community Flashcards
Goals and key elements of PHC?
-ultimate goal of primary health care is better health for all through five key elements:
1. Reducing exclusion and social disparities in health (universal coverage reforms).
2. Organizing health services around people’s needs and expectations (service delivery reforms).
3. Integrating health into all sectors (public policy reforms).
4. Pursuing collaborative models of policy dialogue (leadership reforms).
5. Increasing stakeholder participation.
Principles of PHC
1.Equitable distribution of healthcare: Providing equally to all individuals.
2.Community participation: Make fullest use of available resources
3.Health workforce development: adequate numbers and distribution of trained physicians, nurses..etc
4.Use of appropriate technology: accessible, affordable, feasible and culturally acceptable
5.Multi-sectional approach: health cannot be improved by intervention within just the formal health sector; other sectors are equally important.
6.Availability: 24 hours
7.Affordability
8.Acceptibilty
9.Appropriateness
10.Comprehensiveness: include promotive, preventive, curative and rehabilitative health care services.
11.Continuous: Womb to tomb
12.Accessibility:
-geographical: <1hour, road and mode of transport
-Social: All people irrespective of class/culture.
-Functional: Kind care good quality health care.
GOBI-FFF approaches in PHC?
To improve maternal and child health
1. Growth monitoring: to prevent most child malnutrition before it begins.
2. Oral rehydration therapy: to combat dehydration associated with diarrhea.
3. Breastfeeding.
4. Immunization.
5. Family planning (birth spacing).
6. Female education.
7. Food supplementation: for example, iron and folic acid fortification/supplementation to prevent deficiencies in pregnant women.
Essential Health Services in Primary Health Care (ELEMENTS)
1.E–Education for Health.
2.L–Locally endemic disease control.
3.E–Expanded program for immunization.
4.M –Maternal and Child Health including responsible parenthood.
5.E–Essential drugs.
6.N–Nutrition.
7.T– Treatment of communicable and non-communicable diseases.
8.S - Safe water and sanitation.
Levels of care provided through PHC?
1- Preventive services:
The Health education, counseling, growth monitoring, supplementing micronutrients to infants, family planning, support environmental sanitation, vaccination of compulsory vaccines, food safety, and early detection and screening tests for neonatal anomalies, tuberculosis, risky pregnancy, and malignant tumors.
2- Curative services:
Treatment of communicable and non-communicable diseases, control of epidemics and endemic diseases, first aid and emergency care, provision of some drugs, and referral
of needy cases to higher care level.
Actually, PHC provides comprehensive, promotive, protective, preventive, and curative care. Curative services constitute 20% only of primary health care. This concept must be practiced and understood by all health care providers.
Criteria of effective and successful PHC?
- Coordination of PHC with different related sectors: as education, social, agricultural, environmental organizations as they share in people’s health.
- Community participation: in PHC management, in needs assessment, setting priorities, helping in resources and in evaluation of activities.
- Customer’s satisfaction: must be the ultimate and remote objective of PHC providers, through providing quality health care and by meeting people’s needs.
- Health provider satisfaction: by continuous education, training, motives and promotion.
- Continuous monitoring and evaluation of services: by collection and analysis of data, follow up of performance, and assessment of output indicators.
Occupational health definition
(WHO) The promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations
Occupational diseases definition
They are group of diseases which are contracted as a result of exposure (over a period of time) to risk factors arising from work activities or diseases that are caused or made worse by occupation”. So, there must be a specific factor or substance in the workplace, exposure to which causes the disease. Silicosis, asbestosis are examples of occupational diseases.
Work related disease definition
Some diseases with multiple causal agents, where factors in the work environment may play a role, together with other risk factors, in the development of such diseases. Hypertension, coronary heart diseases are examples of work related diseases.
Definition of occupational medicine
(royal college)It is primarily a branch of preventive medicine with some therapeutic functions
Differences of occupational medicine VS clinical medicine (A)
Target group: Workers at all jobs VS Patients irrespective to their jobs
Health status: Healthy and diseased VS Diseased only
Place: Plants (Worksites) VS Hospitals and Clinics
Diagnosis: System of medical examinations VS Examination and investigations
Management: Occupational health program VS Medical/surgical treatment.
Occupational health team consists of who? (B)
1.Physician
2.Hygienist
3.Egonomist
4.Nurse
5.Safety engineer
6.Epidemiologist
Promotion of workers’ health (c)
(A) Improvement of the health and working capacity of workers through:
1. Adequate nutrition (for every type of occupation) either by nutrition education and support as well as prevention and control of parasitic diseases.
2. Socioeconomic development through:
- Improving workers’ income.
- Guidance for proper expending of this income.
3. Social welfare through:
* Management of family problems.
* Making good social relations at work.
* Encouragement of sport activities.
4. Health education and keeping good medical records.
B)Improvement of work environment:
This can be achieved through good sanitation of workplace by:
✔ Good design of the machines.
✔ Suitable housekeeping.
✔ Proper lighting and ventilation.
✔ Good control for physical hazards such as heat, radiation and noise.
✔ Supplying work place with washing facilities and suitable transportation means
Prevention of occupational health hazards (C)
i. Medical prevention:
- Pre-employment or pre- placement medical examination to choose the suitable worker to the job which suits his physical capacities and mental abilities, providing baseline data about worker’s health and to identifying susceptible workers to certain exposures .
- Periodic medical examination for early detection of any health hazards arises from exposure to an offending agent at workplace. In Egypt, the law specifies the periodicity of the examination for workers in each work or job. It is either every sixmonths, one year or every two years depending on the duration of exposure needed to develop the occupational disease. The periodic examination is focused on the body systems which can be affected by exposure in the job depending on the result of periodic examination, the workers may be temporarily or permanently removed from further exposure or may be advised to continue work.
- Health education about early symptoms and signs of occupational diseases and the importance of early management.
- Immunization of workers and chemoprophylaxis to combat any infectious disease that may be contracted during the course of their occupation. For example, the vaccinations should be given to healthcare workers:
▪ BCG vaccination of tuberculin non reactors.
▪ Hepatitis B vaccine.
▪ Meningococcal vaccine.
▪ Influenza vaccine.
▪ Others, according to expected exposure.
ii. Engineering prevention: through:-
- Mechanization of heavy work process to lighten the physical strain.
- Enclosure and segregation of hazardous processes.
- Good ventilation, lighting and control of other physical hazards at the workplace such as heat, noise and radiation.
iii. Hygienic prevention: through:-
- Providing good sanitary facilities as washing, changing clothes before and after work, skin and mouth hygiene.
- Supplying protective equipment as respirators, protective clothes, and ear muffs or plugs.
- Work environment monitoring for detection and evaluation of environmental pollutants.
iv. Administrative prevention: through:-
-Reducing the number of exposed workers
-Reducing the length of time and/or frequency of exposure.
- Ensuring that work legislations are applied as: work and rest hours, setting rules for employment of women and children and investigation for detection of the cause of workers’ absenteeism.
- Education and training of workers.
What will happen if the physicians don’t take occupational and environmental history? (A++)
- The disease may be attributed to non-occupational/non-environmental causes.
- Unnecessary tests or treatment may be ordered.
- Opportunity for protecting other workers at risk may be missed
Control of occupational health hazards (C)
a- Survey (questionnaire): inquires about history of exposure to any hazardous substance or process at work place as well as any abnormal symptoms or complains.
b- Clinical examination.
c- Laboratory investigations as: chest X-ray, pulmonary function tests, audiometric evaluation.
d- Biologic monitoring for early detection of any disturbed physiologic function as examination of blood, urine, exhaled air.
e- Early treatment of the diagnosed occupational diseases.
f- First aid treatment of any occupational injuries.
Aim of rehabilitation of disabled workers?
- Minimize or prevent the disability.
- Retraining the disabled worker for a new job suitable for his new physical and mental capacities.
- Compensation of the disabled workers after evaluation of the disability resulted from occupational disease or accident and giving him some privileges.
Classifications of occupational hazards and diseases
(A) Diseases caused by physical agents as:
1- Exposure to high or low temperatures.
2- Exposure to noise.
3- Exposure to radiation (ionizing and non-ionizing).
4- Exposure to vibration.
5- Exposure to atmospheric pressure changes.
6- Exposure to electricity.
(B) Diseases caused by chemical agents as:
1- Exposure to toxic metals.
2- Exposure to dusts and fumes.
3- Exposure to noxious gases.
4- Exposure to toxic organic compounds.
(C) Diseases caused by biological agents as:
1- Parasites.
2- Bacteria.
3- Viruses.
4- Rickettsia.
(D) Diseases caused by psychosocial hazards as: Exposure to work stress - night work shifts - long working hours – hazardous work
environment.
(E) Diseases caused by mechanical (ergonomic) hazards as: Wrong lifting - wrong movements - wrong postures -slippery floor or stairs.
Aim of health management (C)
- To improve population health.
- To scale up the quantity and quality of health service according to the perceived needs and demands of the community.
Scopes of health management (c)
- Mapping community health profile and policy.
- Running and improving health services (Primary care units, Hospital, clinic).
- Introduce new health services, treatment, protocol… etc.
- Running a health program or a project.
- Conducting research, thesis, survey …etc
Management VS administration (B)
Management and administration may seem the same and used interchangeably; however, they are two different levels of the organization. Administration frames the policies and goals of an organization. Management implements these policies and goals. Administration is the top level with the decisive functions, whereas management is a middle level activity with executive function.
Steps of situational analysis (A++)
a) Data collection from the information sources (e.g. records, books, previous researches, surveys, focus group, in depth interview, census, internet, experts, etc.).
b) SWOT analysis to assess
● Internal factors: (strengths and weakness)
● External factors (opportunities and threats) that can help or complicate our research.
c) Formulate problem statement after thinking in the whole situation (needs assessment to choose problem to be solved or improved)
