History of Primary Health Care

Primary health care was defined in the Declaration of Alma-Ata at the International
Conference on Primary Health Care, Alma-Ata, USSR, in 1978. Delegates to the conference
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 the people of the world…."
In 1986 at the First International Conference of Health Promotion in Ottawa the Minister
of Health and Welfare, Jake Epp, unveiled a new framework for health promotion as a means
of achieving health for all.
Primary health care came to the fore again, in late 1990 and early 2000. To view various
examples of discussion and planning documents, click on the links below.
In 2001 Caring for Medicare: Sustaining A Quality System, the Fike Commission released
its recommendations on the future of medicare.
In November 2002 the Commission on the Future of Medicare in Canada published its
finding in "Building on Values: The Future of Medicare in Canada."
In June 2002 the Saskatchewan Government released "The Saskatchewan Action Plan for
Primary Health Care." This plan, along with "Guidelines for the Development of Regional Health
Authority Plans for Primary Health Care Services", provided the necessary mandate and direction
for the province's Regional Health Authorities to begin work.

Legal Basis
The PHC was later adopted in the Philippines by virtue of Letter of Instruction (LOI) 949
of 1979, making the Philippines the first country in Asia to embark on meeting the challenge of
PHC. It must be noted that even prior to LOI 949, whi provided impetus to then Ministry of Health
, there were several health workers, non-governmental organizations (NGOs), and church
organizations offering community- based health programs in the rural areas of Visayas and
Mindanao applying the spirit of PHC even before it was formally adopted by the government.
Basic to the PHC declaration is the common view that health “Is a state of complete physical,
mental, and social well-being and not merel the absence of disease or infirmity”. Viewing health
from a holistic perspective, beond just physical and mental maladies, the WHO has put equal
emphasis on the social dimensions of health, that wellness can be achieved by considering different
factors that interdependently influence the health of the population, such as the environment,
education, and social services and politics or leadership.
In addition, health is seen as not just a product of social and economic development but
more so as a means of achieving development. Thus, government investment in the health of the
population is ultimately linked to the country’s development. A healthy population has the
capability to contribute more to its development.

Definition
 essential health care made universally accessible to individuals and families in the community
by means acceptable to them, through their full participation and at cost that the community
can afford at every stage of development.
 a practical approach to making health benefits within the reach of all people.
  an approach to health development, which is carried out through a set of activities and whose
ultimate aim is the continuous improvement and maintenance of health status

Goals
 HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS
OF THE PEOPLE by the year 2020.
 An improved state of health and quality of life for all people attained through SELF
RELIANCE.
 Key Strategy to Achieve the Goal:
 Partnership with and Empowerment of the people – permeate as the core strategy in the
effective provision of essential health services that are community based, accessible,
acceptable, and sustainable, at a cost, which the community and the government can afford.
Objectives of Primary Health Care

 Improvement in the level of health care of the community

 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and other disease.
 Reduction in morbidity and mortality rates especially among infants and children.
 Extension of essential health services with priority given to the underserved sectors.
 Improvement in Basic Sanitation
 Development of the capability of the community aimed at self- reliance.
 Maximizing the contribution of the other sectors for the social and economic development
of the community.

Elements
There are 8 elements of primary-health care (PHC). That listed below-
E– Education concerning prevailing health problems and the methods of identifying, preventing
and controlling them.
L– Locally endemic disease prevention and control.
E– Expanded programme of immunization against major infectious diseases.
M– Maternal and child health care including family planning.
E– Essential drugs arrangement.
T– Treatment of communicable and non-communicable disease and promotion of mental
health.
S– Safe water and sanitation.
N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
T– Treatment of communicable and non-communicable disease and promotion of mental health.
S– Safe water and sanitation.
 Principles of Primary Health Care
1. 4 A’s = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health
services.
 The health services should be present where the supposed recipients are. They should make
use of the available resources within the community, wherein the focus would be more on
health promotion and prevention of illness.
2. Community Participation
 heart and soul of PHC
3. People are the center, object and subject of development.
 Thus, 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)
 Part of the people’s participation is the partnership between the community and the
agencies found in the community; social mobilization and decentralization.
 In general, health work should start from where the people are and building on what they
have. Example: Scheduling of Barangay Health Workers in the health center
Barriers of Community Involvement

 Lack of motivation
 Attitude
 Resistance to change
 Dependence on the part of community people
 Lack of managerial skills
4. Self-reliance
 Through community participation and cohesiveness of people’s organization they can
generate support for health care through social mobilization, networking and mobilization of
local resources. Leadership and management skills should be develop among these people.
Existence of sustained health care facilities managed by the people is some of the major
indicators that the community is leading to self-reliance.
5. Partnership between the community and the health agencies in the provision of quality of life.
 Providing linkages between the government and the nongovernment organization and
people’s organization.
6. Recognition of interrelationship between the health and development
Health- Is not merely the absence of disease. Neither is it only a state of physical and mental well-
being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and
economic factors as its determinant. Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life enjoyed by the community residents (PCF,)
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).
Therefore, it is measured by the ability of people to satisfy their basic needs.
7. Social Mobilization
 It enhances people participation or governance, support system provided by the
Government, networking and developing secondary leaders.
8. Decentralization
 This ensures empowerment and that empowerment can only be facilitated if the
administrative structure provides local level political structures with more substantive
responsibilities for development initiators. This also facilities proper allocation of
budgetary resources.

Strategies
1. Elevating Health to a Comprehensive and Sustained National Effort.
 Attaining Health for all Filipino will require expanding participation in health and
health related programs whether as service provider or beneficiary. Empowerment to
parents, families and communities to make decisions of their health is really the
desired outcome.
 Advocacy must be directed to National and Local policy making to elicit support and
commitment to major health concerns through legislations, budgetary and logistical
considerations.
2. Promoting and Supporting Community Managed Health Care
 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.
3. Increasing Efficiencies in the Health Sector
 Using appropriate technology will make services and resources required for their delivery,
effective, affordable, accessible and culturally acceptable. The development of human
resources must correspond to the actual needs of the nation and the policies it upholds such
as PHC. The DOH will continue to support and assist both public and private institutions
particularly in faculty development, enhancement of relevant curricula and development of
standard teaching materials.
4. Advancing Essential National Health Research
Essential National Health Research (ENHR) is an integrated strategy for organizing and managing
research using intersectoral, multi-disciplinary and scientific approach to health programming and
delivery

Levels of Prevention
Primary prevention—those preventive measures that prevent the onset of illness or injury before
the disease process begins.
 Examples include immunization and taking regular exercise.
Secondary prevention—those preventive measures that lead to early diagnosis and prompt treatment
of a disease, illness or injury to prevent more severe problems developing. Here health educators
such as Health Extension Practitioners can help individuals acquire the skills of detecting diseases
in their early stages.
  Examples include screening for high blood pressure and breast self-examination.
Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness.
At this level health services workers can work to retrain, re-educate and rehabilitate people who
have already developed an impairment or disability

Universal Health Care (UHC)

Legal Basis
To address the remaining gaps and challenges on inequity in health, the Aquino Health
Agenda (AHA), through Administrative Order No. 2010-0036 was launched. It contains the
operational strategy called Kalusugan Pangkalahatan (KP) which aims to achieve universal health
care for all Filipinos. KP seeks to ensure equitable access to quality health care by all Filipinos
beginning with those in the lowest income quintiles. KP further fulfills President Aquino’s “social
contract” with the Filipino people, as stated in Section 7 of Executive Order 43 series 2011:
1. Investing in our people, reducing poverty and building national competitiveness;
2. Advancing and protecting public health;
3. Building of capacities and creation of opportunities among the poor; and 4. Increasing social
protection
Health-related public policies and laws have provided the impetus for comprehensive reform
strategies identified in the Health Sector Reform Agenda (HSRA) launched in 1999 and its
implementation framework, the FOURmula One (F1) for Health in 2005. Since then, substantial
gains in health sector improvements have been achieved in the areas of social health insurance
coverage and benefits, execution of Department of Health (DOH) budgets and its use to leverage
local govemment unit (LGU) performance, LGU spending in health, systematic health investment
planning through the Province-wide Investment Plan for Health (PIPHy Citywide Investment Plan
for Health (CIPHy Annual Operational Plan (AOP) process, capacities of government health
facilities, and the implementation and monitoring of public health programs.
However, poor Filipino families have yet to experience equity and access to critical health services,
despite all of these achievements.
DOH and PhilHealth recently conducted a joint Benefit Delivery Review highlighting the need to
increase enrollment coverage, improve availment of benefits and increase support value for claims
in order for the National Health Insurance Program (NHIP) to provide Filipinos substantial
financial risk protection. More importantly, benefit delivery for the sponsored program (poorest
quintile) was found to be lowest among our people. To date, only 53 percent of the entire
population is covered by the program, worth 42 percent availment rate, and 34 percent support
value or a total benefit delivery ratio of 8 percent.
Public hospitals and health facilities have also suffered neglect due to the inadequacy of health
budgets in terms of support for upgrading to expand capacity and improve quality of services. As
of October 2010, eight hundred ninety two (892) rural health units (RHUs) and ninety nine (99)
govemment hospitals have yet to qualify for accreditation by PhilHealth. Data have also shown that
the poorest of the population are the main users of govemment health facilities. This means that
the deterioration and poor quality of many government health facilities is particularly
disadvantageous to the poor who needs the services the most.
 Goals
Financial Risk Protection
To protect all Filipinos, especially the poor, against the catastrophic cost of ill health, KP
shall strengthen the National Health Insurance Program (NHIP) as the prime mover in improving
financial risk protection, generating resources to modernize and sustain health facilities, and
improve the provision of public health services to achieve the Millennium Development Goals
(MDGs).
Responsive health system
KP aims to enhance the responsiveness of the health system and client satisfaction by
improving the quality hospitals and health care facilities. Government owned and operated hospitals
and health facilities will be upgraded to expand capacity and provide quality services to health attain
MDGs, attend to traumatic injuries and other types of emergencies, and manage non-
communicable diseases and their complications.
Better health outcomes
KP aims for the attainment of health-related MDGs by focusing on the reduction of maternal
and child mortality, morbidity and mortality from TB and malaria, and the prevalence of
HIV/AIDS, in addition to being prepared for emerging disease trends, and prevention and control
of non-communicable diseases.

Strategic Thrust
KP shall be attained by pursuing the three strategic thrusts:
 Financial risk protection through expansion in NHIP enrollment and benefit delivery -The
poor shall be protected from the financial impacts of health care use by: a. Redirecting
PhilHealth operations towards the improvement of the national and regional benefit delivery;
b. Expanding enrolment of the poor in the NHIP to improve population coverage;
c. Promoting the availment of quality outpatient and inpatient services at accredited facilities
through reformed capitation and no balance billing arrangements for sponsored members,
respectively,
d. Increasing the support value of health insurance for the poor through the use of
information technology upgrades to accelerate PhilHealth claims processing, among others,
and
e. A continuing study to determine the segments of the population to be covered for specific
range of services and the proportion of the total cost to be covered/ supported.
 Attainment of the health-related MDGs - This will be attained by:
a. Deploying Community Health Teams (CHTs) that shall actively assist families in assessing
and acting on their health needs;
b. Utilizing the life cycle approach in providing needed services, namely family planning;
ante-natal care; delivery in health facilities; essential newborn and immediate postpartum
care; and the Garantisadong Pambata package for children 0-14 years of age;
c. Aggressively promoting healthy lifestyle changes to reduce non-communicable diseases;
d. Ensuring public health measures to prevent and control communicable diseases, and
adequate surveillance and preparedness for emerging and re-emerging diseases; and e.
Harnessing the strengths of inter-agency and inter-sectoral approaches to health especially
with the Department of Education and Department of Social Welfare and the Department
of Interior and Local Government
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