Alma Ata Declaration PDF

COURSE TITLE: PRIMARY HEALTH CARE I COURSE CODE: BMP 107 PLACEMENT: FIRST YEAR FIRST SEMESTER DURATION: 75HOURS (LECTURE 30 HOURS; PRACTICAL 45 HOURS) CREDIT UNITS: 1 LESSON NOTE INSTRUCTIONAL OBJECTIVES:- At the end of this session, the students should be able: - Understand the historical...

COURSE TITLE: PRIMARY HEALTH CARE I COURSE CODE: BMP 107 PLACEMENT: FIRST YEAR FIRST SEMESTER DURATION: 75HOURS (LECTURE 30 HOURS; PRACTICAL 45 HOURS) CREDIT UNITS: 1 LESSON NOTE INSTRUCTIONAL OBJECTIVES:- At the end of this session, the students should be able: - Understand the historical perspectives, philosophy, concepts and principles of primary health care and public health nursing - Explain health patterns and scope of primary health care services in Nigeria etc. **ALMA ATA DECCLARATION** The World Health organisation and United Nations Children's fund organised an international conference on Health for all and primary Health care at Alma Ata Kazaklolan from 6^th^ to 12^th^ sept 1978 and proclaimed the need for urgent action by all gov'ts, all health and developmental workers and the world community to protect and promote the health of the people of the world. The conference made the following declarations: 1. The conference strongly reaffirms that health, which is a state of complete physical, mental and social well being and not merely the absences of diseases or infirmity. Is a fundamental human right and that the attainment of the highest possible level of health. 2. The existing gross inequality in the hla status of people particularly between developed and developing countries should be addressed. 3. Economic and social development, based on a new international economic order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to better quality of life and to world. 4. The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. 5. Gov't have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. The main social target of gov'ts, international organisations and the whole world community is the attainment by the people of the whole level of health that will permit them to lead a socially and economically productive life. PHC is the key to attaining the target. 6. Primary Health Care is essential health care based on practical, scientificantly 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 community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination. It forms an integral part both of the country's health system, of which it is a central function and main focus and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people live and work, and constitutes the 1^st^ element of a continuing health care process that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development. The primary health care approach is based on principles of social equity, nation-wide coverage, self-reliance, intersectoral co-ordination and people's involvement in the planning and implementation of health programmes in pursuit of common health goals. This approach has been described as ''Health by the people'' and placing people's health in people's hands'' PHC was accepted by the member countries of WHO as the key to achieving the goal of health for all by the year 2000 AD. **PHC IN NIGERIA** In 1975-1980 health system development initiated PHC. Prof Olukoye Ransome-Kuti in 1985 adopted it in 52 LGA. In 1986-1990, he expanded PHC to all local gov't and achieved child immunization by 80% Professor Olukoye Ransome-Kuti of blessed memory work assiduously between 1985-1992 to implement PHC policy based on the Alma-ata declaration for the benefit of Nigerian population. He introduced the national health policy with a focus on PHC, place emphasis on preventive medicine and health care services at the grass root, ensure exclusive breast feeding practice, introduced free immunization to children, encouraged the use of oral rehydration therapy by Nigerian mothers, made compulsory the recording of maternal death and encouraged continuous nationwide vaccination and pioneered effective HIV/AIDS campaign. In 1992, The National primary health care Development Agency (NPHCDA) was established to ensure continued and sustained. In 1993, the military takeover the govt and affected the process **PHILOSOPHY OF PRIMARY HEALTH CARE** Health care is an expression of concern for fellow human beings. It is defined as a multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health. Such services might be staffed, organised, administered and financed in every imaginable way, but they all have one thing in common. People are being ''served'' that is diagnosed, helped, cured, educated and rehabilitated by health personnel. Health care is completely or largely a government function. Health care has many characteristics: They include: i. Appropriateness (relevance) ie whether the services is needed at all in relation to essential human needs, priorities and policies. ii. Comprehensiveness ie whether there is an optimum mix of preventive, curative and promotional services. iii. Adequacy ie if the service is proportionate to requirement. iv. Availability ie ratio between the population of administrative unit and the health facility (eg population per centre, doctor-population ratio). v. Accessibility ie this may be geographic accessibility, economic accessibility or cultural accessibility. vi. Affordability ie the cost of health care should be within the means of the individual and the state. Feasibility ie operational efficiency of certain procedure, logistic support, manpower and material resources **CONCEPTS OF HEALTH AND DISEASE** Health is a common theme in most cultures. In fact, all communities have their concepts of health, as part of their culture. Among definitions still used, probably the oldest is that health is the absence of disease. In some cultures, health and harmony are considered equivalent, harmony being defined as being at peace with self, the community and gods. Nevertheless, some people have the feeling that the well being of an individual is dependent on the result of living in accordance with natural rules pertaining to the body, mind and environment. These rules relate to exercise, attitudes, good health habits and above all life styles. However, some professionals view health as a balance living between man and his environment. Indeed a person is considered to be healthy if there is nothing that affects his functioning or survivial. Health involves not only the body but emotions, attitudes and interactions with other people. It is a natural condition and a fundamental human right. **CHANGING CONCEPTS** An understanding of health is the basis of all health care. Health is not perceived the same way by all members of community including professional group eg biomedical scientist, social science specialist, health administrators, ecologist etc giving rise to confusion about the concept of health. However, it encompasses the whole quality of life. Biomedical concept: Traditionally health as been viewed as an absence of disease, and if one was free from disease, then the person was considered healthy. This concept has the basis of germ theory of disease which dominated the thought at the turn of the 20^th^ century. The medical profession view the human body as machine, disease consequence of the breakdown of the machine and the doctor task is to repair the machine, thus the view of health was narrowed and inadequate. Ecological concept: Deficiencies in the biomedical concept give rise to other concept. The ecologist put forward an attractive hypothesis which viewed health as a dynamic equilibrium between man and his environment, and disease a maladjustment of the human organism to environment. They defined health as a relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function. They consider the availability of food and population explosion. The ecologist raises two issues ''Imperfect man and imperfect environment. History argues strongly that improvement in human adaptation to natural environment can lead to longer life expectancies and a better quality of life. Psychosocial concepts: Contemporary development in social sciences revealed that health is not only a biomedical phenomenon, but one which is influenced by social, psychological, cultural, economic and political factors of people concerned. That these factors must be considered when defining and measuring health. Holistic concept: The holistic model is a synthesis of all the above concepts. It recognizes the strength of social, economic, political and environmental influences on health. It has been variously described as a unified or multi-dimensional process involving the well-being of the whole person in the context of his environment. They view health as living a sound mind. **DEFINITION OF HEALTH** Health is one of those terms which most people find it difficult to define although they are confident of its meaning. Therefore, many definitions of health has been offered. a. The condition of being sound in body, mind or spirit especially freedom from physical diseases or pain. (Webster.) b. Soundness of body or mind, that condition in which its functions are duly and efficiently discharged (Oxford English Dictionary) However, World Health Organisation (WHO) defined health as a state of complete physical, mental and social wellbeing and not merely on absence of disease or infirmity. (1948) Dimension/Aspect of Health WHO envisages three specific dimension: Physical, the mental and social wellbeing, though spiritual aspect of health is being considered. PHYSICAL HEALTH: This aspect relates health biologically as a state in which every cell, organ and systems are functioning at optimum capacity and in perfect harmony with the rest of the body. The physical dimension of health also refers to the completeness in appearance of the individual without any infirmity or disability and disease. MENTAL HEALTH: This dimension see health as a psychological state in which the individual feels a sense of perfect wellbeing and control over his environment. Mental health is also concerned with a balanced development of the individual's personality and emotional attitudes, which enables to live harmoniously with his fellow men. It involves mental abilities as reasoning, thinking, feeling, good behaviour and positive attitudes required for normal living. SOCIAL HEALTH: This fact of health is concerned with the individual's participation and contribution to the growth of the community as well as carrying out normal activities in the society. It also involve positive interaction with other peoples. Social health refers to the ability to interact effectively with other people and the social environment, to develop satisfying interpersonal relationship and to fulfil social roles. It involves participating in and contributing to your community, living in harmony with fellow human beings, developing positive interdependent relationship with others and practicing healthy sexual behaviour. SPIRITUAL HEALTH: This dimension is sometimes confused with religion but it definition has been abstract. However, Miller and price (1998) explained the characteristics of spiritual health. That is having the ability to articulate and act on one's own basic purpose of life, giving and receiving love, trust, joy and peace, having a set of principles or ethics to live by, having a sense of selflessness, honour, integrity and sacrifice and being willing to help others achieve their full potentials or one purpose in life. Others: Emotional, vocational dimension, environmental, educational etc. **FACTORS THAT DETERMINE OR INFLUENCE THE HEALTH STATUS OF INDIVIDUAL IN THE COMMUNITY** Health does not exist in isolation. It is influenced or affected by cultural, social, economic, environmental and personal factors **PRINCIPLES OF PRIMARY HEALTH CARE** 1. Principle of prevention: It's all measures put in place to limit the progression of disease at any stage of its course. There are two types of prevention namely primary prevention which avert the occurrence of disease and secondary prevention control disease occurrence. 2. Community participation: Community participation is the process by which individuals and families assume responsibility for their own health and welfare and for those of the community and develop the capacity to contribute to their and the community's development. They come to know their situation better and are motivated to solve their common problem (WHO 1978) 3. Principle of intersectional approach (Multi-sectional collaboration) No sector involved in socio-economic development can function properly in isolation. PHC also requires the support of other sectors, these can also serve as entry points for the development and implementation of PHC. PHC involves in addition to health sector, all related sectors and aspects of national and community development in particular Agriculture, Education, Housing, Public works and other sectors and demand the co-ordinated efforts of all these sectors to function. 4. The spirit of Social Justice and Equity: Government is determined to set in motion the process that will ensure that every person obtain the health services he or she needs, when and where it is needed at a cost the community and country can afford. 5. Principles of Self-Reliance: All health problems cannot be solved once owing to financial, human, material and other resources. Therefore arises for us to go at a pace that takes into consideration these resources and constraints. Self-reliance involves skills and a cluster of qualities that sustains an individual under adverse conditions. it also involves confidence in an individual's ability to work effectively under those circumstances and a problem solving action towards the confronting obstacles. 6. Appropriate Technology: PHC requires the development, adaptation and application of simple equipment, techniques and methods that people can afford and use to solve health problems. Appropriate technology is a fashionable way of doing things, in low cost, effective ways that local people can manage and control. 7. Referral System: PHC need to be sustained by integrated, functional and mutually supportive referral system that will enhance comprehensive or integrated health care. 8. Health Team Approach: PHC relies on health workers eg physicians, Public Health Nurses, midwives, pharmacists, medical laboratory scientists, pharmacist technicians, community health workers and traditional practitioners that are needed. 9. The principles of Availability: Efforts should be made to make PHC available especially essential drugs and other supplies. 10. Principle of Accessibility: It should be within the reach of individual, family and community. 11. Principle of Affordability: PHC should be delivered at the lowest possible cost. 12. Principle of political commitment or will: Government should make sure all the cadar of workers. The term ''Public Health'' came into general use around 1840. It arose from the need to protect the public from the spread of communicable diseases. Later, it appeared in 1848 in name of a law, the public Health Act in England to crystallise the efforts organised by society to protect, promote and restore the people's health. In 1920, C.E.A Winslow, a former professor of public health at yale university, gave the oft-quoted definition of public health. The WHO Expert Committee on public health Administration, adopting Winslow's earlier definition has defined. The science and art of preventing dx, prolonging life and promoting health and efficiency through organised community efforts for the sanitation of the environment and the individual in personal hygiene, the organization medical and nursing services for early diagnosis and preventive treatment of disease and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. Read up The roles of the primary health care workers **HEALTH PATTERN** Primary health care (PHC) addresses the majority of a person's health needs throughout their lifetime. This includes physical, mental and social well-being and not merely the absence of disease. It's based on promotive, preventive, curative, rehabilitative and supportive care. Another dimension of health pattern is to: - Integrate health services to meet people's health needs throughout their lives. - Addressing the broader determinants of health through multisectoral policy and action. - Empowering individual, families and communities to take charge of their own health. Health pattern of utilization: Pattern of utilization of PHC services varies from place to place and can change over time within the same community depending on the quality of services rendered. Health which basically refers to a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity is an important concept in assessing the well-being of an individual and the community in general (WHO Constitution, 2008) the body's is homeostatic system aim at maintaining good health, but should be supported by good practices aimed at maintaining good health, e.g good nutrition, good hygiene, and proper utilization of health care facilities. WHO definition of Primary Health Care indicate quality health care essential for all citizens of Nigerian but the primary health care centre are under used by citizen due to certain factors that could be addressed by the government of nigeria **THE ELEMENT OF PHC** 1. Health education (promotive) 2. Promotion of food supply and proper nutrition. 3. Provision of comprehensive maternal and child health including family planning. Preventive 4. Immunization of children against major communicable diseases. 5. Provision of adequate supply of water and basic sanitation. 6. Prevention of control of locally endemic diseases. CURATIVE 7. Appropriate treatment of common diseases and injuries. 8. Provision of essential drugs. Health education concerning prevailing health problems and methods of preventing and controlling them. What is health education? It's concerned with: i. Promoting health and it's reducing behaviour-induced disease. ii. Inducing changes in personal and group attitudes and behaviour that promote healthier living. iii. It's a process that informs, motivates and helps people to adopt and maintain healthy practices and lifestyles. iv. It's a process that advocates environmental changes as needed to facilitate healthy practices and lifestyles. v. It's a process that promotes complete physical, mental and social well-being, as well as absence of disease and infirmity. vi. It involves the teaching, learning and inclusion of habits concerned with the objective of healthful living. **OBJECTIVES OF HEALTH EDUCATION** 1. Information a. To inform and spread knowledge about the scientific ways of preventing diseases and promoting health. b. To expose people to scientific knowledge so as to remove their misconceptions, ignorance and prejudice about health and health. c. To create awareness of health needs and problems and the peoples responsibilities to them. 2. Motivation: a. To encourage people to change their habits and ways of living and health practices when these are detrimental to health eg outdoor defecation, cigarette smoking b. To encourage people to make their choices and decisions about health matters after providing them with learning experience which will influence their habits, attitudes and knowledge. 3. Guiding into Action a. To encourage people to judiciously and adequately use the health services provided for them. b. To encourage people to undertake various practical self health programme and measures to improve their own health status. c. To bring together appropriate personnel eg health, education and communication to guide people into action that will help maintain healthy practices and lifestyles. **\ ** Course Title: Primary Health Care I Course Code: BMP 107 Placement: First Year First Semester Duration: 75Hours (lecture 30 hours; Practical 45 hours) Credit Units: 2 **Introduction** The course exposes the students to the rationale for the choice of Primary Health Care as the global option for making healthcare available to all. It is designed to equip students with the knowledge, skills and attitudes essential for teamwork and to efficiently assist individuals, families and communities in identifying, prioritizing and attending to their health needs in a responsible and sustainable manner. **Course Objectives** At the end of this course, the students should be able to: 1. Understand the concepts, rational and principles of Primary Healthcare. 2. Describe community structure and functions. 3. Understand strategies for community diagnosis **The Community: Structure and Function of Groups and People in Community** - Community Structure: Leadership and decision making in a community. - Family Patterns - Staffing in Primary Health Care System - The roles of Primary Health Care workers: - Traditional Birth Attendants - Village Health Worker - Community Health Extension Workers (Senior, Junior) - Community Health Officers - Midwives - Public Health Nurses - Community Physicians etc. - The role of voluntary and non-governmental agencies in primary health can - Functions and responsibilities of the nurse in relation to other workers WI' primary health care setting. **What is a Community?** This is a unit of people having common attributes, rights or interest. It may include people living in a common house, neighbourhood or those with common occupation, religion or ethnic group. A group of individual and families living together in a defined geographic area usually comprising a village, town or city. The definition accepted by WHO expert committee is: A community is a social group determined by geographical boundaries and/or common values and interests. It members known and interact with each other. It functions within a particular social structure and exhibits and creates certain norms, values, and social institution. The individual belongs to the broader society through his family and community. Community consists of people living together in some of social organization and sharing varying degree of political, economic, cultural characteristic and aspiration, Alakya 2000. Communities have leaders who may be formally appointed and recognised by the people or informal leaders whose abilities in indicating and creating activities make them very outstanding. Community is a group of people who live together, who belong together, so that they share, not ties or that particular interest, wide enough and complete enough to include their lives. He included in community small aggregation, such as villages, and large ones, such as cities and tribes and nations (Maduer) Community Structure **Leadership Composition of a community** - Formal leaders Informal leaders Official opinion leaders Unofficial opinion leaders - Representative of the poor the disadvantage - Representative of the youths and age grades - Representative of women. **Functions of Community** 1. To determine the use of space for living and other purpose. 2. To make available the means for production and distribution of necessary goods & services 3. To protect and conserve the life, resources and property of individuals. 4. To educate of acculturate newcomers ie children and immigrants 5. To transmit information, ideas and beliefs 6. To provide opportunities for interaction between individual and groups. **Family Patterns** Family patterns are the characteristics of specific relationships within a family unit or collective groups of individuals such as the relationship between the mother and the daughter. Family patterns typically fluctuate across different cultures. Family patterns are typically confined to specific cultures, although there is some niche overlap, for e.g. we observe the strong relationship between a father and their daughter across countries. Throughout history, family composition has affected children's lives in important ways. The nuclear household contain two generation, parents and children. Extended families are multi generational and include a wide circle of kin of servants. In blended households- the result of divorce or the death of a spouse followed by remarriage of a new generation of children- mothers and fathers can be both biological parents and step-parents simultaneously. **Family Structure** **What is a family?** It means the people who accept you no matter who are you, where there is no hatred or judgement. The love of a family should be unconditional, and everyone should try their best to provide all they can for the people in their family emotionally and financially. Family structure is a family support involving two married individuals providing care and stability for their biological offspring, extended family. A family consisting of parents and children, along with Grandparents, grandchildren, aunts or uncles, cousin etc. The family structure or family composition consists of individuals each with socially recognised status and positions who interact with one another on a regular recurring basis in socially sanctioned ways. When members are gained or lost through events (of marriage, divorce, birth, death abandonment. incarcerators), the family composition altered, and roles must be redefined or redistributed. The following are some different family forms: - **Nuclear:** A father, mother, and child living together but apart from both sets of their parents. - **Extended:** Three generations, including married brothers and sisters and their families. - **The Generational**: Any combination of first, second, and third generation members living within a household. - **Dyad:** Husband and -wife or other couple living alone with out children. - **Single Parent:** Divorced, never married separated, or widowed male or female and at least one child. Most single parent families are headed by women. - **Step-parent:** One or both spouses have been divorced or widowed and have remarried into a family with atleast one child. - **Blended or reconstituted:** A combination of tow families with children from one or both families and sometimes children of the newly married couple. - **Single adult living alone:** An increasingly common occurrence for the never married, divorced or widowed. - **Cohabiting:** A unmarried couple living together. - **No-kin:** A group of atleast two people sharing a relationship and exchanging support who have no legalized or blood tie to each other. - **Compound:** One man (or woman) with several spouses. - **Gay:** A homosexual couple living together with or without children. Children may be adopted, from previous relationships or artificially conceived. - **Commune:** More than one monogamous couple sharing resources. - **Group marriage:** All individuals are married to each other and are consider as parents of all the children. **Classification of Family** Family classified into two main categories viz. the patriarchal and the matriarchal, A large number of family systems are examples of one or the other pattern or some combination of the two: **The Matriarchal Family** Matriarchal family is that type in which the control of the family is centered around some woman member. It is a system under which status, name and sometimes inheritance are transmitted though the female line, The thief characteristics of this type of family are as follows: 1. **Matrilineal Descent:** 2. **Matrilocal Residence:** 3. **Authority in Maternal Family:** Authority within the family group primarily belongs not to the husband but to some male representative of the wiles-kin. 4. Stress on Consanguinity: The maternal system tenth to weld the kin group or consanguine family together but to lessen the cohesiveness of the conjugal family itself It is usually associated with the principle of exogamy the tribe being separated into separate intermarrying groups. **The Patriarchal Family** The patriarchal family was the prevailing type not only in the greater civilization of antiquity but also in the feudal society from which our own society has evolved. It is a form of family organization in which the father is the formal head and the ruling power in the family. The authority of the father is absolute and Final. The patriarchal family is usually an extended consanguine family in which the patriarch is the senior male member. He presides over the religious rites of the household. **Factors that favour patriarchal system**: The mode of production in advanced societies, the specialization it requires and the relationship it gives birth to, all these tends to strengthen the patriarchal system. That is to say, the patriarchal type of family is more in conformity with the economic patterns of production. The growth of property, the development of agriculture, the concentration of authority and specialization of functions, which characterize the more modern societies, are more in harmony with the patriarchal principle. Moreover, the patriarchal principle permitted the family to serve as a compact unit of society. In the patriarchal system, the man holds the dominant position as compared to the women folk. It confers lower social status on woman. But in modem times, woman has been placed on equal footing with man but her status as a whole continues to be unequal as compared to man. **Characteristics of the Family** The above quoted definitions of family may appear to be quite comprehensive but without more examination, a full evaluation of family will not be possible. As a social unit, family reveals the following characteristics: i. **Mating Relationship:** A family is based on mating relationship, that is to say that family comes into existence when a man and woman establish mating relation between them. ii. **A Form of Marriage**: A family pre-supposes the institution of a marriage. Mating relationship is established through the institution of marriage. It may take the institutional form of monogamy. It may be polygamous involving either polyandry and polygyny. Partners may be selected by parents or the choice maybe left to the wishes of the individual concerned. It may be socially compulsory to marry within a group to which one belongs (endogamy) or else to marry into another group (exogamy). iii. **A System of Nomenclature:** Each family has nomenclature which reckons its descent. Descent may be reckoned through the male line, i.e. path- lineal or through the female line, i.e., matrilineal. Both systems have been used successfully, and though there is more difficulty hi establishing the fact of biological paternity, many groups have shifted from the matrilineal to the patrilineal form. On the other hand, a few people have shifted in the opposite direction. iv. **An Economic Provision**: In a family, head of the family is supposed to meet the economic need of the members and to raise their living standard. He is to see that family members are comfortably placed. v. **A Common Habitation**: Each family must have common habitation which implies that the members of family must live together under one roof. **General Functions of the Family** A society can survive only if its members through their activities, perform certain social functions. There is an institutional complex adapted to meet the societal need for continual replacement of the societal membership. This replacement has several aspects. It involves the physical reproduction of new individuals, the nourishment and maintenance of these individuals during infancy and childhood, and the placement of these individuals in the system of social positions. The main social functions of the family as falling in four closely related divisions; reproduction, maintenance, placement and the socialization of the young. These may have variations. The main family functions are as follows; 1. **Satisfaction of Sex Needs**: In all societies, primitive or modern, simple or complex, human sex urge requires established and socially-recognized channels of satisfaction. Family enables adults of both sexes to maintain a socially approved sexual relationship. Besides, the family shapes, channelizes and restricts the sex drive of man in all societies in terms of social norms. 2. **Reproduction of Children**: Satisfaction of sex needs leads to reproduction of children. To have children is considered both a religious as well as social need in Hindu society. Children perpetuate race which is desire of every individual. 3. **Provide Minimum Basic Facilities**: The family is the only social institution charged with transforming a biological organism into a human being. Man matures much later than any other animal. His lack of instinct is however compensated by his possession of the most complex brain among all animals. This trait enables man to build several cultural aids to protect himself, to collect food, to build shelter etc. Among many aids, family is the one which he builds in order "to be fed, protected and taught what nature has not provided." 4. **Social Functions:** One of the most important functions of the family is the social function. Family in primitive and simple societies formed the basic unit of social organization. However, in advanced societies, the position is not the same. Here family does not exactly represent the basic organizational unit of the society but us role in the determination of the texture and stability of social organization has not at all diminished. 5. **Socialization of Members:** Socialization of human personality is another important function of family. The child's first human relationships are with the immediate members of his family. Here he experiences ideal love, authority, direction, protection, setting of example and ideals. "Habits form according to the treatment they give him and according to the reactions determined by his inherited capacity. As he grows older initiation of parental actions and exposures to their suggestion leads him to form habits which affect his social life more profoundly than he will recognize until many years after, if at all," 6. **Helps in Building Integrated Personality:** Family helps an individual develop an integrated personality. Man is a cultural being and, as such he has both emotional and physical needs. He need, food, protection and care for his survival. He also needs love, affection, understanding and sympathy for satisfaction of his emotional needs. The family creates the necessary environment in which he develops a well-rounded personality. Family is therefore, described as a 'factory' which produces human personality. 7. **Formation of Personality Traits:** There are many aspects of human personality which are regarded to be the products of family organization. No influence is initially as great, however, as the family on the individual. Sociologists have reached a rather wide consensus on the influence and role of family in personality formation. These are as follows: a\. The family is responsible for the universalization of personality. That is the sentiments of love, the feeling of right and wrong and of sympathy find their expression through the family. b\. The family is responsible for the formation of a child's basic personality traits derived from the standards and values peculiar to the family.These trails are handed down through family tradition and custom from generation to generation. 8. **Economic Functions**: In the economic field it is the responsibility of the family to see that there is proper division of work. None of the members is overburdened with work. It is through family that the economic needs of the people are met. It looks after family property. 9. **Social Functions:** Family is required to perform social functions. It is the centre of all social activities. An individual gets social status through the family. It helps in socialization and exercise social control over members. It preserves moral norms and customs and conventions. It also helps the young members in marriage. 10. **Religious Functions:** Family is also required to perform many religious functions. What is the religion of a family and what are the modes and methods of worship are taught in the family. 11. **Educational Functions:** It is the responsibility of every family that it should teach the children and give them good education. 12. **Recreational Functions:** Family has some recreational functions also. The family members get together and sing and dance at the time of festivals. **Staffing in Primary Health Care System** 1. Public Health Doctor 2. Public Health Nurse 3. Pharmacist 4. Nurse midwife 5. Community Health Officer 6. Senior extension health worker 7. Junior extension health worker 8. Health educator 9. Laboratory technician 10. Dental technician 11. Health information management officer 12. Driver 13. Security **The Roles of Primary Health Care Workers** Public Health Doctor 1. General - Community health diagnosis - Health planning 2. Curative: Outpatient clinics - Assess emergency needs - Arrange staff and equipments - Evaluate post performance 3. Preventive Work: Sub Centre Visit - Supervision - Guidance - School health visit - Investigation of epidemics 4. Promotive work: Organisational/participation in village level health activities - Organise health education 5. Administrative work: Supervision - Programme planning - Management Implementation - Maintain records - Finance - Personnel management 6. Training: Organise training programme - Conduct training sessions **Public Health Nurse/ Nurse midwife** 1. Maternal & Child Health: Register Pregnancy - Confirm pregnancy - Referral (high risk) - Conduct aseptic deliveries - Supervision & training - Postnatal visits - Growth monitoring - Conduct MCH clinics/Health education 2. Family planning: Maintain eligible couple register - Family planning counselling - Conventional contraceptive distribution - Rapport with local leader - Motivate and refer for safe services 3. Nutrition: Identify malnutrition - IFA distribution e.g. Iron, folic acid - Vitamin A prophylaxis - Nutrition education 4. Communicable disease - Notification of disease ARI control, Diarrhoea, STD etc. 5. Immunisation: Immunise pregnant women & children with TT. (tetanus toxiod) and other vaccines. - Training: Plan and conduct training - Vital events: Programme implementation - Maintain registers - Record keeping - MCH registers - Eligible couple registers - Daily clinic attendances register etc. - Primary medical care Treatment for minor ailments - First aid - Team activities - Attend and participate in staff meetings - Co-ordinate activities with other staff. **Community Health Extension Worker** (Senior, Junior) 1. Preventive services 2. Scrutinise and maintain records **Traditional Birth Attendants (TBA)** In many developing countries, traditional birth attendants play an important role in the delivery of pregnant women. These people are usually women, who have acquired their skills in delivery women by working with other traditional birth attendant and from their own experience. In some countries, formal programmes have been devised for further training of these traditional birth attendants and for incorporating them within the health services. In favour of such schemes is that these attendants usually belong to local community in which they practices where they have gained the confidence of the families and where they are content to live and serve Their training programme is designed to promote safer birth practices, to avoid harmful practices to improve their technique (with particular reference to cleanliness) to recognise abnormalities which indicate the need for referral for more skilled evaluation and management , and to know their own limitation, thereby refraining from attempting ,to deal with problems beyond their skill. They are also equipped or supplied with simple kit which include hygiene dressing and basic equipment. However, the education training and skills of TBA's are not sufficient to fulfil all requirements for management of normal pregnancies and birth and for identification and management of referral of complication. Their strong cultural and traditional beliefs may influences their practices and thereby impede the effectiveness of their training There is no consensus about the appropriate role for TBA's, because of their limited skills they should practices in close relationship with the community could be used to advantages in promoting modern midwifery services. World Health Organisation defines TBA as a person who assist the mother during child birth and initially acquired her skills by delivering babies herself or through an apprenticeship to other traditional birth attendant (TBA) and skilled birth attendant as accredited health professional such as a midwife, doctor etc The services provided by the TBA ranged from (1) antenatal care - Child delivery - Treatment of infertility - Management of male babies - Circumcision of male babies - Treatment /care of cord stump with methylated spirit, herbal preparation, dry heated sand, engine oil etc. Medication include animal dung , files, scarification mark and cow urine to treat, which could serve as source of infection CAUSES of Materials Mortality in Nigeria - Haemorrhage - Unsafe abortion - Eclampsia - Obstructed labour - Malaria - Anaemia and other causes National demographic and health survey (NDHS) 2013 The finding - Only 36 deliveries were conducted by skilled birth attendants - Over all delivery in the facility -38% - 60% of pregnant women had at least on antenatal visit. The TBA are part of the socio-cultural fabric of the various communities **The village health worker** (VHW) The community select volunteer as village health worker , who after training , act as a link between the community and government health system The purpose of VHW was to elicit community participation in primary health care and recruited to mobilise community for self-reliance, safe water and promotion of nutrition and acceptance of contraception to limit the sizes of family - They were given medicines for minor ailments and first aid. - The trained YHW are certificated - They should provided with adequate means of transportation - VHW should be supervised by the health team and CDC committee at interval - They should participate continues in education e g workshop , seminars - Forum for discussion of problems eg monthly meeting - During training the community should take the responsible - A minimum token salary is given and should be deducted from the profit of - Sale of drugs **International Health** What is the origin of International Health? 1. Spread of disease from one country to another has been recognized as far back 14th century 2. Diseases-like plague and cholera were known to kill a lot of people and these were traced to ships passing through trade routes. 3. Quarantine was introduced in Europe in the 14th century to prevent ship crews and travelers suspected to harbour disease from landing. 4. Quarantine took 40 days during which ships crew were detained 5. The inconveniences of 40 days detention led to the first international sanitary conference of 1851 **Formation of World Health Organization** 1. In International Sanitary Conference of 1851 a. It was held in Paris. b. The objectives were to regulate the quarantine measures which varies from country to county. c. The meeting did not achieve much. It dealt With cholera, yellow fever and plague but no agreement was reached on quarantine measures. d. Only France, Portugal, Sardinia ratified the agreement. 2. Pan American Sanitary Bureau (1902) PASB: a. It was the first international health agency. By 1947 the bureau had become the general secretariat for Pan American Health Organization. b. The objective of this conference was to co-ordinate methods of quarantine in the Americas c. The bureau subsequently became the WHO regional office for the Americas. 3. Office Internationale DHygienc Publiquc (1907) OIPH: a. The objective of ibis office is to disseminate information about communicable diseases and supervise international quarantine measures. b. The office was in Paris and about 60 countries were supervised. c. It ceased to exist by 1950 when its responsibility as overtaken over by WHO 4\. The Health Organization of the League of Nation (1923). a. Formed after the first world (1914/1918). b. The objective included supervising quarantine regulations, epidemiological information, nutrition and housing problems, issuing & epidemiological reports periodically, and the use of expert committees on technical studies. c. Alter the dissolution of the league of nations in 1939, the Health Organization continued to function in Geneva publishing weekly epidemiological records. **The United Nations Relief and Rehabilitation Administration (1943) UNRRA** a. The objective was for its health division to help organize recover from effects of 2nd world war. b. It was able to deal with malaria control in ltaly and Greece. c. It ceased to exist in 1946 and its activities were taken over by the interim commission of the WHO. a. Originally the organization was born after the San Fransisco Conference of the United Nations in 1945 but the contribution was drawn up in 1946 and ratified by 1948. **The objectives of WHO?** 1. The broad objective is to have a single worldwide inter governmental health agency. 2. The specific objective is the Attainment by all peoples of the highest level of health by all people. 3. Membership is opened to all countries. In 1948 there were 56 members, and in 1971 there were 131 members and one associate member. **The functions of WHO? The functions include** a. Helping member countries to improve their own health. b. Advising member countries in areas of public health by sending experts and consultants to such countries. c. Giving information about possible epidemics. d. Formulating international health regulations. The present regulations was issued in 1971 and covers 3 diseases e.g. cholera, plague, yellow fever. e. Deciding what type of diseases should be put under surveillance e.g. the 5 diseases at present are: 1. Louse borne typhus 2. Louse borne relapsing fever 3. 3Viralinfluenza 4. Pra1ytic poliomyelitis 5. Malaria \(f) Compilation of health statistics on notifiable diseases and causes of death e.g international statistical classification of diseases, injuries and causes of diseases. \(g) Standardization of medical substances h\) Publication of technical health problems. \(i) Co-ordination of research activities of health problems e.g. special programme on research and training in tropical diseases. \(j) Promoting primary health care. **The structure of WHO?** \(i) Determine what type of health policy to be followed in the intentional scene. \(ii) Vote for budget needed to run the affairs of WHO. \(iii) Vote for members to serve on the executive board for 3 years. 2\) The Executive Board is made up of representative from member states. a\) It meets at least twice a year. b\) It carries out policy decided by the assembly. 3\) The secretariat is headed by the Director General and he heads staff which include doctors nurses, technicians. He As assisted by 5 Assistant Director Generals each of whom has divisions to administer e.g. Division of Health. Statistics. Education and Training. **The WHO Regional Office** 1. South East Asia with New Delhi (India) as the headquarter. 2. Africa with Brazzaville (Congo) as the headquarter (now Harare) 3. The Americas with Washington D.C. (USA) as the headquarter. 4. Europe with Copenhagen (Denmark) as the headquarter. 5. Eastern Mediterranean with Alexandra (Egypt) as the headquarter. 6. Western Pacific with Manila (Philippines) as the headquarter. Name some other United Nations Agencies associated with International Health. **1. UNICEF (United Nation International Children's Emergency Fund)** a. It was established in 1941, to deal with rehabilitation of children in Countries affected by war. b. When the war was over it was changed to United Nation Children's Fund as there was no more emergencies. However the initials UNICEF was still used c. UNICEF collaborates with FAO (Food and Agriculture Organization) UNESCO United Nation Education. Scientific and Cultural Organization. d. UNICEF also assists family planning programme. **The Responsible Role of Nurses/Midwives in PHC** In 1981, an informal meeting was convened by WHO to consider the role of nursing in contributing to the achievement of the goal of health for all through primary health care: The following five basic strategies have been proposed by WHO meeting by nurses 1. The development in each country of a wips of nurses that is well informed about health care and ready to bring necessary changed in the nursing system 2. The inclusion of nursing personnel s at all level of policy making and administration so that the profession can contribute to determine the action plan 3. The involvement of nurses and the use of their skills in initiating or extending PHC. 4. Fundamental changes at all levels of nursing education basic, post basic and continuing to ensure that the priority need of, population are functionally integrated into the education and into nursery practice 5. Research into nursing administrations, practice and education that will demonstrate nurse^s^ contribution to primary health care. Nursing personnel are one of the most valuable assets of any health care system and represent considerable national investment**\ ** Course Title: Primary Health Care I Course Code: BMP 107 Placement: First Year First Semester Duration: 75Hours (lecture 30 hours; Practical 45 hours) Credit Units: 3 **COMMUNITY DIAGNOSIS** The diagnosis of disease is an individual patient fundamental idea in medicine. It is based on signs and symptom and the making of inferences from them. When this is applied to a community, It is known as community diagnosis. The community diagnosis may be defined as the pattern of disease in a community described in terms of the important factors which influence this pattern. It is a process whereby the health needs of the community (either those identify by the community itself (felt need) or those identified by the health team. To identify such needs, it will be necessary to collect information about the community, birth, deaths and other demographic events, health manpower, environmental problems and other infrastructure that contributes to health. Information on community diagnosis can be obtained by: \(a) Observation (b) review of records (c) screening for specific problems Information collected for community diagnosis are used to find out constraints which will hinder effective planning or health services and to arrive at baseline for evaluation or intervention programmes. The community diagnosis is based on collection and interpretation of the relevant data such as (a) the age and sex distribution of a population. The distribution of population by social groups. (b) Vital statistical rates such as the birth rate, and the death rates. (c) The incidence and prevalence of the important diseases of the area. In addition, a midwife must be able to find information on wide variety of social and economic factors that may assist her in making a community diagnosis. The focus is on the identification of the basic health needs and health problem of the community. The needs as felt by the community (some of which may has no connection at all with health), should be next investigated and listed according to priority for community treatment. **Steps in Community Health Diagnosis** While planning and taking any actions or measures for any health programme, it is imperative to first complete a community diagnosis. In diagnosing and treating the sick persons, the following steps shall be considered - Get a map of the community showing boundaries, landmarks, rivers, streams etc - List all the resources available in terms of men, money and equipment - Find out more about social and cultural practices - Locate infrastructure related to health activities e.g water, electricity, transportation - Find out major economic activities. - Carryout interview among the people using questionnaires - Have group discussion with staff and community leaders - Recognition of need. - Actual visit and observation of the community think or feel it needs. - Vital statistics and other records. - Routine studies, questions, observations, examinations. - Tentative status and chief problems. - Specific studies felt pertinent and necessary. - This is your problem in writing with publicity. - Community involvement, community forecast of future course of diseases or disorders, prognosis with alternatives. - Plan, Procedure and programme, community understanding, co-operation and participation. - Finally give feedback to the community - Follow-up and evaluation of the programmes, community involvement. - Carryout a survey on instruments that have been pre-tested and using appropriate sampling technique - Train interviewers and validate the result of their data **Implementation of plan of action (Action plan) for PHC programmes** A plan of action is to: - Method which facilities implementation of PHC activities - Define community health care problems - Identities unmet needs and surveys the resources to meet them - Establish realistic and feasible goals - Outlines the action to accomplish the proposed programme **Objectives of Planning PHC programme** - To improve PHC services - To match available resources with prevailing health problems - To eliminate wasteful expenditure - To develop the best course of action to accomplish the defined objectives - To plan health centre activities for the delivery of PHC services in line with stated national PHC objectives and strategies. - To prepare annual plan of action in consultation with regional / state / sector PHC manager **Steps in Planning Primary Health Care** 1. Situation analysis 2. Defining the problems 3. Setting objectives and targets 4. Reviewing obstacles and limitation 5. Final planning Contents of situation analysis and baseline study (local health study) A. General background information 1. Geographical characteristics of the area including boundary, size, communication, sanitary conditions, number and of houses. B. The census 1. De facto census to include temporary residents and visitors 2. De jure census excluders temporary resident and visitors and includes permanent residents who are away. C. General social / economic condition 1. Housing condition in relation to type. 2. Organization association with social works D. Available Health Service 1. List of health services and function 2. Private hospital, voluntary hospitals and organization responsible for administration. 3. Doctors clinic hours, health activities observe eg control of communicable diseases, environment sanitation, material and child health, veterinary services, E. Local and economic changes: 1. Agricultural development and co-operative organization 2. Industrial development including category of employment, effective wages of labourers 3. Housing project and percentage of population benefiting 4. National disaster affecting health F. Education: 1. Number and types of schools including special schools 2. Sanitation of school premises 3. Nature of classroom, playground 4. Water supply, toilet facilities 5. Percentage of school age children attending school 6. Percentage of illiteracy G. Statistical and other data 1. Age / sex distribution 2. Principal causes of morbidity and mortality. **SITUATION ANALYSIS** - **The Problem** It size and impact - **The health situation-** Its size and who is affected, where and the capacity of the health system to address - **The Broad Context:** Its size and who is affected, where and the capacity of the health system to address. - **Media Access:** The communication infrastructure - **The issue effort-** Passed, current and planned effort to address the issue (an closely related issues) This analysis is performed to compare the present situation against an ideal situation in order to determine the course of action for improving program management. The present situation is analyzed by studying the (a) Internal environment and capabilities and (b) external political, social, economic and programmatic environment in which the program works. **Methods used for gathering information for situation analysis** 1. Listening, observation and talking with: a. Teachers, religious leaders, agricultural workers b. Traditional healers and other health workers c. Collection of data from health centre, clinic, hospital, national health policy documents, annual report, census and maps. **Steps in situation analysis** Identify the health issue.: Health programme or strategies, the health care provide need to identify the broad health issue that needs to address in a particular community or geographical area. **General Steps of conducting situation analysis** - Identify the health issue - Develop a problem statement - Draft a shared vision - Conduct a desk review - Decide the scope of the review - Identify the relevant information - Review and organize the data - Analyse the data and summarize the findings **Who should conduct a situation analysis?** A small, focused team should conduct the situation analysis. Members should include communication staff, health / social service staff and, if available research staff. Throughout the data collection process team members should also consider how to engage stakeholder including opinion leaders, service policy makers, partners, and potential beneficiaries ways to obtain. **When should a situation Analysis be conducted?** A situation analysis should be conducted as the beginning of a programme or project, before developing a SBCC strategy. Social and behavior change communication changes (SBCC) it involves a systematic collection and study of health and demographic data, study findings and other contextual information in order to identify and understand the specific health issue to be addressed. It examines the current status of the health issue as well as social, economic, political and health context in which the health issues exist and establishes the vision for the SBCC programme. A complete situation analysis gather information in four areas. **When to conduct situation analysis** 1. The problem, its severity and its causes 2. The people affected by the problem (potential audience) 3. The broad context in which the problem exists 4. Factors inhibiting or facilitating behavour change Why conduct a situation analysis A situation analysis guides the identification of priority for an SBCC intervention and informs all the following steps in the SBCC process. It establishes a clear, detailed and realistic picture of the opportunities, resources, challenges and barriers regarding a particular issue or behavour. The quality of the situation analysis will affect the success of the entire SBCC effort. Steps SWOT ANALYSIS (Strengths, Weaknesses, Opportunities and Threats) The process of analyzing strength and weaknesses, as well as the opportunities and threats that exist outside the program. **References** - Basavanthappa BTB (2008) Community Health Nursing - Jabalpur (2010) Park's Textbook of Preventive and Social Medicine - Newel, K.W. (1978) Health the people, WHO Geneva - Sunder (2009) Community Medicine Preventive and Social Medicine - WHO (1978) Alma Ata 1978: Primary Health Care. HFA Sr. No. 1 - WHO (1981) Report of the Working Group on Health for All by 2000 - WOLE Alakija, (2010 Essential of community Health, Primary Health Care and Health Management