UNIT III. PRIMARY HEALTH CARE Flashcards
health leaders from around 200 countries attended the
international conference for primary health care held at Alma Ata USSR a call for urgent
action by all governments, all health and development workers, and the world community to
protect and promote the health for all the people of the world
September 6-12, 1978
- Health is the Basic fundamental right
- There exists a global burden of health inequalities among populations
- Economic and social development is of basic importance for the full attainment of Health
for all - Governments have a responsibility for the health of their people
The Alma Ata declaration
The strategy was later adopted in the Philippines by the virtue of LOI 949 of 1979,
making the Philippines the first country in Asia to embark on meeting the challenge of PHC
(Bautista 2001) even before the adoption there is a community-based health program in the
rural areas of Visayas and Mindanao, applying the spirit of PHC even before it was formally
adopted by the government
Legal Basis of PHC
Practical, scientifically sound, and socially acceptable methods, and technology
made universally accessible to individuals and families in the community through their full
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.”
Primary Health Care
As stated in the Alma Ata declaration is “Health for all” by the year ____. Health for all
means an acceptable level of health for all the people of the world through community and
individual self-reliance
2000
means an acceptable level of health for all the people of the world through community and
individual self-reliance
Health for all
The policy agenda for Health for all has three main Objective
- Promotion of healthy lifestyles
- Prevention of diseases
- Therapy of existing conditions
To put further emphasis on PHC in the Philippines, President Ferdinand E. Marcos
signed the ____ which has the underlying theme “Health in the Hands of the people by 2020”
LOI 949
Five elements to achieve the goal
- Reducing exclusion and social disparities in health (universal coverage)
- Organizing health services around people’s needs and expectations (health service
reform) - Integrating health into all sectors (Public policy reform)
- Pursuing collaborative models of policy dialogue (leadership reforms)
- Increasing stakeholders’ participation
The Alma Ata Declaration listed eight essential health services, using the acronyms
ELEMENTS as a memory aid;
E-Education for Health
L – Locally endemic disease control
E – Expanded program for immunization
M – Maternal and Child Health including responsible parenthood
E – Essential Drugs
N – Nutrition
T – Treatment of communicable and non-communicable diseases
S – Safe water and sanitation
Key principles of Primary Health Care
- 4A’s of PHC accessibility, affordability, acceptability, and availability
- Support mechanism
- Multisectoral approach
- Community participation
- Equitable distribution of health resources
- Appropriate technology
The 4As of PHC:
Accessibility, Affordability, Acceptability, and Availability
usually refers to the physical distance of a health facility or the travel time
required for people to get needed or desired health services. According to WHO to be
considered accessible it must be within 30 minutes from the communities, Barangay
health stations (BHS) are facilities intended to provide accessible health services at the
community level
Accessibility
is not only in consideration of an individual or family’s capacity to pay for
basic health services, WHO considers in determining the affordability of health care, are
the out-of-pocket expenses for health care. In the Philippines, government health
insurance is covered through Philhealth. There are other health insurance policies
offered by private companies or health management organizations.
Affordability
means that the health care offered aligns with the prevailing culture and
traditions of the population.
Acceptability
is a question of whether the basic health services required by the people
offered are offered in the health care facilities or are provided in a regular and organized
manner
Availability
drugstores established by the
Philippine government ensuring the availability, affordability, safe and
effective quality essential drugs to all
Botika ng bayan and botika ng barangay
Consider the following health program under 4As
Botika ng bayan and botika ng barangay-
“Ligtas sa tigdas ang pinas”
The resources for essential health services come from 3 major entities; the people
themselves, the government, and the private sector like NGOs and socio-civic and faith groups.
Health programs and projects provide better outputs when these three entities are involved.
For efficient utilization of resources from these three major sectors, a Multisectoral approach
is necessary
Support mechanisms
As health and disease are outcomes of multiple interrelated factors, PHC requires
communication, cooperation, and collaboration within and among various sectors, this is
exemplified through intersectoral and intrasectoral linkages.
Multisectoral approach
refer to communication, cooperation, and collaboration within
the health sector: among the members of the health team and health agencies. This is
exemplified by the team approach utilized by the personnel of a health center in dealing with
health conditions and problems
Intrasectoral linkages
another illustration of
intrasectoral linkages, is necessary so that clients get the needed and desired care. For
example, a pregnant woman who had prenatal checkups in the BHS or rural health unit (RHU)
has been identified as a high risk. She would refer to the appropriate hospital for childbirth.
two-way referral system
One of the major criticisms against the traditional perspective in development is that
the tools for analysis and strategies used are primarily economic in orientation. The idea that
the population is sick because they are poor implies that illness or health is a result of
economic gains or the lack thereof.
Intersectoral linkages
PHC seeks this paradigm, advocating a more
comprehensive view of the synergy between health and economic development. Health is a
Multisectoral concern.
Intersectoral linkages
encompass the communication, cooperation, and
collaboration between the health sector and other sectors of society like education, public
works, agriculture, and local government officials.
Intersectoral linkages
A key to understanding the concept of PHC emphasizes how it is defined: that health
is achieved through self-reliance and self-determination, and those individuals, families, and
communities are not considered recipients of care but active participants in achieving their
health goals.
Community Participation
is an educational and empowering process in which
people, in partnership with those who can assist them, identify the problems and the needs and increasingly assume responsibilities themselves to plan, manage, control, and assess the
collective actions that are proved necessary
Community participation
PHC advocates for care that is community-based and preventive in orientation. It calls
for an inventory and analysis of health resources, facilities, and manpower.
There is a general impression that graduates of health-related college programs prefer
to work abroad rather than stay in the Philippines.
Equitable distribution of health resources
To reverse this trend, the DOH is
spearheading two programs to ensure equitable distribution of manpower to the rural areas.
These programs are;
- Doctor to the barrios (DTTB) program.
- Registered Nurses Health Enhancement and Local Service (RN HEALS)
is the deployment of
doctors to municipalities that are without doctors
-volunteers are fielded to
manage the RHU or health centers in unserved, economically depressed fifth or sixthclass municipalities for 2 years, they also have the option of being permanently
absorbed by the municipality, and the volunteers are offered competitive
compensation by the DOH and the LGU
Doctor to the barrios (DTTB) program
s a
training deployment program for unemployed nurses. volunteers are
deployed to unserved, economically depressed municipalities for one year to address
the inadequate nursing workforces in rural communities and Health facilities.
Registered Nurses Health Enhancement and Local Service (RN HEALS)
includes
tools, drugs, methods, procedures, and techniques
health technology
refers to the
technology that is suitable to the community that will use it to better capture its essence, the
terms “people’s technology” and “indigenous technology” are also used about appropriate
technology
Appropriate technology
this means that the technology results in minimal risk to the user and that the
intended positive outcomes of the use of technology far outweigh its unintended negative
effect
Safety.
the technology should accomplish what it is meant to accomplish
Effectiveness.
Measures for health promotion and disease prevention are cost-effective in
comparison to the treatment of disease. Prevalent childhood conditions such as cough
and colds, diarrhea, and fever, often require home management only. These cost-effective
interventions require an educated community
Affordability
The technology that requires readily available simple materials and that
involves a simpler process in its use can be more easily adopted by the people in the
community when and where applicable
Simplicity.
Technology is effective only when it is used by those who need it. thus,
culture is an important consideration in determining the appropriateness of technology.
Also, education regarding a particular technology is essential for its adoption
Acceptability.
The technology must be easy to apply considering the people’s
natural settings like the home, school, workplace, and community. Supplies must be
constantly available.
Feasibility and reliability.
Effects on ecology are an important consideration in choosing or
rejecting a particular technology
Ecological effects.
mandated the gradual phase-out of mercury in all
Philippine health care facilities and institutions
DOH administrative order no. 2, s. 208
Appropriate technology
promotes self-sufficiency on the part of those using it.
Potential to contribute to individual and community development.
Lagundi
Asthma, cough, colds, fever,
dysentery, pain, skin diseases
Decoction
Wash the affected site with a
decoction
Yerba Buena
Headache, stomachache
Cough and colds
Rheumatism and arthritis
Decoction
Infusion
Massage sap
Sambong
Antiedema/antiurolithiasis
Decoction
Niyog-niyogan
Anthelminthic
Seeds are use
Bayabas
Washing wounds
Diarrhea, gargle, toothache
Decoction
akapulko
Antifungal
Poultice
Ulasimang bato/
Pansit-pansitan
Lowers blood uric acid
(rheumatism and gout)
Decoction
Eaten raw
Bawang
Hypertension
Lowers blood cholesterol
Toothache
Eaten raw/fried
Apply on part
Ampalaya
Diabetes mellitus (mild NIDDM)
Decoction/steam
Boil the recommended part of the plant material in water, recommended
boiling time is 20 minutes
Decoction
Plant material is soaked in hot water, much like making tea, recommended
period of soaking is 10 to 15 minutes
Infusion
Directly apply the plant material on the part affected, usually used on
bruises, wounds, or rashes
Poultice
Mix the plant material with alcohol
Tincture
is a strategy for the delivery of health programs, it should not be confused with
primary care according to the American association of family medicine
PHC
Primary Care
includes;
- Health promotion
- Disease prevention
- Counseling
- Patient education
- Diagnosis and treatment of acute and chronic illnesses in a variety of health care settings
is often performed and managed by a personal physician often
collaborating with other health professionals
Primary care
is a model of nursing care that emphasizes the continuity of
care by having one nurse providing complete care for a small group of inpatients within a
nursing unit of a hospital. Nursing care is directed toward meeting all of the individualized
patient needs
Primary Nursing
is a strategy for health care delivery focusing on the
community, family, and individuals
Primary Health Care (PHC)
Focus Client
PHC Family and community
PC Individual
Focus of Care
PHC Promotive preventive through
community participation
PC Curative, provided by
health professionals
Decision-Making
Process
PHC Community centered consultative participative
PC Health worker-driven
Outcome
PHC Self-reliance / Self-help
PC Reliance on health
professionals to
restore/regain health
Setting for Services
PHC Rural base satellite clinics,
Community Health Center, and
health posts that are accessible to all
PC Mostly urban-based;
hospitals clinics
Goal
PHC Development and preventive care
PC Absence of disease
Also
called the Aquino Health Agenda, is the latest in a series of continuing efforts of the
government to bring about health sector reforms.
Universal Health Care (UHC) (Kalusugan Pangkalahatan
UHC built upon the strategies of two
previous platforms of reform:
the initial Health Sector Reform Agenda (1999-2004) and
FOURmula One (F1) for Health (
are intended to bring about equity in health service delivery.
Health sector reforms
From a high under-five child mortality rate
of 80 per 1,000 live births in 1990, the 2008 data shows a decrease to 34 per 1,000 live births.
There is a high probability of meeting MDG goal 5 (NEDA, 2010) To address these challenges,
UHC(Kalusugan Pangkalahatan) was launched through
Administrative Order 2010-0036
s directed towards ensuring the achievement of the health system goals of (1)
better health outcomes, (2) sustained health financing, and (3) a responsive health system
by ensuring that all Filipinos, especially disadvantaged groups, have equitable access to
affordable health care
UHC
The attainment of the goal of UHC is through the pursuit of three strategic thrusts:
- Financial risk protection through expansion in NHIP enrolment and benefit
delivery. - Improved access to quality hospitals and health care facilities
- Attainment of the health-related MDGs
To achieve the three strategic thrusts, six strategic instruments shall be optimized HSPSRGHHH
. Health financing , Service delivery , Policy, standard, and regulation, Governance for health, Human resources for health, Health information
an instrument to increase resources for health that will be
effectively allocated and utilized to improve the financial protection of the
poor and the vulnerable sectors.
Health financing
an instrument to transform the health service utilization
and health outcomes across socioeconomic variables.
. Service delivery
an instrument to ensure equitable access to
health services, essential medicines, and technologies of assured quality
availability, and safety
Policy, standard, and regulation
an instrument to establish the mechanisms for
efficiency, transparency, and accountability, and to prevent opportunities for
fraud.
Governance for health
an instrument to ensure that all Filipinos have
access to professional health care providers capable of meeting their health
needs at the appropriate level of care.
Human resources for health –
an instrument to establish a modern information system
that shall:
a) Provide evidence for policy and program development;
b) Support for the immediate and efficient provision of health care and
management of province-wide health systems (DOH, 2010).
Health information –
prepregnancy services and care during
pregnancy, delivery, and the postpartum period.
Reproductive and maternal health
advocacy for exclusive
breastfeeding in the first 6 months of life, newborn screening program, immunization,
nutrition services, and integrated management of childhood illness.
Expanded Garantisadong Pambata (child health):
When was the alma Ata international conference for primary health care held
September 6-12, 1978
After the Alma Ata conference, the Philippines adopted the PHC strategy by the virtue of:
LOI 949 of 1979
The universal goal of primary health care as stated in the Alma Ata declaration was
“health for all” by the year 2000, which means?
cceptable level of health for all the people of the world through community and
individual self-reliance
Key principles of primary health care include all except
a. 4A’s of PHC accessibility, affordability, acceptability, and availability
b. Support mechanism
c. Multisectoral approach
d. Absence of community participation
d. Absence of community participation
In what key principles of primary health care are the resources for essential health
services come from 3 major entities; the people themselves, the government, and the
private sector like NGOs and socio-civic and faith groups
a. Support mechanism
b. Multisectoral approach
c. Intrasectoral linkages
d. Intersectoral linkages
a. Support mechanism
The following are the criteria for Appropriate Health technology:
a. Safety
b. Effectiveness
c. Affordability
d. Unreliability
d. Unreliability
The Alma Ata Declaration listed eight essential health services in primary health
care, identifying at least four (4)
E-Education for Health
L – Locally endemic disease control
E – Expanded program for immunization
E – Essential Drugs
