PRIMARY HEALTH CARE AND ITS DELIVERY

PRIMARY HEALTH CARE

Primary health care is a whole-of-society approach to health and well-being centred on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.

DEFINITION

The term ‘Primary Health Care’ (PHC) is the name given to the essential healthcare that is universally accessible to individuals and is acceptable to them at a cost that the country and community can afford.

ORIGIN OF PRIMARY HEALTH CARE

The "Barefoot Doctors“: The Bare Foot Doctors of China were an important inspiration for PHC because they illustrated the effectiveness of having a healthcare professional at the community level with community ties. Barefoot Doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. The Barefoot Doctors had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices.

ALMA ATA DECLARATION

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of "Health For All" but only in developing countries at first. This applied to all other countries five years later. The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of "Health for All" around the globe.

GOALS OF PRIMARY HEALTH CARE

• Comprehensive Care: It provides comprehensive care for health needs throughout the lifespan, not just for a set of specific diseases. It ensures people receive care ranging from promotion and prevention to treatment, rehabilitation and palliative care - as close as feasible to their everyday environment.
• Equity/ Equal Care: Primary health care is rooted in a commitment to social justice and equity and in the recognition of the fundamental right to the highest attainable standard of health. “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services
• Selective Care: The concept of primary health care is referred to the provision of ambulatory or first-level of personal health care services. In other contexts, primary health care has been understood as a set of priority health interventions for low-income populations (also called selective primary health care).

ESSENTIALS OF PRIMARY HEALTH CARE

• Education on health problems and how to prevent and control them. Development of effective food supply and proper nutrition.
• Maternal and child healthcare, including family planning.
• Adequate and safe water supply and basic sanitation. Immunization against major infectious diseases.
• Local endemic diseases control.
• Appropriate treatment of common diseases and injuries.
• Provision of essential basic medication.

PRINCIPLES OF PRIMARY HEALTH CARE

Accessibility (equal distribution):

• Healthcare services must be equally shared by all the people of the community irrespective of their race, creed or economic status. This concept helps to shift the accessibility of healthcare from the cities to the rural areas where the most needy and vulnerable groups of the population live.

Community participation:

• This includes meaningful involvement of the community in planning, implementing and maintaining their health services. Through the involvement of the community, maximum utilization of local resources, such as manpower, money and materials, can be utilised to fulfill the goals of PHC.

Health promotion:

• Health promotion involves all the important issues of health education, nutrition, sanitation, maternal and child health, and prevention and control of endemic diseases. Through health promotion individuals and families build an understanding of the determinants of health and develop skills to improve and maintain their health and wellbeing.

Appropriate Healthcare Technology:

• Appropriate Healthcare Technology refers to methods, procedures, techniques and equipment that are scientifically valid, adapted to local needs and acceptable to those who use them and to those for whom they are used, and that can be maintained and utilized with resources the community or country can afford.

Inter-sectoral collaboration:

• Inter-sectoral collaboration is to be able to improve the health of local people the PHC programme needs not only the health sector, but also the involvement of other sectors, like agriculture, education and housing.

IMPORTANCE OF PRIMARY HEALTH CARE

• Primary health care is important to respond to rapid economic, technological, and demographic changes, all of which impact health and well-being (such as, water and sanitation, education, economic growth).
• Primary health care has been proven to be a highly effective and efficient way to address the main causes and risks of poor health and well-being today, as well as handling the emerging challenges that’s a threat to future wellbeing.
• Quality primary health care reduces total healthcare costs and improves efficiency by reducing hospital admissions.
• Addresses the increasingly complex health needs through multi-sectoral approach that integrates health-promoting and preventive policies, solutions that are responsive to communities, and health services that are people-centred.
• Primary health care also includes the key elements needed to improve health security and prevent health threats such as epidemics, through such measures as community engagement and education of essential public health functions, including surveillance.
• Strengthening systems at the community and peripheral health facility level contributes to building resilience, which is critical for preventing burden to the health system.
• Stronger primary health care is essential to achieve the health-related Sustainable Development Goals (SDGs) and universal health coverage.

ROLE OF NURSE IN PRIMARY HEALTH CARE DELIVERY

• Health promotion
• Illness prevention
• Midwifery, antenatal and postnatal care
• Treatment and care of sick people, usually in interdisciplinary teams
• Rehabilitation and palliation
• Community development
• Population health and public health Education: Educating others within the practice and disseminating important information
• Research
• Advocacy
• Chronic illness management by providing long term care
• Organizing clinical work environments, including infection control and risk management
• supporting to other providers such as doctors and administration staff
• Problem solving in clinical or organizational context that arise on a day-to-day basis, such as addressing patient emergencies
• Quality control by managing the accreditation process and other quality and risk management activities such as infection control and the safe disposal of sharps
• Being an agent of connectivity between different health disciplines and between patients and health services.