Primary Health Care Introduction

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Questions and Answers

What are the five types of care embraced by the primary health care approach?

Curative (correct)

Promotive (correct)

Preventive (correct)

Supportive/Palliative (correct)

Rehabilitative (correct)

What does PHC stand for?

Primary Health Care

Equity in health care means that resources should be distributed equally among all individuals.

False

Appropriate technology in primary health care emphasizes the fullest use of available resources and relevant technologies such as ____________.

immunizations Signup and view all the answers

Match the primary health care personnel with their roles:

Community Health Officer (CHOs) = Trained individuals providing patient-facing support and services Senior Community Health Extension Workers (SCHEWs) = Senior cadre member responsible for supervising Junior Community Health Extension Workers and other volunteers Field Health Workers = Health attendants providing field health services Junior Community Health Extension Workers (JCHEWs) = Entry-level workers living and working in the community Public Health Nurses = Health professionals involved in public health programs Signup and view all the answers

What are some examples of health needs mentioned in the provided content?

good roads, good water supply, education, agriculture, Nutritional problems, HIV/AIDS, poverty eradication Signup and view all the answers

What are some responsibilities of a Community Health Officer?

Community, medical, training, and administrative/supervisory responsibilities Signup and view all the answers

Health insurance is a social device for aggregating the health risk and costs with a view towards predictability. In May 1999, the government created the National Health Insurance Scheme for government employees, the organized private sector, and the informal sector. The scheme also covers children under five, permanently disabled persons, and prison inmates. Health insurance could be ______ or voluntary.

mandatory Signup and view all the answers

Out-of-pocket payments are payments made by a patient to a health care provider.

True Signup and view all the answers

What is the purpose of the National Health Management Information System?

collecting, collating, processing/analyzing data and disseminating information to stakeholders Signup and view all the answers

A referral system involves transferring the management of a patient's condition only from a higher level of care to a lower level.

False Signup and view all the answers

In order to establish and sustain an effective referral system in a LGA, all cases that need referral services should be ____________.

referred Signup and view all the answers

What are factors that affect the functioning of a referral system? (Select all that apply)

Affordability of cost of transport Signup and view all the answers

Match the following with their descriptions:

Positive human relationship = Built on trust, mutual respect, credibility Continuity of care = Describes a lasting relationship between health workers and society Relationship between first referral center and health facilities = Establishes a referral system Signup and view all the answers

What is the role of a Spokesman in an organization?

Transmit information to outsiders Signup and view all the answers

What is the responsibility of a Decisional Entrepreneur in an organization?

Search for opportunities and bring about change Signup and view all the answers

Define 'Scalar Chain' in the context of management principles.

Scalar chain refers to the line of authority from the top to the bottom of an organization. Signup and view all the answers

Unity of command follows the principle of one __________, one superior.

man Signup and view all the answers

Match the following management principles with their descriptions:

Subordination of individual interest to the general interest = Interests of one individual should not prevail over the general good Initiative = Encouraging staff at all levels to show initiative within authority limits Order = Assigning the right man to the right place Equity = Combination of kindness and justice towards employees Signup and view all the answers

Study Notes

Definition of Primary Health Care

Primary Health Care (PHC) is essential health care based on practical, scientifically sound, and socially acceptable methods and technology.
It is made universally accessible to individuals and families in the community through their full participation and at a cost the community and country can afford.
PHC is a philosophy of health care and an approach to providing health services that includes promotive, preventive, curative, rehabilitative, and supportive/palliative care.

Principles of Primary Health Care

Equity: Health care should be related to the needs of the people, with more resources given to the disadvantaged to reduce the gap between the rich and poor.
Community Participation: Involving people individually and collectively to manage their lives more effectively, respect diversity, and ensure effective and strategic planning.
Intersectoral Coordination: Recognizing that health and well-being are linked to economic and social policy, and that providers from different disciplines should collaborate to meet the needs of health care consumers.
Appropriate Technology: Using the fullest available resources and relevant technologies, considering alternatives to high-cost, high-tech services, and promoting healthy communities.

Key Goals and Strategies for PHC in Nigeria

Enactment of the Nigerian Health Act: Ensuring effective access to equitable, affordable, and quality health care.
Establishment of a minimum (essential) health package: In all Wards across the country.
Reduction of financial barriers to health services: Through community-based social health insurance schemes.
PHC infrastructural development: Promoting comprehensive and qualitative integrated health services delivery.

Primary Health Care Personnel

Health workforce: All people engaged in actions whose primary intent is to enhance health, including health professionals, public health workforce, and those addressing social determinants of health.
Categories of health professionals: Medical doctors, nurses, midwives, clinical officers, laboratory technicians, pharmacists, community health workers, and management and support staff.

Community Health Care Workers

Community Health Officer (CHO): A senior cadre member of the primary health care team, responsible for community-based functions and supervision.
Community Health Supervisor (CHS): A frontline public health worker with a close understanding of the community, serving as a liaison between health/social services and the community.
Community Health Extension Worker (CHEW): A junior-level worker, responsible for community-based functions and supporting the CHO and CHS.

Community-Based Functions

Community mobilization for health action: Explaining the PHC approach, carrying out community mobilization, and guiding and supporting Volunteer Village Health Workers (VVHWs) and Traditional Birth Attendants (TBAs).
Supervision and monitoring: Supervising JCHEWs, VVHWs, and TBAs, and monitoring their activities.
Health education and promotion: Teaching simple methods of data collection and analysis, and promoting health education campaigns.

Clinic-Based Functions

Providing integrated PHC services: Organizing and running integrated PHC services, including health education, promotion of water supply and basic sanitation, maternal and child health, and immunization services.

Training Functions

Identifying learning needs: Identifying learning needs of JCHEWs, VVHWs, and TBAs, and members of the Community Development Committee.
Providing on-the-job training: Providing on-the-job training as necessary.

Financing of Primary Health Care

Mechanisms for financing health care: Governments, donors, insurance, NGOs/CBOs, and out-of-pocket financing.
Government budget allocation: Government budget allocations come from direct and indirect tax revenues, and should provide for public spending on primary healthcare.
Health insurance: A social device for aggregating health risk and costs, with mandatory and voluntary schemes.### Primary Health Care (PHC) Financing
Employment-based health insurance schemes are common, where employees and employers contribute to the scheme.
Collaborating/Development Partners (donor agencies) are a major source of funds for PHC activities.
- Multilateral organizations (e.g. UNDP, WHO, UNICEF, World Bank) and Bilateral Agencies (e.g. USAID, DFID) provide funding in the form of loans or grants.

Non-Governmental Organizations (NGOs) and Community-Based Organizations (CBOs)

NGOs and CBOs are also a significant source of funding and provision of services in most communities in Nigeria.
Examples of NGOs include Rotary International, Medicine San Frontiers, Lions, and Red Cross.

Out-of-Pocket Payments (OOPs)

OOPs are direct payments made by patients to healthcare providers.
Examples of OOPs include fees paid for consultations, traditional medicine, and other healthcare services.

Management of Primary Health Care

Management involves making efficient use of resources (manpower, material, and money) to achieve predetermined objectives.
Ten roles of a manager:
1. Interpersonal figurehead
2. Leader
3. Liaison
4. Information monitor
5. Disseminator
6. Spokesman
7. Decisional entrepreneur
8. Disturbance handler
9. Resource allocator
10. Negotiator

Principles of Management

Division of work: reduces the span of attention or effort for any one person or group.
Authority: the right to give orders.
Discipline: outward marks of respect in accordance with formal or informal agreements.
Unity of command: one person, one superior.
Unity of direction: one head and one plan for a group of activities with the same objective.
Subordination of individual interest to the general interest.
Remuneration: fair pay for both employees and the organization.
Centralization: always present to a greater or lesser extent.
Scalar chain: the line of authority from top to bottom of the organization.
Order: a place for everything and everything in its place.
Equity: a combination of kindliness and justice towards employees.
Stability of tenure of personnel: employees need time to settle into their jobs.
Initiative: encourages staff to show initiative within their authority and discipline.
Esprit de corps: harmony is a great strength to an organization.

Devolution and Decentralization of PHC Management

Devolution of power: transferring power from the federal government to lower tiers of government.
Decentralization: sharing decision-making power from the center with lower levels of management.

Management Committees and Community Participation

A committee is a group of people appointed to deal with a particular matter.
Community participation in PHC involves:
- Identification of health needs
- Design of required PHC activities
- Monitoring quality of services
- Participation in solving problems

Primary Health Care Facilities and Equipment

Health facilities are categorized into four types:
1. Type 1: health post, health clinics, and dispensaries
2. Type 2: primary health care centers
3. Type 3: comprehensive health centers, cottage hospitals, and general hospitals
4. Type 4: specialist and teaching hospitals
A primary health care facility is functional when it is well-staffed, equipped, and provides basic services.

Problems with PHC Facilities in Nigeria

Mal-distribution
Poor physical structures
Inadequate staffing
Poor access roads
Poor referral networks

Utilization of Health Facilities

Factors affecting utilization:
- Proximity
- Attitude of staff
- Availability of essential services/drugs
- Payment policy
- Literacy level
- Economic status of community members

Patient Satisfaction

Factors affecting patient satisfaction:
- Cleanliness of facilities
- Patient-provider interaction
- Waiting time
- Availability of essential drugs at affordable prices

Provision of PHC Facilities

Expected provision of facilities:
- Federal government: one tertiary health facility or federal medical center per state
- State government: one general hospital per LGA
- Local government: one comprehensive/primary health center per political ward
- Ward development committee: one health clinic per group of villages/communities
- Village development committee: one health post per village

Types and Ownership of Health Facilities

Type of health facility and ownership:
- Teaching/tertiary hospital: federal government
- General hospital: state government
- Primary health center: local government
- Health clinic/health post: ward development committee or village development committee

Equipment and Logistic Support for PHC

Facility-based equipment: necessary for technical activities
Programme-specific equipment: necessary for specific health programs
Examples of equipment and logistic support:
- Health education: overhead projectors, projector screens, public address systems
- Nutrition: arm circumference tapes, cooking pots, store, poster on growth monitoring and promotion
- Maternal and child health/family planning: delivery bed, foetal stethoscope, examination table, standing-weighting scale

National Health Management Information System (NHMIS)

NHMIS: an organized way of collecting, collating, processing, and analyzing data and disseminating information to stakeholders.

Referral System

Referral system: a predetermined arrangement for transferring patients from lower to higher levels of care.
Factors affecting referral system:
- Availability and accessibility of care facilities
- Distance
- Road condition
- Affordability of cost of transportation
Need for referral system:
- Ensures quality of PHC services
- Promotes credibility and quality of PHC services
- Allows for supervision/support from higher levels
- Promotes satisfaction of health care providers and consumers

Standard of Referral System

In order to establish an effective referral system:
- All cases that need referral services should be referred
- All PHC staff should be trained on the system
- An enabling environment should be provided
- Referral should be a 2-way process

Steps in Developing Effective Referral System

Identify services to be provided at each level
Strengthen lower levels of care with material resources, manpower, and regular supervision
Develop referral protocol cards and manuals
Establish a functioning communication network
Identify suitable transport mechanisms
Establish a program in the community with agreed goals and objectives

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Description

Learn about the principles and definition of Primary Health Care, including its importance, accessibility, and affordability. This quiz covers the basics of PHC.