History of Primary Health care

Question 1

Define Primary health care.

Answer 1

Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology universally accessible to individuals and families in the community through their participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Question 2

Primary health care is made up of three main areas:

Answer 2

1. Empowered people and communities.
2. Multi-sectoral policy and action
3. Primary care and essential public health
   * These function as the core of integrated health services.

Question 3

Alma Ata Declaration:

Answer 3

The Alma Ata declaration expresses a philosophy of thinking of health and health care. It pursued the values of social justice, the right to better health for all, participation and solidarity. It required that health systems put people at the centre of healthcare. It Requires that health systems respond to the challenges of a changing world and growing expectations for better performance.

Question 4

How did the alma ata declaration come to be?

Answer 4

In 1978 people mobilized the primary health care movement. The goal was to have Health for All by the year 2000 => Universal access. They said Health is a fundamental Human right. Many sectors other than the health sector must also take action. There was a shift in planning for health care services.

Question 5

The WHO defines health as?

Answer 5

A state of physical, mental and spiritual well-being, not merely an absence of disease and infirmity. Beyond the individual, they are part of community and a society. They are a product of that society, in terms of poverty, unemployment, and racism.

Question 6

The 3 key elements permeating the declaration:

Answer 6

• Negative role of disease-oriented technology. i.e. highly specialised equipment which was irrelevant to the needs of the poor communities.
• Urban hospitals in developing countries need to concentrate on human resource distribution to rural areas.
• Training of lay health personnel as opposed to highly specialised staff involved in top down service delivery. PHC at the centre with intersectoral collaboration. Health and development links had political implications.

Question 7

Principles of Primary Health Care Approach

Answer 7

^Universal accessibility and coverage on the basis of need =Equity
^Comprehensive care with an emphasis on disease prevention and health promotion
^Community and individual involvement and self reliance
^Inter-sectoral action for health
^Appropriate technology and cost effectiveness in relation to available resources

Question 8

What are the 6/4 misconceptions about primary health care?

Answer 8

1. The misconception that Primary health care is only community-based health care
2. The misconception that Primary health care is the first level of health care within the health system
3. The misconception that PHC is concerned with only rural areas, simple “low tech” interventions, health workers with limited knowledge and training
4. The misconception that PHC is cheap

Question 9

Misconception number 1 debunked?

Answer 9

1. x The misconception that Primary health care is only community-based health care:
   = PHC includes community participation and action but includes support and involvement of all health related sectors. Defined referral system up till the district level of care.

Question 10

Misconception number 2 debunked?

Answer 10

2. x The misconception that Primary health care is first level of health care within the health system:
   = PHC includes primary level of medical care, general practitioners, nurse practitioners, clinics and mobile services. Opens opportunities for disease prevention, health promotion and early detection of disease at all levels.

Question 11

Misconception number

3 debunked?

Answer 11

3. x The misconception that PHC is concerned with only rural areas, simple “low tech” interventions, health workers with limited knowledge and training
   = Teams of health professionals and assistants required with specific and sophisticated biomedical and social skills. PHC uses appropriate technology.

Question 12

Misconception number 4 debunked?

Answer 12

4. x The misconception that PHC is cheap
   = Requires evidence based interventions and appropriate technology, adequate resources and investment- not cheap but does advocate for equity with a re-distribution to those most in need.

Question 13

DEMISE OF PRIMARY HEALTH CARE

Answer 13

.

• The rise PHC coincided with global debt crisis and conservation macroeconomic policies.
• Imposition of Structural Adjustment policies in 80s and 90s undermined many countries’ capacity to support health systems development as fiscal stringency, user charges etc. were introduced
• In late 1980s ‘health sector reform’, based on market principles, economic efficiency and cost-effectiveness was promoted.

Question 14

SELECTIVE PRIMARY HEALTH CARE

Answer 14

> Selective PHC focuses on prevention or treatment of the few diseases that cause the most mortality and morbidity and for which there are effective interventions

• Interventions delivered through “vertical” programmes, taking decisions out of the hands of communities, but rapidly reaching high coverage, in some selected priorities.
• Decreased morbidity & mortality of major illnesses.
• Funded by donor agencies easily since measurable results could be achieved easily and in a short space of time
• BUT:
  
  • Less community participation
  • Less development of broadly based health care
  • Target priority diseases only
  • Technical solutions - ‘quick fix’

Question 15

More on selective Primary health care.

Answer 15

• Child survival programs -UNICEF
• Control of diarrhoeal disease - CDD
• Expanded programme of immunization EPI
• Integrated Management of Childhood illness IMCI
• Baby friendly hospital initiative BFHI

Question 16

The GO-BIFFF programme

Answer 16

• Growth monitoring
• Oral rehydration solution
• Breast feeding
• Immunisation
• Family planning
• Female literacy
• Food supplementation

Question 17

What is the history of primary health care in South Africa?

Answer 17

• The evolution of primary health care in South Africa.
• In 1940, Pholela Health Centre
• Community orientated primary care (COPC)
• Reliance on a social and epidemiological investigation to inform health services.
• Empowerment of the family to improve collective health.

#Pioneering feature was the Pholela Health model. 
> Dr Kark argued that conducting a community diagnosis was the mainstay of informing service provision. 
> Allowed for the measurement of change over time. 
> Community involvement and empowerment was central to the model .

Question 18

Primary health care in South Africa (1970 -1994)

Answer 18

• 1942: National Health Services Commission
• 1944: Gluck man report
  
  • A National Health system available to all sectors “all sections of the people of this country according to their needs and not according to their means”
• 1946:
  
  • National Health Programme
  • 1946:Institute of Family and Community Health
• Political and financial pressure scuttled the idea
• Progressive PHC philosophy by the anti-apartheid movement
• Homelands were responsible for health and public health
• Church played an important role in establishing mission hospitals
• Erika Stutter started the “care group” (Trachoma and other infectious diseases)
• Deregulation of the health sector and privatisation

Question 19

Primary health care from 1994 ONWARDS.

Answer 19

• National Health Plan
  
  • COPC, Alma Ata Declaration
• Reconstruction and Development Programme
  
  • Free Maternal and Child health
  • Free PHC
  • PHCs to increase access
  • Infrastructural development
• District Health System
• “White Paper on the Transformation of the Health System” in 1997
• PHC a Provincial responsibility.
  #Early reform focused on the structural integration of the health sector. Delivery of services via the DHS [DISTRICT HEALTH SYSTEM]. Required reorganization of structures at this level.

Question 20

• 1976: in South African Primary health care.

Answer 20

• Medical staff feared entering Soweto
  
  • Clinical training for nurses to run PHCs
  • Integrated in Nursing Diploma
    National Progressive Primary Health Care Network

Question 21

Need for national re-engineering of the previously existing PHC strategy has been based on the following criticisms

Answer 21

• Curative, vertical focus on programs.
• Weak in addressing the social determinants of disease.
• Hospi-centric facility based information, which excluded community participation.
• Bias in the allocation of resources towards higher levels of care, as opposed to preventive and promotive care.

Question 22

Three streams to re-engineering PHC

Answer 22

• a ward-based PHC outreach team for each electoral ward
• strengthening school health services
• district based clinical specialist teams

Question 23

Policy Shift

Answer 23

• Re-engineering of PHC (2010)

- National Health Insurance

Question 24

RE-ENGINEERING PRIMARY HEALTH CARE

Answer 24

1. Policy shift
2. Need for national re-engineering of the previously existing PHC strategy has been based on the following criticisms
3. Three streams to re-engineering PHC

Question 25

School Health Teams

Answer 25

• Integrated School Health policy (2012)
• School health teams of nurses
• Involvement of DOE, DOH, unions

Question 26

District Clinical Specialist Teams

Answer 26

• Family physician;
• Primary health care nurse;
• Anaesthetist in an expanded role;
• Obstetrician and Gynaecologist;
• Advanced midwife;
• Paediatrician; and
• Paediatric nurse