SEMINAR ON PRIMARY HEALTH CARE AND PRIMARY HEALTH CENTRE

PRESENTED BY: MS. NEETA JIMMICHEN GUIDED BY: MRS. VRUSHALI K.

Evolution of primary health care

PHC is a universal concept with infinite adaptability to any region, culture and stage of development.

PHC begins with the admission that the prevalent pattern which emphasizes sophisticated and costly tertiary institutions and highly specialized professionals does not work.

Evolution of primary health care

PHC proceeds by involving all sectors of the community, those dealing with health, housing, transportation, agriculture, the media, to create a partnership among the family, health professionals and government agencies.

Evolution of primary health care

The drive towards PHC requires careful determination of priorities. The priorities should be such as to create healthy nations comprising healthconscious individuals, families and communities that are free from social, environmental, cultural and political ills.

Evolution of primary health care

The experience and concern in health development and PHC in India date back to the Vedic period.

Evolution of primary health care

In the Indus Valley Civilization as far back as 3000 B.C. one finds well-developed environmental sanitation programmes such as underground drains, public baths in the cities, etc. Arogya or health was given high priority in daily life and this concept of health included physical, mental, social and spiritual well-being.

Evolution of primary health care

The modern period, the primary health movement officially began in 1977 when the 30th World Health Assembly adopted resolution accepting the goal of attaining a level of health that permitted all citizens of the world to do live socially and economically productive lives.

Evolution of primary health care

At the International Conference in 1978 in Alma Ata, USSR, it was determined that this goal was to be met through Primary Health Care. This resolution became known by the slogan Health For All by the year 2000 and captured the official health target for all of the member-nations of WHO.

Definition of PHC
Primary Health Care as defined in Alma Ata Declaration status: Primary health care is essential health care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost which the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self-determination.

Characteristics of PHC

Universally accessible. Socially acceptable. Affordable.

Characteristics of PHC

Full participation of the community people. Use of appropriate technology.

Based on socially accepted methods which the country can afford.

Key principles for PHC approach

The right and duty of individual and communities to become self-reliant and to participate fully in matters related to their health. Programmes reflect and evolve from the unique socioeconomic and political characteristics of the country. Programmes address main health problems, integrate preventive, curative and rehabilitative services and are sustained by a referral system.

Key principles for PHC approach

Reliance at all levels, in suitably trained health workers who function as a team and respond to the expressed health needs of the populations. Programmes based on relevant research findings and experiences.

Key principles for PHC approach

Government and health professionals have the duty and the responsibility to provide the public with relevant information about health.
In addition to health sector, primary health care relates to other relevant sectors and aspects of national and community development.

PRINCIPLES

OF
PRIMARY HEALTH CARE

RICH
URBAN
EQUITABLE DISTRIBUTION

RURAL

POOR

Manpower development

PHC aims at mobilizing the human potential of the entire community by making use of available resources. Ensure availability of adequate number of appropriate health personnel required to devise and implement plan of action. This would require reorientation of the existing health workers, development of new categories of workers in health and related sectors and motivation and training of all manpower to serve the community.

Community participation

Process by which individuals, families and communities assume responsibility in promoting their own health and welfare. Most vital. Necessary to promote the development of the community and the communitys self reliance.

Residents and health providers need to work together in partnership.

Appropriate technology

Refers to health care that is relevant to peoples health needs and concerns, as well as being acceptable to them.

It includes issues of costs and affordability of services within the context of existing resources as the number and type of health professionals and other workers, equipment and their pattern of distribution throughout the community.

Multisectorial approach

Multisectorial approach

Therefore, these sectors need to work together in a multisectoral approach to coordinate their goal, plans & activities to ensure that they contribute the health of the community & to avoid conflicting or duplicating efforts.

ELEMENTS OF

PRIMARY HEALTH CARE

Education concerning prevailing health problems & the methods of preventing & controlling them

The poor & those with limited resources suffer the most from the diseases of poverty- malnutrition, diarrhea, acute respiratory infections & the vaccine preventable diseases.

Education concerning prevailing health problems & the methods of preventing & controlling them

In all countries, the education required to identify & prevent the prevailing community health problems should extend to health professionals. Uncover major hidden health problems & challenges by careful observation & by listening to community members.

Promotion of food supply & proper nutrition

Food security has become a critical issue in many parts of the world where civil disturbances exacerbate existing problems of drought & under development.

Promotion of food supply & proper nutrition

Community health nurses throughout the world who see the connection between the food security & land mines should be active in the international campaign to ban their use.

Maternal & child health care, including family planning

In spite of decades of concentrated efforts to address this problem, it is estimated that each year of disease or malnutrition before their fifth birthday (UNDP, 1998).

Maternal & child health care, including family planning

It is important to realize that education employment opportunities, an end to gender discrimination & the general empowerment of women may ultimately have more impact on womens & childrens health status than specific MCH efforts. Believing that health is fundamental human right, women are further demanding that they be ensured access to adequate nutrition, clean water, sanitation & shelter for all.

Adequate safe water supply & basic sanitation

Nearly 30% of the population of developing countries do not have access to safe water & over 60% lack basic sanitation.

Adequate safe water supply & basic sanitation

Although the poor suffer most from these problems, many environmentally caused diseases respect no barriers or social class & affect the whole community.
Community health nurses in such areas, are aware of the links between industrial development, trade, the envt & health, see involvement in these & similar issues as integral part of their practice.

Immunization against major infectious diseases & prevention & control of locally endemic diseases

UNICEF & WHO reported in 1993 that their campaign for universal immunization against these killers was reaching more than 80% of the worlds children before their first birthday. (UNICEF, 1993).

Immunization against major infectious diseases & prevention & control of locally endemic diseases

When their lack of communication is compounded by poverty, malnutrition, abuse & locally endemic diseases, children have little hope of living socially & economically productive lives as adults.
In addressing the main health problems of a community children, a PHC approach requires the provision of appropriate promotive, preventive, curative & rehabilitative services.

Immunization against major infectious diseases & prevention & control of locally endemic diseases

Where & when this cannot be done locally, referral should be made to integrate functional & mutually- supportive referral systems, leading to the progressive improvement of comprehensive care of all giving priority to those most in need. (WHO, 1998)

Immunization against major infectious diseases & prevention & control of locally endemic diseases

Secondary & tertiary care facilities, as well as more complex rehabilitation & long-term care facilities, as well as more complex rehabilitative & long-term care facilities, have a critical role to play in the provision of PHC. Without adequate referral systems to all levels of care, PHC at the local level will ultimately fail.

Appropriate treatment of common diseases using appropriate technology

The PHC health team may include not only physicians, nurses, midwives, & auxiliaries, but also community health worker (agents, promotoras de salud, & so on)& traditional practitioners (herbalists, curanderos & shamans).

Appropriate treatment of common diseases using appropriate technology

When such non-traditional members are added to the health team, care should be exercised in their selection, training & ongoing supervision.

Whatever the makeup of the local health team, the goal should be to concentrate on the expressed needs of the community & to work with in in achieving its health related goals.

Provision of essential drugs

The WHO has long been convinced that adequate provision of essential drugs at a cost that the community can afford is critical to the success of PHC.

Provision of essential drugs

Appropriate treatment requires the provision of essential drugs that are safe & effective; of high quality; capable of being adequately supplied, stored & distributed; & of course, affordable.

Provision of essential drugs

In addition to the provision of essential drugs, many countries are studying the use of herbal & other traditional medicines & treatments in PHC.

To achieve this goal, the pharmaceutical industry, health professionals, communities, schools, universities, & governments must all collaborate & co-operate.

Promotion of mental health

With the development of effective psychotropic medication & the civil rights movement in the 1960s, the philosophy of community mental health care turned from an institutional to community based system.

Promotion of mental health

Working together with the community from a proactive stance, the PHC team should concentrate on those mental health problems that are of highest priority in & for the community. Assistance from & collaboration with many other disciplines & civic groups active in the broader community & crucial in such efforts.

Role of nurses 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 by 2000 through primary health care.

Role of nurses in PHC

The following five basic strategies have been proposed by the WHO-ICN meeting by nurses:

1.The development in each country of a Corps of Nurses that is well-informed about health care and ready to bring necessary changes in the nursing system. 2.The inclusion of nursing personnel at all levels of policy making and administration so that the profession can contribute to determining the action plan.

Role of nurses in PHC

3.The involvement of the nurses and the use of their skills in initiating and extending primary health care.
4.Fundamental changes at all levels of nursing education to ensure that the priority needs of, population are functionally integrated into the education and into nursing practice. 5.Research into nursing administrations, practice and education that will demonstrate nurses contribution to primary health care.

Health education

Health education is an integral part of all health services. In India, the primary education has been made compulsory and enrolment of children has improved over years.

Health education

As per census of India 2001, literacy rate is 65.38% the corresponding figures for male and females are 75.85% and 54.16% respectively.

In rural areas, female literacy is still lower.

This coupled with highly dependent status of women, acts as a communication and kills their initiatives and enthusiasm for any social change.

Health education

In addition, socio-economic backwardness, ignorance, traditions and superstitions has been acting as blocks in progressive thinking including development of concept of positive health.
The community health nurse has to play an important role in organizing appropriate health educational programmes according to the needs of the community, colaborating and co-ordinating with intra-disciplinary and inter-disciplinary teams.

Health education

Health education to the community should be prime function of the health workers and village level functionaries. In this endeavor, functionaries of other sectors such as social and womens welfare, education, agriculture and animal husbandry, panchayat and voluntary agencies can contribute very significantly. Health education in school and adult education session should incorporate various health problems and the methods for their prevention and control.

Food supply and proper nutrition

In India, available statistics indicate that 65% of our children are malnourished; about 1,00,000 die due to it every year, protein-calorie malnutrition dominating among under-fives.

There are 9 million blind of whom, 5 million are curable. Nutritional deficiency states are particularly noticeable among pregnant and lactating mothers and in infants and children.

Food supply and proper nutrition

The responsibility of the community health nurse in this regard is to provide essential health services.
These include surveillance and case finding through use of growth charts in children, making provisions for the supply of iodized salt, vitamin A supplements, food supplements in collaboration with other members of health team for prevention and treatment of malnutrition.

Food supply and proper nutrition

Community health nurse also takes suitable measures for prevention and treatment of diarrhoeal diseases, intestinal parasites and other diseases affecting ability to utilize food.
The nurses also take health promotional measures like encouraging adequate child spacing, promote longer breast feeding and safe weaning practice.

Food supply and proper nutrition

Nurses are responsible to teach community members to cook the supplementary food for malnourished children as well as for teaching people about the preparation of food, balanced diet and selection of food in sufficient quantity and quality. They also teach the people to adopt basic sanitary skills like cleaning their hands before cooking or handling food and to wash dishes and appliances so as to prevent endemic and epidemic diseases.

Food supply and proper nutrition

The community health nurse is also responsible for weighing infants and small children and maintain growth-charts for monitoring growth of children and conducting nutritional education programme in the community and schools.

Food supply and proper nutrition

He/she should encourage people to make kitchen gardens and community gardens and educate the people on food hygiene. In co-ordination with other sector, steps also should be taken to encourage growing locally more foods such as cereals, pulses, vegetables, fruits, milk, fish and poultry products through co-operative and other efforts so as to make these easily affordable and accessible to the people.

Food supply and proper nutrition

Nurse has also the responsibility to train the community health workers in this regard to promote food supply and proper nutrition in the community.

Water supply and basic sanitation

In India, safe and potable water is not available to a major section of the population.

Many water-borne diseases prevalent are preventable. The environmental sanitation is also very poor.

Water supply and basic sanitation

There are no proper arrangements for disposal of human excreta and animal waste, sewage, garbage and sullage, etc.
In co-ordination with other sectors, systematic approach should be made to survey and identify resources of safe water and to carry out proper analysis of water and also to encourage people to construct household and community latrine, composting facilities and soakage pits.

Water supply and basic sanitation

In India, sanitary inspectors and male health workers are responsible for safe and potable water, hygienic latrines and sewage and garbage disposal.

Community health nurses have to co-operate with the sanitary inspectors and health workers to inform people about germ theory, hygienic personal habits, causes of insanitation, benefits of sanitary regulations and so on. Nurses also supervise and monitor community health workers/volunteers in dealing with hygiene and sanitary problems.

Maternal and child health including family planning

In India, maternal morbidity rate is quite high as compared to other countries [MMR 4-5/1000 live births]. Our infant mortality rate is 95/1000. The rural IMR is 105 and the urban IMR is 57. Community health nurses are assigned to carry out maternal and child health care, which includes antenatal, prenatal, perinatal and postnatal care.

Immunization

It is to prevent endemic and epidemic diseases. Now Universal Immunisation Programme is in operation in India.

Nurses and nursing team plan immunisation programmes for adults and children, particularly infants and pregnant women. Encouragement and persuasion are strategies used in monitoring and scheduling immunisation.

Prevention and control of locally endemic diseases

In India, the government has launched various national programmes for the control or eradication of these endemic diseases like Leprosy Eradication Programme, Tuberculosis Control Programme. Programme for controlling blindness, Malaria Eradication Programme and others. In this diseases control and prevention, nurses and nursing team collect and record data about communicable diseases, provide surveillance over the target population to ensure that communicable diseases are eradicated or controlled.

Treatment of minor ailments

It may be taken at village level. Treatment of common diseases and injuries are to be provided at the sub-centre and primary health centres and appropriate referral services are to be organized.

Nurses have been trained to treat patient under a doctors standing order.

Treatment of minor ailments

Since wherever there are not enough qualified doctors to have one each subcentre or primary health centre, nurses has to provide possible care and refer to higher health centres and hospitals for further treatment.

Provision of essential drugs

The community health nurse has to procure and keep and also utilize whenever necessary essential drugs to treat minor ailments, etc. She/he should be aware of the resources and facilities for getting essential drugs to inform the client within a short distance.

Provision of essential drugs

With regard to the role of nurse and primary health care, WHO study group [1985] identified four main selfexplanatory roles of the nurses as given below:

1.Nurse as a direct care provider:

She/he can provide direct care to individual who seeks medical help.

2.Nurse as a teacher and educator:

Community health nurse can play an important role in educating the people on prevailing health problem.

Provision of essential drugs

3.Nurse as a supervisor and manager:

She/he can possess and exercise some kind of leadership while supervising other personnel in providing care, planning health services for the community in conjunction with other members of the health team and organizing and administering community health services.

Provision of essential drugs

4.Nurse as a researcher and evaluator:

Nurses are needed to be dynamic in their services, to bring about changes and innovations in the health care provided. These can be achieved, based on a role of a researcher and evaluator, nurses have to play for providing better services to the community.

APPROACH TO PRIMARY HEALTH CARE

Vadu Budruck Rural Health Project an attempt by the King Edward Memorial Hospital, Pune , in partnership with local & state governments was made to deliver comprehensive health care to rural population, the 3 wks community training has been given to 45 people (23 men & 24 women) at Vadu Badruk for collecting vital statistics, health education & preventive & promotive care.

APPROACH TO PRIMARY HEALTH CARE

The community health workers are expected to function as important change agents in their villages. They register all pregnant women, visit them in their houses , do hemoglobin estimation, & distribute hemotonics & calcium.
They give advice on nutrition & health education & persuade pregnant women to be vaccinated against tetanus.

APPROACH TO PRIMARY HEALTH CARE

Detect women at high risk of complications & make sure that they are examined by ANM, PHN or if necessary, a doctor. Community health workers are encouraged to be present at deliveries to ensure cleanliness & record birth weights.

APPROACH TO PRIMARY HEALTH CARE

They distribute a compact delivery pack to each pregnant women, & teach birth attendants how to use them.
They detect & transport women with abnormalities to the health centres.

APPROACH TO PRIMARY HEALTH CARE

They make regular post-natal visits, give advice on post-partum care, neonatal care, hygiene & nutrition. They detect the children & workers at risk, register all marriages, births & deaths.

APPROACH TO PRIMARY HEALTH CARE

They make regular post-natal visits, give advice on post-partum care, neonatal care, hygiene & nutrition.

They maintain eligible couple, register & motivate couple to practice family planning. They arrange health education & nutrition education campaigns.

APPROACH TO PRIMARY HEALTH CARE

The community health worker takes slides, in cases of fever, start presumptive treatment with chloroquine & they used to treat minor ailments & injuries with simple measures.
This project has shown some achievements: the community had become aware of their health needs & there was 100% registration of ANCs & coverage of pregnant women with nutritional supplement.

APPROACH TO PRIMARY HEALTH CARE

About 55% of the eligible couples had been sterilized & a birth rate of 26 per 1000 population has been achieved. A 50% reduction in the incidence of malaria & gastroenteritis had been recorded. There was high rate of immunization & there was high rate 100% disinfection of public wells & the building of soakage pits & sanitary latrines.

APPROACH TO PRIMARY HEALTH CARE

Kitchen garden & fruit trees were flourishing. The following activities are carried out in attaining the goal of Health For All in INDIA.

APPROACH TO PRIMARY HEALTH CARE

The Minimum Needs Programme continues to be the sheet anchor for the promotion of the primary health care. Serious efforts are being made for coordinating & coupling of health & health related programmes & activities. Programmes involving community & voluntary organizations & health education are given priority.

APPROACH TO PRIMARY HEALTH CARE

For bringing qualitative improvement in the services, greater attentions paid to supplies & logistic support. Training programmes of the workers have been made, more need-based & community oriented. Management information system is being improved & supervision strengthened.
Adequate provision of essential drugs, vaccines & sera is being made by paying special attention to their production, supply, pricing & distribution. Coverage by mental & dental health services & school health programmes would be extended.

APPROACH TO PRIMARY HEALTH CARE

The specific diseases control programmes have been strengthened. Appropriate action is being initiated for the prevention & control of non-communicable diseases. medical research having special relevance to the common health problem is given priority.

Indigenous system of medicine needs standardization, integration & wider application in the National Health Planning. Extension planning in this sector is essential.

PRIMARY HEALTH CENTRE

Set up:

First contact between people & doctor. Primary health centre is established to cover 30,000 population in plains & 20,000 population in hilly/tribal areas. The work of PHC is looked after by a medical officer.

Personnel/staffing:

Medical officer Nurse Female health worker/ANM Pharmacist Block Extension educator Health Assistant male Health Assistant Female Lower Division clerk Upper division clerk Lab technician Driver (if vehicle available) 4th class servants Total

1 1 1 1 1 1 1 1 1 1 1 1 15

Functions of PHC

Medical care. Basic sanitation and clean supply. Treatment and prevention of endemic diseases. Reproductive and child health, collection of vital statistics, family planning programmes/services.

Functions of PHC

Health education. Referral services. Basic lab tests/services. National health programmes.

Training of village health guide, local dais, health workers and health assisstants.

VARIOUS ACTIVITIES THAT TAKES PLACE IN THE PHC

Maintenance of records

Fridge and ice lined refrigerator temperature regulation record. Birth and death records. Immunization records.

Maintenance of records

Antenatal care register. Tuberculosis register. Injection register.

Maintenance of records

High risk ANC register. Triple vaccine and polio vaccine register. Copper-T, oral contraceptives and Nirodh register.

Maintenance of records

Medicine register. Laboratory register. Vaccine indent register. Postnatal care register.

Carrying out various procedures

Conducting deliveries. Conducting antenatal check ups.

Administering postnatal care.

Various immunization. Administering TT and Rabies vaccine.

Carrying out various procedures

Administering OPD prescribed injections.

Dressing of wounds. Conducting various screening tests and lab tests.

Giving supplementary supplements.

Carrying out various national health programmes.

Implementing National Health Programmes

Universal Immunization Programme. Family Planning Programme. Mother And Child Health Programme.

National Malaria Control Programme.

National TB Control Programme.

PRIMARY HEALTH CENTRE AND NURSE

The nurse employed at PHC has to be more involved with medical care and treatment.

FHA have to supervise the work of all sub centres under the PHC.
Similarly, she has to fulfill all her work at the headquarter of PHC. Community health nurse looks after the supervisory work mainly.

Functions of FHA working at PHC

Supervision and guidance of female health workers employed at the sub centres. Working as a member of health team. Arranging material, equipment, etc for the sub centre. Scrutiny of records and reporting. Training of dais.

Functions of FHA working at PHC

Assisting in weekly antenatal and well baby clinic at the sub centre.
Advisory services for reproductive and child health and medical termination of pregnancy. Providing family planning services. Nutrition services; referring cases of malnutrition to next centres.

Functions of FHA working at PHC

Looking after immunization work. Providing first aid services.

Giving health education.

Functions of MHA working at PHC

Supervision and guidance of male health workers. Working as a member of health team. Assisting FHA/FHW to collect equipment and material for sub centres.

Scrutiny and supervision of records of male workers.

Working for malaria control.

Functions of MHA working at PHC

Immediate notification of communicable diseases. Environmental sanitation and nutrition. Family planning services. Reporting of birth and death. First aid service. Health education.