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THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health Care, Northern-West State Medical University named after I.I. Mechnikov, Saint- Petersburg
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Page 1: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION

Elena A. AbumuslimovaPh.D., Assistant Professor

Department of Public Health and Health Care,Northern-West State Medical University named after I.I. Mechnikov, Saint-Petersburg

Page 2: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

DECLARATION OF ALMA-ATA

In 1978 the WHO Declaration of Alma-Ata launched primary health care as the route to health for allhealth for all. This was a deliberate effort to tackle huge, and largely avoidable, differences in the health status of populations.

It means that people should not be denied access to life-saving and health-promoting interventions for unfair reasons, including those with economic or social causes.

Page 3: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

WHO: THE WORLD HEALTH REPORT, 2008

Primary health care is a people-centered approach to health that makes prevention as important as cure. As part of this preventive approach, it tackles the root causes of ill health, also in non-health sectors, thus offering an upstream attack on threats to health.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding the emergency wards of hospitals. …primary health care produces better outcomes, at lower costs, and with higher user satisfaction.

Page 4: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

WHO: THE ULTIMATE GOAL WHO: THE ULTIMATE GOAL OF PRIMARY HEALTH CARE OF PRIMARY HEALTH CARE

IS IS BETTER HEALTH FOR ALL. BETTER HEALTH FOR ALL.

Page 5: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

FIVE KEY ELEMENTS TO ACHIEVING THAT GOAL: reducing exclusion and social disparities

in health (universal coverage reforms); organizing health services around

people's needs and expectations (service delivery reforms);

integrating health into all sectors (public policy reforms);

pursuing collaborative models of policy dialogue (leadership reforms);

increasing stakeholder participation.

Page 6: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

GLOBAL TARGETS OF PHC BY WHO(1)

All people in every country will have ready access at least to essential health care & to first-level referral facilities

All people will be actively involved in carring for themselves & their families, as far as they can, in community action for health

Communities throughout the world will share government’s responsibility for the health care of their members

All governments will assume the overall responsibility for the health of their people

Safe drinking water & sanitation will be available to all people

Page 7: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

GLOBAL TARGETS OF PHC BY WHO (2)

All people will be adequately nourished All children will be immunizes against

the major diseases of childhood Communicable diseases in the

developing countries will be of no greater public health significance than they were in the developed countries

All possible ways will be applied to prevent & control non-communicable diseases& promote mental health through influencing the life styles & controlling the physical & psychological environment

Essential drugs will be available to all

Page 8: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

OBSTACLES TO THE IMPLEMENTATION OF PHC STRATEGY

Misinterpretation of the PHC Concept Misconception that PHC is a second rate

health care for poor Selective PHC Strategies Resistance to Change Lack of political will Centralized Planning & Management

Infrastructure

Page 9: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

REASONS FOR SLOW PROGRESS TOWARDS HEALTH FOR ALL (1)

Insufficient Political commitment to implementation of HFA

Failure to achieve equity in access to all PHC elements

The continuing low status of women Slow socioeconomic development Difficulty in achieving intersectoral

action for health Unbalanced distribution of, and week

support for, human resources

Page 10: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

REASONS FOR SLOW PROGRESS TOWARDS HEALTH FOR ALL (2)

Widespread inadequacy of health promotion activities

Weak health information systems and no baseline data

Pollution, poor food safety, and lack of safe water supply and sanitation

Rapid demographic and epidemiological changes

Inappropriate use of, and allocation of resources for, high cost technology

Natural and man-made disasters

Page 11: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

NEW TRENDS THAT WILL INFLUENCE HEALTH IN THE 21ST CENTURY Widespread absolute and relative poverty Demographic changes: aging and growth of

cities Epidemiological changes: continuing high

incidence of infections diseases; increasing incidence of non-communicable diseases, injuries and violence

Global environmental threats to human survival

New technologies: information and telemedicine services

Advances in biotechnology Globalization of trade, travel and spread of

values and ideas

Page 12: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

PRIMARY HEALTH CARE IN THE 21TH CENTURY

Policy Objectives to Reinforce the PHC Policy Objectives to Reinforce the PHC approach by WHO:approach by WHO:

Make health central to development and enhance prospects for intersectoral action

Combat poverty as a reflection of PHCs concern for social justice

Promote equity in access to health care Build partnerships to include families,

communities and their organizations Reorient health systems towards

promotion of health and prevention of disease

Page 13: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

PRINCIPLES OF PHC

Health Prevention & Promotion Equity Appropriate Technology Community Participation Intersectoral Coordination Decentralization

Page 14: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

COMPONENTS OF PHC

Education concerning prevailing health problems & the methods of preventing & controlling them

Promotion of food supply and proper nutrition

An adequate supply of safe water and basic sanitation

Maternal and Child Health (MCH) including Family Planning (FP)

Immunization against major infectious diseases

Prevention and control of locally endemic diseases

Appropriate treatment of common diseases and injuries

Provision of essential drugs

Page 15: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE ORGANIZATION OF THE ORGANIZATION OF PRIMARY PUBLIC HEALTH PRIMARY PUBLIC HEALTH

SERVICES SERVICES IN RUSSIAN FEDERATIONIN RUSSIAN FEDERATION

Page 16: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

ESTABLISHMENTS IN PHC IN RUSSIA

Polyclinic (render the territorial polyclinics serving adult population)

Children's polyclinics Female consultations

protect the motherhood and the childhood

Page 17: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

A MODERN POLYCLINIC IS A LARGE A MODERN POLYCLINIC IS A LARGE MULTYFIELD TREATMENT-&-MULTYFIELD TREATMENT-&-

PROPHYLACTIC ESTABLISHMENT, PROPHYLACTIC ESTABLISHMENT, INTENDED TO RENDER MEDICAL AID INTENDED TO RENDER MEDICAL AID AT OUTPATIENT RECEPTION HOURS & AT OUTPATIENT RECEPTION HOURS &

AT HOME, AT HOME, & ALSO TO REALIZE A COMPLEX OF & ALSO TO REALIZE A COMPLEX OF

PREVENTIVE ACTIONS ON PREVENTIVE ACTIONS ON IMPROVEMENT OF THE POPULATIONIMPROVEMENT OF THE POPULATION

HEALTH AND PREVENTION OF HEALTH AND PREVENTION OF DISEASES.DISEASES.

Page 18: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE MAIN ASPECTS OF WORK OF A MUNICIPAL POLICLINIC medical – diagnostic workmedical – diagnostic work, including selection

for sanatorium-and-spa treatment, examination of temporary disability, reference to medical-

social examination; preventive work, sanitary – antiepidemic preventive work, sanitary – antiepidemic

workwork; organizational – methodical work organizational – methodical work

(management, planning, statistical account and reporting, analysis of activity, improvement of professional skills, etc);

organizational – mass work organizational – mass work (sanitary – hygienic education of the population, popularization of a healthy way of life). Medical workers of a polyclinic should know main risk factors of the major diseases and for popularization of medical knowledge use correctly main forms and methods of educational work.

Page 19: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE BASIC ORGANIZATIONAL - METHODICAL PRINCIPLES OF WORK

District principle District principle - attaching to a medical post of normative number of inhabitants

Dispanserisation method Dispanserisation method - regular active supervision over a state of health of the certain contingents

Accessibility Accessibility of PHC Preventive orientation Preventive orientation of PHC

Page 20: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE BASIC SCHEDULED - NORMATIVE PARAMETERS The district specification The district specification (1700 patients on one

post of the local therapist); Norm of local therapist loading Norm of local therapist loading (5 visits at one

hour on reception in a polyclinic and 2 visits - at patient service at home)

The function of physician position The function of physician position (number of visits per year for one post of doctor)

The regular specification of local therapists The regular specification of local therapists (5,9 on 10 000 inhabitance more senior than 18 years old).

The head physician of a polyclinic has the right to change these parameters depending on local conditions. For example, he can increase or reduce number of a site and loading of doctors.

Page 21: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

FUNCTION OF THE DISTRICT PHYSICIAN-THERAPIST Rendering of the qualified medical aid in

speciality “internal diseases” during outpatient reception hours and at home.

 Provide preventive and sanitary – antiepidemic work, dispensarisation & hygienic popularization.

 Timely hospitalization of patients in accordance with established order.

 Organization of consultations of patients with doctors of other specialties.

 Realization of medical and rehabilitation activities in out-patient establishment.

 Realization of examination of temporary disability and reference to medical-social examination.

 Analysis health status of the served population.

Page 22: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

Reorganization of out-patient - polyclinic service in Russia will pass in a direction of creation of institute of family doctorsfamily doctors/ general practitioner general practitioner (GP). (GP).

GP is the expert widely focused in the basic basic medical specialitiesmedical specialities, and capable to render the multyfield out-patient medical aid for the most widespread diseases and urgent conditions (GP is the highly skilled expert of a primary link at a pre-hospital stage).

Number of a served contingent at the doctor of the general/common/ practice - 1500 adult person, at the family doctor (in view of the children's population) - no more than 1200 person in all age.

Page 23: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

DUTIES OF THE GP (1)

GP should know the demographic and medico-social characteristic of the attached contingent.

Promote healthy way of life; Give recommendations for questions of feeding,

preparations of children for preschool establishments;

Advice about family planning; Carrying out antiepidemic actions; Revealing the primary and latent forms of diseases

and risk factors;

Page 24: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

DUTIES OF THE GP (2)

Organization of all complex of diagnostic, medical - improving and rehabilitation actions;

Diagnostics of pregnancy and supervision over current of pregnancy, treatment extragenital diseases, revealing of contra-indications to pregnancy, a direction on interruption, conducting the postnatal period;

Organization help, together with establishments of social security and services of mercy for lonely, aged and disable people and chronic ill patients, including placement of patient in houses-boarding schools and so forth;

Carrying out of medical-social examination; The analysis of a state of health of the attached

contingent, conducting the registration - accounting documentation.

Page 25: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

PREVENTIVE PROPHYLAXIS CONCEPT

Preventive prophylaxis (preventive Preventive prophylaxis (preventive measures) is a main component of measures) is a main component of

medicinemedicine.

Creation of system of the prevention of Creation of system of the prevention of diseases and elimination of risk factors is diseases and elimination of risk factors is the major social, economic and medical the major social, economic and medical

tasks of the state.tasks of the state.

There are individual and public forms of There are individual and public forms of preventive prophylaxis.preventive prophylaxis.

Page 26: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

Primary preventive maintenancePrimary preventive maintenance Secondary preventive maintenanceSecondary preventive maintenance Tertiary preventive maintenanceTertiary preventive maintenance

THREE KINDS OF PREVENTIVE MAINTENANCE (1):

Page 27: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THREE KINDS OF PREVENTIVE MAINTENANCE (2):

Primary preventive maintenancePrimary preventive maintenance is a system of measures of the prevention of illness occurrence and influence of risk factors in diseases development (vaccination, a rational way of work and rest, a rational qualitative food, physical activity, improvement of an environment, etc.)

Page 28: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THREE KINDS OF PREVENTIVE MAINTENANCE (3):

Secondary preventive maintenanceSecondary preventive maintenance is a complex of actions eliminat the expressed risk factors, which under certain conditions (immune status decrease, the overstrain, adaptability failure) can lead to occurrence, aggravation or relapse of disease.

Page 29: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THREE KINDS OF PREVENTIVE MAINTENANCE (4):

o Tertiary preventive maintenanceTertiary preventive maintenance is a complex of rehabilitation actions of the patients who have lost an opportunity of high-grade ability to live. Tertiary preventive maintenance has four directions of rehabilitations:

o - social (formation of confidence of own social suitability),

o - labour (an opportunity of restoration of labor skills),

o - psychological (restoration of behavioral activity of the person),

o - medical (restoration of functions of bodies and systems).

Page 30: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE MAJOR COMPONENT OF THE MAJOR COMPONENT OF ALL ALL PREVENTIVEPREVENTIVE ACTIONS IS ACTIONS IS

FORMATIONFORMATION AT THE POPULATION AT THE POPULATION MEDICAL -SOCIAL ACTIVITYMEDICAL -SOCIAL ACTIVITY AND AND

INSTALLATIONS ON INSTALLATIONS ON A A HEALTHY WAY OF LIFEHEALTHY WAY OF LIFE..

Page 31: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

DISPENSARISATION (PROFILACTIC MEDICAL EXAMINATION)

DispensarisationDispensarisation is a main method of secondary prophylactic using in PHC.

Dispensary method is regular active Dispensary method is regular active supervisionsupervision over a state of health of the certain groups of patients which include:

active early revelation; dynamic follow up; complex sanitation.

Page 32: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

THE EVALUATION OF THE ORGANIZATION OF THE DISPENSERISATION Quality of dispenserisation:Quality of dispenserisation:1. coverage by dispensary supervision of those who were

not observed within one year period, 2. coverage by various social–prophylactic and medical–

preventive measures (sanatorium-and-spa treatment, invalid food, rational employment, etc.);

 Efficiency of dispensarization: Efficiency of dispensarization: 1. dynamics of morbidity rate and disease rate

according to MRTD (morbidity rate with temporary disability) – for working persons;

2. general disease rate – due to the main and accompanying pathology;

3. hospitalized morbidity;4. incapacity, including primary one;5. lethality; 6. outcomes of dispensarisation according to annual

account – recovery, improvement, without changes, deterioration.

Page 33: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

ESTIMATION OF ACTIVITY OF MUNICIPAL POLYCLINIC

The analysis of activity of out-patient – The analysis of activity of out-patient – polyclinic establishments is carried out polyclinic establishments is carried out forfor::

the improvement of organization of work of municipal polyclinics,

current and forward planning of their activity; evaluation of efficiency of various methods of

treatment evaluation of efficiency of diagnostic, new

medical technologies and new forms of the organization of work;

evaluation of quality of rendering of the primary medical-aid to urban population.

Page 34: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

Occupation of posts of doctors Ratio number of physician posts to number

of posts of the middle medical personnel Dynamics of patient visits to the polyclinic Distribution of visits of a polyclinic by the

form of application (for treatment or for preventive medical check up)

Loading for a medical post (for a year, month, reception hours)

Completeness of coverage of the population served by a polyclinic by preventive medical check ups

QUANTITATIVE COEFFICIENTS OF ACTIVITY OF MUNICIPAL POLYCLINIC

Page 35: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

QUALITATIVE COEFFICIENTS OF ACTIVITY OF MUNICIPAL POLYCLINIC A level of the general disease rate (due to

visits) A level of disease rate with certain diseases Structure of the general disease rate Primary disablement Structure of primary disablement Structure of contingents of the disabled

persons Death rate at home Relative number of incorrect diagnoses Number of the advanced cases of oncologic

diseases Frequency of cases (days) of temporary

disablement. Structure of disease rate with temporary

disablement etc.

Page 36: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION Elena A. Abumuslimova Ph.D., Assistant Professor Department of Public Health and Health.

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