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Organized at 3 levels & each lvl sp by a higher lvl

to which Patient is referred Primary Health Care

First lvl of contact between indl & health sys Essential health care is provided BHU, RHC Closest to people & less costly Majority of health problems satisfactorily

dealt here

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Secondary Health Care Lvl at which more complex problems are dealt Usually provided at district hospitals Comprises curative services 1st referral level

Tertiary Health Care Lvl which offers super specialist care Provided by regional & central hospitals Provide training progms Costly

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Growing concern in world over unacceptably low

lvls of health status of world population Special concerns

Rural areas Disparities in health between rich & poor Urban & rural

both between countries and within countries

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3 decades of dissatisfaction World Health Assembly (May 1977) decided that

main social goal of govts & WHO in coming yrs should be:“Attainment by all people of the world by yr 2000

of lvl of health that will permit them to lead a socially & economically productive life”

Given the name “ Health for all by year 2000” HFA

Decision to hold conference to achieve this concept in 1978

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Unicef collaborated effort (1978) held at Alma Ata

(former USSR) with 188 countries & NGOs

All countries should deliver at least basic health

svc to indls by 2000

All govts to plan & develop policies / take actions

to implement Primary Health Care in the country

Key to attainment of health for all ???

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“Essential health care that is based on practical,

scientifically sound, socially acceptable methods &

technologies made universally accessible to indls &

communities through their full participation & at the

cost that community & country can afford to

maintain at every stage of their dev in the spirit of

self reliance & self determination”

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E – Health edn about prevailing health problems

L – Prevention & Control of locally endemic diseases

E – Provision of essential drugs

M – MCH care (Maternal & Child health) incl family

planning

E – (EPI) Immunization against infectious diseases

N – Proper nutrition and food supplies

T – Treatment of common diseases & injuries

S – Adequate safe water supply & sanitation

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Equity According to needs”First key principle - equitable distribution of health svcs

Health svcs must be shared equally by all irrespective of their ability to pay & as per need

Aim of PHC is to redress the imbalance by: Shifting the centre of gravity of health care

sys from cities to villages Imbalance of preventive health care svcs &

curative health svcs

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Community Participation A process by which people individually or

collectively assume inc responsibility for their own health needs

No universal coverage without involvement of local community

Community should be involved from Inception of needs Planning Implementation & maint of health svcs

besides reliance on local resources(MMMT)

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Intersectoral Coordination Componants of PHC cannot be provided by health sector alone Alma Ata declaration states: PHC Involves in addition to health sector all related

sectors & aspects of national & community dev in particular agriculture, food, edn,

public works, & others It can be at the lvl of

PlanningPolicy makingProgm & Svc deliveryImplementation, monitoring & eval

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Appropriate Technology Technology that is scientifically sound,

adoptable to local needs, acceptable to those who apply it & can be maint by people themselves

4 x As Available to community Accessible to community Acceptable to community Affordable by the community is called the appropriate technology

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“Essential health care that is based on practical,

scientifically sound, socially acceptable methods &

technologies made universally accessible to indls &

communities through their full participation & at the

cost that community & country can afford to

maintain at every stage of their dev in the spirit of

self reliance & self determination”

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Safe water supply within 15 minute walk 100% safe excreta disposalProvn of health svcs at max of 20 min drive or 01

hour walk100% immunization coverage to all under 5

children IMR should be less than 50/1000 live births MMR should be less that 2/1000 live births

INDICATORS / TGTS OF PHC EVAL STRATEGIES

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Literacy rate more than 70%Family planning coverage to 60% or more eligible

couple Life expectancy > than 62 (for both genders) Provn of 23 essential drugs to all Birth wt of all newborn babies should be > 2500

gm (2.5 kg)

INDICATORS / TGTS OF PHC EVAL STRATEGIES

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Govt of Pakistan embarked on PHC prior to Alma

Ata declaration

Build up sys of “Integrated rural health complex”

which comprises of whole sys of BHU, RHCs,

Tehsil hospitals and DHQs

EPI, CDD, TBA’s trg, malaria &TB control progm

are integral part of this sys

PHC IN PAKISTAN

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PHC IN PAKISTAN

BHUBHU

RHCRHC

BHU BHU BHU

BHUBHU

BHU BHU BHU

THQ

DHQ

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Almost one third of Pakistan's 170 million people live in poverty

More than 60 % live on less than 2 dollars/ day The infant mortality rate for Pakistan is 76.7 per

1,000 live births Maternal Mortality Rate 350/ 100,000 live births 40% of population has access to safe water

supply Literacy rate ??? Life expectancy ???

CURRENT STATUS / INDICATORS OF PAKISTAN

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Political Climate Afghan Russian War with large number of

refugees Rapidly changing political climate -- failure of

proper implementation Law & Order Sit in various areas of Pakistan were

the reason of failure to achieve goals Lack of political cmt by govt Lack of appreciation of multifaceted apch Multiple horizontal progm Curative svcs given pri over preventive svcs

WHY PHC FAILED

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Lack of involvement of community & pte sector Lack of awareness regarding PHC among health

professionals Shortage of health manpower & unequal distr of

resources Technical reasons & lack of implementation Illiteracy, Poverty & population explosion

WHY PHC FAILED

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Idea was to give pri to certain diseases Prevalence of disease Morbidity & disability Effectiveness of measures and their cost

UNICEF proposed selective apch (1982) G - Growth monitoring O - ORT B - Breast feeding I - Immunization F - Family planning F - Female literacy F - Food supplements for children & pregnant women

SELECTIVE HEALTH CARE APCH

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Cmt to Health For All again renewed (1998) by

World Health Assembly

HFA for 21st century or HFA by yr 2000 & beyond

Progm cmt to continue till achievement of its tgts

ANOTHER MILESTONE

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AppropriatenessAvailability AdequacyAccessibilityAcceptabilityAffordability AssessabilityAccountability

BASIC REQ FOR SOUND PHC 8 A’S & 3 C’S

Completeness

Comprehensiveness

Continuity

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MDGs

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MDGs Millennium declaration (Sep 2000) -- 189 members

states of UN made cmt to address poverty

Set date of 2015 for MDG achievement

8 goals defined -- broken down in 21 quantifiable

tgts & measured by 60 indicators

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MDGs Eradicate extreme poverty & hunger Achieve universal primary edn Promote gender equity Reduce child mortality Improve maternal health Combat HIV/AIDS / Malaria & other diseases Ensure environmental sustainability Dev a global partnership for dev

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THANK THANK YOU YOU