OUTLINE

1
OUTLINE

• Community Health Assessment review
• Health Care Reform
• Primary Health Care
• Video A Better Way to Care, BCs Community
  Health Centres

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HEALTH CARE REFORM

• Started in 1980s in Canada
• Global phenomenon
• Primary Health Care seen as the model for health
  care reform
• PHC was the way to reach the goal of Health for
  All by 2000

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PRIMARY HEALTH CARE

• Was first named in 1978 Alma Ata Declaration on
  Primary Health Care
• Definition page 7, Vollman et al.
• Includes a framework, principles, and essential
  elements (confusing???)
• Philosophy of health care, not just a set of
  activities

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Primary Health Care a philosophy

• First point of contact and much more
• Calls for health care providers to work with
  people to assist them in making decisions about
  their health
• Social justice, equity, participation
• Cost-effectiveness and the capacity to benefit
  those most in need

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PHC a philosophy

• Decentralization
• Adjustment of financing
• Looks at the causes of ill health
• Focus on health promotion
• Balances prevention and promotion with treatment
  and rehabilitation

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PRINCIPLES OF PRIMARY HEALTH CARE

• Health promotion and illness prevention
• Public participation
• Intersectoral and interdisciplinary collaboration
• Accessibility
• Appropriate technology

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Elements of a health system based on PHC

• Education about health problems prevention
• Safe food supply and adequate nutrition
• Safe water and basic sanitation
• Maternal and child care
• Immunization (basic infectious diseases)
• Prevention and control of endemic diseases
  (Malaria, Flu)
• Appropriate treatment of common diseases
• Essential drugs

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Director General of WHO issued a challenge to
nurses around the world

• If the millions of nurses in a thousand different
  places articulate the same ideas and convictions
  about primary health care, and come together as
  one force, then they could act as a powerhouse
  for change. I believe that such a change is
  coming, and that nurses around the globe, will
  greatly help to bring it about. (Mahler, 1985)

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NURSES AND PHC IN CANADA

• Political will for PHC
• CNA and provincial nursing associations
  demonstrated leadership position statements,
  projects, government task forces
• Innovative ideas and collaboration with
  governments

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PHC in Nursing Education

• Survey of 25 university nursing programs (1995)
• 60 had integrated PHC into courses
• Health promotion was the most common principle
  included
• Faculty and students involved in PHC activities
  and projects

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Ongoing efforts by nursing

• Trying to make PHC a reality in Canada
• PHC projects continue
• Lobbying to support PHC
• PHC included in nursing standards and practice
  documents
• Nurse Practitioner programs fit with PHC model

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Critical Analysis of PHC Movement

• Confusion with primary care
• Some integration into the hc system
• Time-limited projects
• Dominant hospital/medical model continues to be a
  barrier
• The work is not done.

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PRIMARY CARE

• The first point of contact with the health care
  system, generally referring to curative and
  rehabilitative care provided to individuals
• Stanhope and Lancaster, 2002.
• (From Stamler Yiu)

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Primary Care

• Services accessed at first point of contact
• Physicians - largest group of primary care
  providers in Canada
• Continues to have a medical focus
• Other providers nurse practitioners, dentists,
  dieticians, chiropractors
• Storefront of the hc delivery system

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Challenges for CHNs (Nurses)

• More research
• Links between PHC theory practice
• Promote community health programs as
  cost-effective and accessible
• Work with clients as equal participants
• Interact with other disciplines sectors
• Integrate PHC in nursing education