Provision of Preventive, Curative, Promotive and Rehabilitative Services in PHC

Question 1

Define preventive services

Answer 1

This refers to the plans for and the measures taken to prevent the onset of a disease or other health problems before the occurrence of the undesirable health event.

Disease prevention focuses on specific efforts aimed at reducing the development and severity of chronic diseases and other morbidities.

Question 2

Discuss the 3 distinct levels of preventive services.

Answer 2

1. Primary preventive services: preventive measures that prevent the onset of illness or injury before the disease process begins. E.g., immunisation, sanitation, use of mosquito nets, fluoridating water to prevent dental caries, proper stretching and warm-up to prevent muscle injuries, and vaccination of pets against rabies to prevent infection of humans.
2. Secondary preventive services: measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent the development of more severe problems
   e.g. screening for high blood pressure and diabetes, breast self-examination, pap smear to identify cervical cancer, and identifying and managing high cholesterol to reduce the risk of heart disease.
3. Tertiary preventive services: 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. E.g., Insulin therapy and dietary counselling for diabetes management, cardiac rehabilitation programs for heart attack survivors, lifestyle adjustments to control BP and reduce the risk of stroke, and speech and physical therapy for patients who have had a stroke.

Question 3

Discuss curative services.

Answer 3

Curative services are medical interventions and treatments aimed at curing diseases, alleviating symptoms, and restoring health.
Examples include medication therapy, surgical interventions, therapeutic procedures such as chemotherapy and dialysis, emergency care and specialised care such as dental treatments and psychiatric care.

These services focus on diagnosing and treating existing illnesses or injuries to restore normal function rather than preventing the occurrence of these conditions in the first place.

Community health workers (CHWs) are trained in preventive efforts, but their effectiveness is hindered, since the community expects curative care.

Most people in the developing countries consider curative care more important, and community members are more willing to pay for curative care rather than preventive care.

Question 4

Discuss promotive services.

Answer 4

Promotive services are proactive health interventions designed to enhance overall health and well-being by encouraging healthy lifestyles and empowering individuals and communities to take control of their health.

These services aim to improve health outcomes by addressing social, environmental, and behavioral determinants of health.

Question 5

How does promotive service differ from preventive service?

Answer 5

Promotive services aim to create a culture of health and well-being, addressing the root causes of poor health and empowering individuals to take charge of their health

                                       while

Preventive services aim to protect against specific diseases or injuries, focusing on risk reduction and early intervention.

Question 6

What is wellness?

Answer 6

Wellness is described as the attitudes and active decisions made by an individual that contribute to positive health behaviors and outcomes.

It involves actively making choices and adopting behaviors that promote a healthy and fulfilling life across various dimensions.

Question 7

What are social determinants of health?

Answer 7

Social determinants of health are the economic, social, cultural, and political conditions in which people are born, grow, and live that affect health
status.

Question 8

Highlight the activities of health promotion, prevention and wellness.

Answer 8

1. Communication: raising awareness about health behaviours for the general public.
   Examples:
   i. public sevice announcement
   ii. health fairs
   iii. mass media campaigns
   iv. newsletters
2. Education: empowering behaviour changes and actions through increased knowledge.
   Examples:
   i. courses
   ii. trainings
   iii. support groups
3. Policy, Systems and Environment: making systematic changes through improved laws and regulations (policies), functional organisation components (systems) and economic, social and physical enviroment.

Question 9

What are the barriers to health promotion and prevention in rural communities?

Answer 9

i. High poverty rates, which make it difficult for participants to pay for services
ii. Cultural and social norms surrounding health behaviours
iii. Low literacy levels
iv Linguistic and educational disparities
v. Unpredictable work hours or unemployment
vi. Lack of knowledge of or access to healthy food and physical activity options
vii. Limited affordable and reliable public transportation options
viii. Inadequate resources to support personnel, facilities and program operations

Question 10

Mention 7 opportunities for health promotion and prevention in rural communities.

Answer 10

i. Strong social network and connections
ii. Supportive communities
iii. Smaller scale and scope of programs, which may accelerate opportunity
iv. Willingness and confidence to confront challenges
v. Emphasis on relationships with family and neighbors
vi. Common shared values and collective interest in improving health
vii. Centralized communication channels
viii. Creativity and devotion to achieving succes

Question 11

Discuss rehabilitative services.

Answer 11

Rehabilitative services are health interventions designed to optimise functioning and reduce disability in individuals with health conditions in
interaction with their environment.
These services aim to enhance independence, functionality, and quality of life.

It does so by addressing underlying conditions (such as pain) and improving the way an individual functions in everyday life. It is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences.

Rehabilitation is not limited to specific diseases but applies to a wide range of conditions, including physical injuries, chronic illnesses, mental health disorders, and developmental impairments and even old age.

Rehabilitation can be provided in many different settings, from inpatient or outpatient hospital settings, to private clinics, or community settings such as an individual’s home.

Question 12

The rehabilitation workforce is made up of different health workers, such as:

Answer 12

i. physiotherapists
ii. occupational therapists
iii. speech and language therapists and audiologists
iv. orthotists and prosthetists
v. clinical psychologists
vi. physical medicine and rehabilitation doctors
vii. rehabilitation nurses

Question 13

Mention 5 examples of rehabilitation services.

Answer 13

i. Physiotherapy for stroke recovery or post-surgery mobility.
ii. Training for using assistive devices (e.g., walkers, prosthetics).
iii. Speech improvement for children with developmental delays.
iv. Workplace modifications for individuals with physical impairments.
v. Modifying an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls
vi. Therapy for aphasia after a stroke
vii. Swallowing therapy for patients with throat injuries or surgeries
viii. Therapy for individuals with depression or anxiety disorders
ix. Support programs for substance abuse recovery.

Question 14

Highlight 5 benefits of rehabilitation.

Answer 14

1. It reduces the impact of a wide range of health conditions, acute & chronic diseases, illnesses and injuries
2. Helps to minimize or slow down the debilitating effect of chronic health conditions
3. It enables individuals to participate in education and gainful employment, remain independent at home, and minimize the need for financial or caregiver support.
4. It is an important part of universal health coverage and is a key strategy for achieving SDG 3 “ensure healthy lives and promote well-being for all at all ages”
5. It is an investment, with cost benefits for both the individuals and society. It can help to avoid costly hospitalisation, reduce hospital length of stay, and prevent readmissions.

Question 15

What are the common misconceptions about rehabilitation?

Answer 15

• That it is for just people with long-term or physical impairment
• That is is a luxury health service for people who can afford it
• That it is for delayed recovery cases