Collage of Medicine

Primary Health Care

Basic Concepts
D .Afkar Awad Morgan
MBBS-MD Community medicine
Objectives of lecture at the end students 

; are able to understand

concept &definition of PHC- 
levels of health care- 
principles of PHC- 
components of PHC- 
Health
A state of complete physical, mental and “
social wellbeing and its not merely the
”absence of disease or infirmity
WHO 1946
Concepts of health
care
Provision of services by health personnel 

:It includes
Prevention 
Diagnosis 
Treatment 
Rehabilitation 

Promotion 
Levels of health care
Primary Health Care (the 1st level of 
contact between individual and the
health system – promotive, curative and
preventive)

Secondary Health Care (essentially 

curative services)

Tertiary Health Care (super-specialist 

care)
 PHC
The PHC is an 
approach and
model of
delivering
health care
adopted by the
.WHO in 1978
 PHC history

1946 WHO’s Constitution

Health for All by the year 2000 (Assembly) 

1977

1978International Conference on Primary 

Health Care (Alma – Ata)

Mile stones:
WHA 1977
The 30th World Health Assembly Comes 

:with new philosophies

Social justice and equity are essential for •
health
Recognition of the role of community •
participation
The importance of the political will •
The relation between health and •
development (health is essential for
development and development is essential
for health)
HFA
The ideas concluded in the international 

objective of Health for All

Definition of HFA: Attainment by all 

peoples of the highest level of health that
permit them to lead socially and
economically productive life
 Fundamental Principles for
Health for All
Health is fundamental human right and a worldwide social goal .1

Health is an integral part of development .2

The existing gross inequality in the health status of people is of .3

.common concern to all countries and must be drastically reduced
People have the right and the duty to participate individually .4
and collectively in the planning and implementation of their
health care

Governments have a responsibility for the health of their .5

people

.Countries must become self-reliant in health matters .6

Fuller and better use must be made of the world’s resources to .7

.promote health and development
 Alma-Ata Conference
(1978)

proclaimed 
PHC as way
to achieving
HFA
Primary Health Care
It is the first level of 
contact of
individuals, the
family and the
community with the
national health
system, bringing
health care as close
as possible to where
people live and work
Primary Health Care

is essential care based on practical,

scientifically sound, socially acceptable
methods and technologies, made
universally accessible to individuals and
families in the community through their full
participation and at a cost the community
and country afford to maintain
Alma Ata declaration, 1978
PHC
Primary Health Care extends beyond the traditional
health sector and includes all human services which
play a part in addressing the inter-related determinants
of health.

Social Environments Employment /

Income & Social Status
Working Conditions

Culture Physical Factors Social Support Networks

Prenatal / Early Childhood

Level of Education
Experiences
 PHC
:It includes
Primary Care (physicians, midwives & nurses) 

Health promotion, illness prevention 

Health maintenance & home support 
Community rehabilitation 
Pre-hospital emergency medical services 
Coordination and referral to other areas of 
health care
Primary Health Care
Services are generally provided in the community 

Some services are also provided in hospitals 

 PHC
Primary health care is an 

approach that more

broadly addresses illness
prevention and health
.promotion

It encompasses 
determinants of health,
such as the influence of
culture, education and
income on health and well-
.being
 Primary Health Care
Varies in each community 

:depending upon
;Needs of the residents 
Availability of health care 
;providers
The communities 
& ;geographic location
Proximity to other health 
.care services in the area
Primary Health Care - Benefits
PHC focuses on keeping people healthy & 

addressing illness early so as to increase

probability of cure
PHC is client focused 

Individuals have access to appropriate care 

Services are matched to community needs 

Targeted services will have a positive impact 

on the utilization of health and social services

Healthy communities with healthy people 

contribute to a vibrant & stable economy

Principles of primary health
care
Principled health care improvements required
based on Declaration of Alma Ata: 1978

Universal access 

Health equity 

Community 
participation
Inter-sectoral 

actions

20
Principles of Primary
Health Care

Appropriateness Intersectoral/
Accessibility
Interdisciplinary

Continuity of Care Population Health Community Participation

Efficiency Affordable & Sustainable

 PHC
:It is an approach to health care that 
is evidence-based 
uses appropriate technology 
promotes community participation in decisions 

about health services

is provided at a cost the community can afford 

encourages self-care and empowerment of 

community members
is the first level of contact with the health-care 

system
brings health care as close as possible to where 

people live, work, and play

Primary Health Care
Reform
Medical model Primary Health Care

 Treatment  Health promotion

 Illness  Health

 Cure  Prevention, promotion, cure

 Episodic care  Continuous care

 Specific problems  Comprehensive care

 Individual practitioners  Teams of practitioners

 Health sector alone  Intersectoral collaboration

 Professional dominance  Community participation

 Passive reception  Joint responsibility

 Accessibility of Health
Services
Componen Shift from to
t
all health physician as• multiple points of •
services gatekeeper and access to health
are ‘authorizer’ of access services; an
universally to and exit from individual may
accessible most health-care directly access a,
to services physician or
individuals dietician based on
and fragmentation, • their needs
families in duplication of care
the with weak linkages integrated service •
community among primary care delivery by inter-
providers and disciplinary teams
between primary and who
secondary/tertiary• together” address“
Use of Appropriate
Technology
Component Shift from to
evidence- • using new appropriate •
based technologies use of
decision- without technology
making and appropriate based on
appropriate health evidence
technology technology
assessment valuing •
which assess the alternative and
benefits and low tech-
costs therapies or
interventions
that have a
proven benefit
 Individual and Community
Participation
Componen Shift from To
t
Individual perception of • meaningful
and public as and informed
Community incapable of public
Participation making complex participation
decisions about in
health care decision-
control, • making about
especially of personal
information, is in health care
the hands of and health
providers system issues
Continuity of care:
Increased Health Promotion and Disease
Prevention
Component Shift from To
health disease-based • health focus •
promotion (e.g. morbidity/ (wellbeing)
self-care mortality ) community- •
based

reactive or • client •
downstream involvement in
approach where care decisions
clients with proactive or •
identified problems upstream
present and are approach where
treated there is early
identification of
 Intersectoral Cooperation
Component Shift from To
link between health-care services • better •
health and as the sole integration with
determinant responsibility of the other sectors
s of health-care system that impact on
health with no links to other health such as
sectors education,
,labour
individually focused •
on person population •
presenting for care focus in
understanding
individuals in a
broader context
and tying health
Main Elements of PHC
Health Education concerning .1
prevailing health problems and the
methods of preventing and controlling
;them
Promotion of food supply and proper .2
;nutrition
An adequate supply of safe water and .3
.basic sanitation
Main Elements of PHC
Maternal and child health care, .4
including family planning
Immunization against the major .5
infectious diseases
Prevention and control of local endemic .6

diseases
Appropriate treatment of common .7
diseases and injuries
Provision of essential drugs .8
elements of )secondary(
PHC
Mental Health •
Care of elderly •
Occupational Health •
School Health •
Reproductive Health •
Adolescent Health •
Selective Primary Health Care, UNICEF
Declaration of
Declaration of A
A Children’s
Children’s Revolution
Revolution.1982
1982.
.G.O.B.I. G.O.B.I
Emphasized new technological breakthroughs
.SPHC: a package of low cost interventions: G.O.B.I. G.O.B.I

Growth monitoring. For identifying at an early stage .1

children who were not growing as they should, because of
.poor nutrition
Oral rehydration. To control diarrheal diseases .2
with ORS, a mixture of water, salt and sugar that could be
.prepared by mothers
Breast feeding of infants as a means to prevent diseases .3
Immunization. Vaccines, especially against diseases of .4
childhood (measles, diphtheria, tetanus, polio, tuberculosis
and whooping cough)
GOBI . GOBI------ FFF
.Food supplementation, Female literacy and Family planning

Appeared as cost-effective & practical Interventions easy

.to monitor and evaluate
 Challenges of PHC
- Lack of community participation
- Lack of inter-sectoral collaboration
- Lack or misuse of human and material resources
- Concentration on sophisticated technology
- Mismanagement
- Lack of inter-country collaboration
- Lack of operational researches
PRIMARY HEALTH
CARE

Working
together for
better health
 :The field visits
Divide into 4 groups- based on the 
attendance sheet (12-13 persons from G1-
G4)
Group 1: EPI 
Group 2: HE & HP 

Group 3: Nutrition 

Group 4: MCH/ RH 

Each group will divide into subgroups A and 

B and C (each 8-9 persons)

Group A: FMOH 
Group B: SMOH 
Group C: Health centre 

Task is : what are the target doing 

?regarding the topic