Primary Health Care From Alma-Ata Declaration to 21st Century

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Primary Health Care-2

• By
• Col Naseer Alam Tariq (Retd)

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Primary Health CareFrom Alma-Ata
Declaration to 21st Century

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Primary Health Care

• The main goal of the governments and the World
  Health Organization in the coming years should be
• The attainment by all people of the world by
  the year 2000, a level of health that would
  permit them to lead a socially and economically
  productive life.

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Primary Health Care

• 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 country and community can afford

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Principles of PHC

• Equity
• Appropriate technology
• Community Participation
• Intersectoral Coordination

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Components of PHC

• Health Education
• Promotion of proper food and nutrition,
• Adequate supply of safe water and sanitation
• MCH including Family Planning
• Immunization against major diseases
• Prevention and control of locally endemic
  diseases
• Appropriate treatment of common diseases and
  injuries
• Promotion of mental health
• Provision of essential drugs

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PHC- Global Targets

• All people in every country will have ready
  access at least to essential health care and to
  first level referral facilities
• All people will be actively involved in caring
  for themselves and their families, as far as they
  can, in community action for health
• Communities will share responsibility for their
  health
• Safe drinking water and sanitation will be
  available to all people.

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PHC- Global Targets

• All people will be adequately nourished
• All children will be immunized against major
  diseases
• All possible ways will be applied to prevent and
  control non-communicable diseases and promote
  mental health through influencing life styles,
  and controlling the physical and psychological
  environment

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PHC-Extended Elements in 21st Century

• Expanded options of immunizations
• Reproductive Health Needs
• Provision of essential technologies for health
• Health Promotion
• Prevention and control of non-communicable
  diseases
• Food safety and provision of selected food
  supplements

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Millennium Development Goals

• Eradicate extreme poverty and hunger
• Achieve universal primary education
• Improve maternal health
• Reduce child mortality
• Combat HIV/AIDS, malaria, and other communicable
  diseases
• Promote gender equity
• Ensure environmental sustainability
• Develop global partnership for development

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Obstacles to implement PHC Strategy

• Misinterpretation of the PHC Concept
• Misconception that PHC is 2nd rate health care
  for the poor
• Resistance to Change
• Lack of political will
• Centralized planning and Management
  infrastructure

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Primary Health Care

• CAUSES OF FAILURE

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CAUSES OF FAILURE

• Managerial Deficiencies
• Service Delivery Failure
• Community Causes

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MANAGERIAL DEFICIENCIES

• Lack of trained managers
• Lack of selection and training criteria for
  managers
• Lack of proper performance evaluation of health
  managers
• Lack of motivation leading to professional and
  financial corruption

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SERVICE DELIVERY FAILURE

• Accessibility problems
• Utilization Failure
• Efficiency problems

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ACCESSIBILITY ISSUES

• 25 30 of PHC facilities have been ill-planned
  and care usually out of reach of the rural
  community where logistics problems is as big
  issue as is poverty.
• Such facilities are a big problem for
  non-resident PHC staff, which further augments
  the problem, and promotes quackery in such areas.

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UTILIZATION FAILURE

• Since its inception, PHC has been promoted as an
  alternative for curative care. This image has
  been promoted by professional as well as
  political forces.
• The result is that the concept of PHC has been
  buried and PHC has been synonymously taken as 2nd
  degree medical care for the poor.

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UTILIZATION FAILURE (CONTD)

• PHC has been down looked upon resulting in the
  vacuum being filled by virtually non-committed
  untrained staff, which has offered a parallel
  system of tertiary care in PHC facilities at
  minimal or no cost.
• Lack of training and proper monitoring / check
  and balance on the PHC staff.

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UTILIZATION FAILURE (CONTD)

• Not being a government priority
• Lack of quality of care yardsticks for Primary
  Health Care
• No active research in this field
• Government one step forward, two steps backward
  approach to PHC, resulting in lack of consistency
  in various PHC program.

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EFFICIENCY PROBLEMS

• Lack of standardized management protocols for
  common PHC problems
• Off and on and un-rational drug policy of the
  Health Department
• Lack of clear cut policy, regulatory and
  organizational mechanisms resulting in haphazard
  experimentation.

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COMMUNITY CAUSES

• Community participation has been virtually
  non-existent in PHC
• Gap in Community and Public sector has widened
  the bridge.
• Health education has been given a backseat in
  PHC.
• Low literacy levels and economic deprivation has
  forced people to shift entire responsibility of
  their health on state shoulders.

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COMMUNITY CAUSES (CONTD)

• Cultural peculiarities have hindered the way of
  whatsoever little implementation of PHC in NWFP.
  Worst hit areas have been the western cultural
  zone, and the mid and mid-north cultural zones.
• Alternatively quackery has filled in the vacuum
  due to cultural considerations.

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FIVE COMMON SHORTCOMINGS OF HEALTH CARE DELIVERY
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INVERSE CARE

• People with most means whose needs for health
  care are often less consume the most care,
  whereas those with the least means and greatest
  health problems consume the least.
• Public spending on health services most often
  benefits the rich more than the poor in high and
  low income countries alike.

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IMPOVERISHING CARE

• Wherever people lack social protection and
  payment for care is largely out of pocket at the
  point of service, they can be confronted with
  catastrophic expenses.
• Over 100 million people annually fall into
  poverty because they have to pay for health care.

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FRAGMENTED CARE

• The excessive specialization of health care
  providers and the narrow focus of many disease
  control program discourage a holistic approach to
  the individuals and the families they deal with
  and do not appreciate the need for continuity in
  care.
• Health services for poor and marginalized groups
  are often highly fragmented and severely
  under-resourced, while development aid often
  adds to the fragmentation.

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UNSAFE CARE

• Poor system design that is unable to ensure
  safety and hygiene standards leads to high rates
  of hospital acquired infections, along with
  medication errors and other avoidable adverse
  effects that are an underestimated cause of death
  and ill health.

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MISDIRECTED CARE

• Resource allocation clusters around curative
  services at great cost, neglecting the potential
  of primary prevention and health promotion to
  prevent up to 70 of the disease burden.
• At the same time, the health sector lacks the
  expertise to mitigate the adverse effects on
  health from other sectors and make the most of
  what these other sectors can contribute to
  health.

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WAYS TO MOVE AHEAD

• Health has to be linked with education and
  poverty alleviation
• PHC has to be redefined in Government books
• Managerial competencies needs to be developed
  through intensive training and very strict
  monitoring.

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WAYS TO MOVE AHEAD(CONTD)

• Ongoing PHC training for all PHC staff with
  proper monitoring and evaluation and made must
  for all promotions in PHC.
• Financial investment in PHC needs to be increased
  with help of donors.
• Health should further be de-centralized with
  involvement of community and mechanism be made
  for partly community funding of PHC.

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WAYS TO MOVE AHEAD (CONTD)

• Precise, clear cut and unambiguous, policy,
  regulatory and organizational paradigms should be
  constructed for PHC.
• Health department should be prepared for change
  management with clear and unconditional backing
  of NGOs, political forces, and Government.

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THANKS