related with climate change, other diseases,
epidemics and disasters.
12. Individuals, families, societies and concerned
agencies shall be made responsible for prevention
and control of non-communicable diseases and
integrated health system shall be developed and
expanded.

13. In order to improve nutritional situation,

adulterated and harmful foods shall be discouraged
and promotion, production, use and access to
qualitative and healthy foods shall be expanded;
14. Health researches shall be made of international
standards and the findings and facts of such reports
shall be effectively used in policy formulation,
planning and health system development

15. The health management information system shall be

made modem, qualitative and technology-friendly
and integrated health information system shall be
developed
16. Right to information related to health and right of a
beneficiary to know about the treatment shall be
ensured.

17. Mental health, oral, eye, ENT (ear, nose and throat)
health services shall be developed and expanded;
18. Quality of health services provided by all health
institutions including hospitals shall be ensured.

19. Good governance and improvement shall be

ensured in policy-related, institutional and
managerial structures in the health sector through
timely amendments;
20. In accordance with the concept of health across the
lifecycle, health services around safe motherhood,
child health, adolescence and reproductive health,
adult and senior citizen shall be developed and
expanded.

21. Necessary financial resources and special fund shall

be arranged for sustainable development of the
health sector,
22.Urbanization, internal and external migration
shall be managed and public health problems
associated with such phenomena shall be
resolved

23.Demographic statistics shall be managed,

researched and analysed to link them with
the policy decisions and programme
designing:
24. Antimicrobial resistance shall be reduced, one-door
health policy shall be developed and expanded for
the control and management of communicable
diseases, environmental pollution such as air
pollution, sound pollution and water pollution shall
be scientifically. regulated and controlled.

25. Necessary arrangements shall be made to reduce

the risks of immigration process on public health
and to provide health protection to Nepalese staying
abroad.
 2nd Long Term Health Plan (1997-2017)

- MoHP has developed a 20 year Second Long-Term

Health Plan for 1997-2017. Focus on gender, disparities
in health care & access to quality health care services.
Aims
- To guide health sector development for the overall
improvement of the health of the population.

- To provide a guiding framework to develop successive

periodic & annual health plans.
- To develop appropriate strategies, programme & action
plans that reflect national health priorities that are
affordable & consistent with available resources.

- To ensure co-ordination among public, private & NGO

sectors & development partners.
• Objectives
- To improve the health status of population of the most
vulnerable groups.

- To extend to all districts cost-effective public health

measures & essential curative services for the appropriate
treatment of common diseases & injuries.

- To provide technically competent & socially responsible

health personnel.
- To improve the mgnt & organization of public health
sector & to increase the efficiency & effectiveness of the
health care system.

- To develop appropriate roles for NGOs & public &

private sectors in providing health services.

- To improve inter & extra sectoral co-ordination & to

provide the necessary support for effective
decentralization of health care services with full
community participation.
 Targets of the SLTHP
• To reduce the infant mortality rate to 34.4/1000.

• To reduce the under-five mortality rate to 62.5/1000.

• To reduce the total fertility rate to 3.05.

• To increase life expectancy to 68.7 years.

• To reduce the crude birth rate to 26.6 per thousand.

• To reduce the crude death rate to 6/1000.

 Cont.

• To reduce the maternal mortality rate to 250

per hundred thousand births;

• To increase the contraceptive prevalence rate to

58.2 percent;

• To increase the percentage of deliveries

attended by trained personnel to 95%;
 Cont.
• To increase the percentage of pregnant women
attending a minimum of four antenatal visits to
80%;

• To reduce the percentage of iron-deficiency

anemia among pregnant women to 15%;

• To increase the percentage of women of child-

bearing age (15-44) who receive tetanus toxoid
(TT2) to 90%;
 Cont.

• To decrease the percentage of newborns

weighing less than 2.5 kg to 12%;

• To have essential healthcare services (EHCS)

in the districts available to 90% of the
population living within 30 minutes' travel time
of facilities;
 Cont.

• To have essential drugs available at 100% of

facilities;

• To equip 100% of facilities with full staff to

deliver essential health care services; and

• To increase total health expenditures to 10% of

total government expenditures.
Thank
You