Primary Health Care: Definitions and Concepts

Primary Health Care (PHC)

• Defined as a complex network of organizations interacting to deliver health services, as per Dizon in 1977

Alma-Ata Declaration (1978)

• Served as a major 20th-century milestone in public health
• Identified primary health care (PHC) as key to achieving "Health for All."
• It addressed widespread health inequities
• Aimed for "Health for all by year 2000"
• The goals were deemed unrealistic, idealistic, and broad

Health Care System

• Organized system of health services, according to Miller-Keane in 1987

Health Care Delivery

• The actual provision of health services to the people, defined by Williams-Tungpalan in 1981

Health Care Delivery System (Williams-Tungpalan, 1981)

• Network of health facilities and personnel that provide health care to people

What is Primary Health Care?

• Focuses on caring for people instead of solely treating specific diseases
• Usually the first point of contact with the health care system
• Aims to deliver comprehensive and community-based care that meets individuals' health needs throughout their lives
• Includes services from prevention (vaccinations and family planning) to chronic condition management and palliative care
• Palliative care provides specialized care for those with serious illnesses like cancer or heart failure

PHC According to the Alma Ata Declaration

• Intended to reach everyone, especially those with the greatest need
• Extends care to the home and family levels beyond just health facilities
• Involves an ongoing relationship with individuals and families
• Aims for "HEALTH CARE FOR ALL"

Goals of Primary Health Care

• Five key elements as defined by WHO:
• Universal Coverage: Ensures access to needed health services without financial hardship and reduces social disparities in health
• Service Delivery: Organizes services to meet people’s needs and expectations
• Stakeholder Participation and Leadership: Enhances collaborative policy models and dialogue
• Public Policy: Integrates health into all sectors
• The ultimate goal is better health care for all

Essential Elements of Primary Health Care

• Focuses on caring for the people, not just treating disease
• Includes:
  • Adequate and safe water supply and basic sanitation
  • Immunization against major infectious diseases
  • Local endemic disease control
  • Appropriate treatment of common diseases and injuries
  • Provision of essential basic medication
  • Expanded options for immunizations
  • Reproductive health needs
  • Essential technologies for health
  • Health promotion
  • Prevention and control of non-communicable diseases
  • Food safety and selected food supplements

Core Principles of Primary Health Care - WHO

• Universal access to care and coverage based on needs
• Commitment to health equity as part of development oriented to social justice
• Community participation in defining and implementing health agendas
• Intersectoral approaches to health

Management of Primary Health Care - Role of Managers

• Basic functions: Planning, Organizing, Staffing, Controlling, Directing
• Additional roles include communication, problem-solving, collaboration, people development, and cost containment

Management of Primary Health Care

• Health Care Managers execute various functions in management
  • Planning: Setting direction and determining what needs to be accomplished, including priorities and performance targets
  • Organizing: Designing the organization or specific division and designating reporting relationships
  • Staffing: Acquiring and retaining human resources and developing the workforce
  • Controlling: Monitoring staff activities and performance, taking corrective actions
  • Directing: Initiating action through leadership, motivation, and communication

Private Health Sector

• Fosters an environment for necessary and quality health care at maximum profit

Philippine Health Care Delivery System Through the Department of Health (DOH)

• Key function is to promote, protect, preserve, or restore the health of people.
• Achieved through providing and delivering health services
• Regulating and encouraging health providers, goods, and services
• Aligns with the Alma Ata Declaration by concerning itself with the health of an individual

Vision of Department of Health

Health Care Facilities

• Health as a right for all Filipinos by the year 2000 and health in the hands of the people by the year 2020

Mission of Department of Health

• Ensures equity, quality, and access to care by:
  • Making services available
  • Arousing community awareness
  • Mobilizing resources
  • Promoting better health

Levels of Health Care and Referral System

• Categorized into primary, secondary, and tertiary levels, with referral system

Levels of Health Care Facilities

• Includes primary, secondary, and tertiary facilities

Primary Health Care Facilities

• Rural health units, chest and malaria clinics, puericulture centers, tuberculosis clinics, community hospitals, etc.

Secondary Health Care Facilities

• Non-departmentalized hospitals, including emergency and regional hospitals

Tertiary Health Care Facilities

• Medical centers and large/national hospitals with highly technological and sophisticated services

Three Levels of Primary Health Care Workers

• Village/Grassroot health workers: first contacts providing socio-economic support, curative, and preventive care
• Intermediate level: first source of support attending to health problems (practitioners, nurses, midwives)
• First-line hospital: providing backup while establishing close contact with patients; made up of physicians, nurses, dentists, pharmacists

Primary Healthcare Service

• Routine care, urgent care, maternity/child care, disease prevention, counseling, health promotion, rehabilitation, end-of-life care

Secondary Healthcare Service

• Provided by medical specialists through referral or self-referral

Tertiary Healthcare Service

• Cardiologists, urologists, dermatologists, psychiatrists, physiotherapists and speech therapists
• Care includes acute-care, short stays at emergency department
• Advanced medical investigation and treatment
• Includes cancer management, and cardiac surgery

Laboratories According to Function

• Includes clinical and anatomic pathology

Laboratories According to Institutional Character

• Can be hospital-based or non-hospital-based

According to Services Delivered

• Primary Category - routine hematology, routine urinalysis
• Secondary Category - Primary Category laboratory examination, routine chemistry,
• Tertiary Category - Secondary Category laboratory, special chemistry, special hematology, immunology laboratory, immunology laboratory

Fragmentation of Philippine Health System

• Separated into distinct parts

Philippine Health System

• 1979: Adoption of PHC promoted participatory management of local health care
• 1982: Reorganization of DOH integrated public health and hospitals
• 1988: Generics Act requires prescriptions use generic drug names
• 1991: RA 7160 "Local Government Code" transfers health service responsibility to LGUs
• 1995: National Health Act provides financial protection prioritizes those in poverty

Health Sector Reform Agenda 1966

• DOH reorganization to improve health care delivery and regulation

Fourmula One (F1) for Health 2005

• Adoption of operational framework to undertake reforms with speed and precision with effective coordination

RA 9502 “ACCESS TO CHEAPER AND QUALITY MEDICINES ACT” 2008

Promote and ensure access to affordable quality drugs and medicines for all.

KALUSUGANG PANGKALAHATAN 2010

• Universal healthcare coverage and access to quality health care for all Filipinos

Directions of the Philippine Health Sector

• AO 2016-0038: The Philippine Health Agenda
• The Philippine Developmental Plan 2017-2022
• NEDA AmBisyon Natin 2040
• Sustainable Developmental Goals 2030