Lecture 2: Primary Health Care PDF

Lecture 2: Primary Health Care Melanjo Rulloda, RN, MAN SLCN –Faculty  Topic Learning Outcome A. Brief History of Primary Health Care (PHC) B. Principles of PHC C. Primary Health Care VS Primary Care D. Roles of the Nurse in PHC  HISTORY OF PRIMARY HEALTH CARE At...

Lecture 2: Primary Health Care Melanjo Rulloda, RN, MAN SLCN –Faculty  Topic Learning Outcome A. Brief History of Primary Health Care (PHC) B. Principles of PHC C. Primary Health Care VS Primary Care D. Roles of the Nurse in PHC  HISTORY OF PRIMARY HEALTH CARE At the end of the 60’s and during 70’s of the last century, it was increasingly clear that health services in the developing countries could not be perceived or oriented according to the western industrial states and societies Western medicine was one sided as it emphasized only curative aspects, being limited to the health services in the hospitals, medical practice and pharmacies based on medicine technology Prevention of diseases has a relatively little place value  History of PRIMARY HEALTH CARE In 1977, the director general of WHO called for a new strategy The WHO developed the policy of health as a response to the problems of health in the developing countries WHO established the concept of the so called PHC concept (Primary Health Care) which was given a central meaning The strategy acknowledged that although the health care strategies of the industrialized world – that of big hospitals, drugs and curative medicines - had been exported to developing countries for 30 years. The health of the world had not improved  ALMA ATA USSR CONVENTION In September 1978, the International Conference on Primary Health Care was held in Alma Ata USSR (now Almaty, Kazakhstan It was attended by all the member nations of the World Health Organization (WHO) and UNICEF 134 governments ratified the WHO Declaration of Alma Ata  ALMA ATA DECLARATION The Alma Ata Declaration of 1978 emerged as major milestone of the 20th century in the field of public health It was the 1st international declaration stating the importance of primary health care and outlining the world governments’ role and responsibilities to the health of the world citizens  ALMA ATA DECLARATION “Health for All by 2020” - refers to the global aspiration set by the World Health Organization (WHO) Government have a responsibility for the health of their people that can be fulfilled only by the provision of adequate health and social measures Primary Health care is the key to attaining a level of health that will permit their citizens to lead a socially and economically productive life  ALMA ATA DECLARATION Those who ratified the declaration hoped that it would be the 1st step toward achieving “Health For All” by the year 2000 Although the goal was not achieved, the declaration still stands as outline for the future of international health care PRIMARY HEALTH CARE Came into existence following Alma Ata Conference Equally valid for all countries Takes varying forms in each country Accepted as the key to attain “Health for All by 2000”  PRIMARY HEALTH CARE “Essential health care based on practical, scientifically 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 can afford to maintain at every stage of their development in the spirit of self-reliance and self determination” - WHO/UNICEF 1978  PRIMARY HEALTH CARE IN THE PHILIPPINES October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed by Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level. Health Reform Framework in the DOH from 2005-2022 Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 255 PRIMARY HEALTH CARE PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy PHC: Conceptual Framework Goal: –Health for all Filipinos and Health in the Hands of the People by the year 2020. PHC: Conceptual Framework Mission: – To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care.  PHC: Conceptual Framework Concept: – Characterized by partnership and empowerment of the people. – Includes the full participation and active involvement of the community towards the development of self-reliant people, capable of achieving an acceptable level of health and well-being. RATIONALE FOR ADOPTING PHC Magnitude of Health Problems Inadequate and unequal distribution of health resources Increasing cost of medical care Isolation of health care activities from other development activities  ESSENTIAL HEALTH SERVICES OF PHC ELEMENTS DAM!!! – E: EDUCATION, INFORMATION, ADVOCACY on HEALTH – L: LOCAL / ENDEMIC DISEASES TREATMENT – E: EXPANDED PROGRAM ON IMMUNIZATION – M: MATERNAL AND CHILD HEALTH – E: ESSENTIAL DRUGS PROVISIONS – N: NUTRITION – T: TREATMENT AND CONTROL OF DISEASES (CD/Non-CD) – S: SAFE WATER/ SANITATION AND ENVIRONMENT – D: DENTAL HEALTH – A: ACCESSIBLE HEALTH CARE / ACCESS TO APPROPRIATE HEALTH FACILITIES – M: MENTAL HEALTH  4 Pillars/Cornerstones 1. Active community participation 2. Intra and inter-sectoral linkages 3. Use of appropriate technology 4. Support mechanisms made available Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 193  Pillars of Primary Health Care SCAN!!! – S: SUPPORT MECHANISMS IN PLACE Elevating health to a comprehensive and sustained national effort – C: COMMUNITY PARTICIPATION (ACTIVE) The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels  Pillars of Primary Health Care SCAN!!! – A: APPROPRIATE TECHNOLOGY (USE OF) Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable. – N: NETWORKING AND LINKAGES (INTRA-INTER-SECTORAL) Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multidisciplinary and scientific approach to health programming and delivery. Primary Health Care Team: 1. Local Chief Executive 2. Physician 3. Nurse 4. Medical technologist 5. Midwife 6. Sanitary Inspector 7. Auxiliaries -BHW Barangay Health Worker? -PHW Public Health Worker?  Two Levels of PHC Workers: 1. Village or Brgy. Health Workers -health auxiliary or volunteers 2. Intermediate Level Health Workers -Physician-Sanitary Inspector -Nurse-Midwife  PHC Worker to Population Ratio 1 Public Health Physician : 20,000 population 1 Public Health Nurse : 10,000 population 1 Public Health Midwife : 5,000 population 1 Public Health Dentist : 50,000 population 1 Rural Health Unit : 20,000 population 1 Barangay Health Station : 5,000 population Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 197  PRINCIPLES of PHC 1. Four (4) A’s: Characteristics 1. Accessibility 2. Affordability 3. Availability 4. Acceptability/ Appropriateness ….. of health services.  PRINCIPLES of PHC 2. Community Participation Community participation is the heart and soul of primary health care. Involvement of individuals, families and communities in the promotion of their own health and welfare Continuous effort to secure meaningful involvement of the community in planning, implementation and maintenance of health services Maximum reliance on local resources like manpower, money and material  PRINCIPLES of PHC 3. People are the center, object and subject of development. – the success of any undertaking that aims at serving the people is dependent on people’s participation at all levels of decision-making; planning, implementing, monitoring and evaluating. – Any undertaking must also be based on the people’s needs and problems (PCF, 1990)  PRINCIPLES of PHC 4. Self-reliance – Self-reliance is the social and economic ability of an individual, a household or a community to meet essential needs (including protection, food, water, shelter, personal safety, health and education) in a sustainable manner and with dignity. – Self-reliance, as a programme approach, refers to developing and strengthening livelihoods of persons of concern, and reducing their vulnerability and long-term reliance on humanitarian/external assistance.  PRINCIPLES of PHC 5. Partnership between the community and the health agencies in the provision of quality of life. – Components of primary health care cannot be provided by health sector alone – Providing linkages between the government and the non-government organization and people’s organization. – Planning with other sectors to prevent unnecessary duplication of activities  PRINCIPLES of PHC 6. Recognition of interrelationship between the health and development – Development is the quest for an improved quality of life for all. Development is multidimensional. – It has political, social, cultural, institutional and environmental dimensions (Gonzales 1994). – Goal is to ensure that health is prioritized within overall economic and development plans – Therefore, it is measured by the ability of people to satisfy their basic needs.  PRINCIPLES of PHC 7. Social Mobilization – It enhances people’s participation or governance, support system provided by the government, networking and developing secondary leaders. – Government – Civil society – Media – Community leaders – Research and academic institutions  PRINCIPLES of PHC 8. Decentralization RA 7160 Devolves and Decentralized Power, Resources and Responsibilities from the National Government (makes general policies) to Local Government (create specific actions to respond to local issues. They also contribute to develop national policies For flexibility and efficiency For innovation For greater commitment and ownership  Primary Care VS Primary Health Care Primary Care Primary Health Care - in the medical model of care, - is an overall approach to provision of interventions to providing people access to basic cure specific conditions of healthcare and ultimately individuals at the level of improve health of communities. community. Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page192  Barriers of Community Involvement Attitude Lack of motivation Resistance to change Dependence on the part of community people Lack of managerial skills  ALTERNATIVE HEALTH CARE Legal Basis: RA 8423 –Traditional and Alternative Medicine Act * created the Philippine Institute of Traditional and Alternative Health Care (PITAHC)  Herbal Medicine S -Sambong (D) anti-edema, diuretic, anti-urolithiasis A Ampalaya (D) DM anthelmintic N Niyog-niyogan (S) diarrhea, stomachache, mouth wash T Tsaang Gubat (D) anti-fungal A Akapulko(Bayabas-bayabasan) Source: Nies, M.A., & McEwen, M. Community and Public Health – (P) Nursing: Promoting the Public's Health. Elsevier. Page 202  Herbal Medicine L Lagundi (D) asthma, cough, fever, dysentery, skin diseases U lowers uric acid -UlasimangBato(Pansit-pans itan)- D lowers cholesterol levels, hypertension, B –Bawang - E toothache washing of wounds, diarrhea, gargle for B-Bayabas -D toothache pain, rheumatism, arthritis, headache, cough Y -Yerba Buena - D and - colds, swollen gums, toothache, menstrual and gas pain, nausea, fainting, insects bites and pruritus Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 202  Methods of Herbal Preparation Decoction COlu-an Poultice diretso na - boil the recommended part - Directly apply of the plant material in recommended part material water on the part affected. Infusion infuse mainit tubig Tincture may alcohol - Plant material is soaked in - mix the plant material in hot water, much like making alcohol. a tea. Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 202 Common Modalities of traditional Healthcare in the Philippines Acupressure Herbal Medicine Acupuncture (phytomedicine) Aromatherapy Massage Nutritional Therapy Chiropractic Pranic healing Reflexology Source: Nies, M.A., & McEwen, M. Community and Public Health Nursing: Promoting the Public's Health. Elsevier. Page 201  SUMMARY PHC is a total approach in achieving health for all, by all. It is regarded as a strategy, goal, and philosophy. HC is characterized by 5A’s. Health is not only a right but a responsibility Appropriate health technology includes meds,vaccines, and supplies, that promote and maintain health Equitable financing for healthcare and deployment of human resources for health are the key determinants in the success of PHC. Thank You!