![The three tier system of health careThe three tier system of health care
Tertiary level [Regional hospital,
medical college hospital]
Secondary level [community
health centre, district
hosp.]
Primary level
[primary health
centre, sub centre]](https://image.slidesharecdn.com/primaryhealthcare-170921095233/85/Primary-health-care-3-320.jpg)
![Primary health care
Village level [grass root level]-
First level of contact bet n. health system and
individual
Provided by –Village health guide
Traditional birth attendant/dai
Anganwadi workers
ASHA](https://image.slidesharecdn.com/primaryhealthcare-170921095233/85/Primary-health-care-4-320.jpg)
Primary health care
- 1. Dr. Anjali Wagh. Prof. & HOD Dept. of Community Medicine D.Y.Patil Medical College, Kolhapur
- 2. Medical care: personal services provided directly by physicians. Health care : Integrated care including preventive, promotive, curative, rehabilitative services for individuals from womb to tomb. Health care includes medical care.
- 3. The three tier system of health careThe three tier system of health care Tertiary level [Regional hospital, medical college hospital] Secondary level [community health centre, district hosp.] Primary level [primary health centre, sub centre]
- 4. Primary health care Village level [grass root level]- First level of contact bet n. health system and individual Provided by –Village health guide Traditional birth attendant/dai Anganwadi workers ASHA
- 5. Secondary health care The First referral level More complex problems are dealt with. Comprises curative services Provided by the district hospitals Tertiary health care Offers super-specialist care Provided by regional/central level institution. Provide training programs
- 7. EVOLUTION OF PRIMARY HEALTH CARE The Alma-Ata Conference International conference on primary health care Conducted from 6-12th September 1978 at Alma Ata Mile stone in the history of public health Key to the attainment of the goal of the Health for All
- 9. Primary health care The “first” level of contact between the individual and the health system. Essential health care (PHC) is provided. A majority of prevailing health problems can be satisfactorily managed. The closest to the people. Provided by the primary health centers.
- 10. PRIMARY HEALTH CARE “Primary Health Care is essential health care made universally accessible to individuals & acceptable to them, through their full participation & at a cost the community & country can afford”.
- 11. Characteristics of PHC COST EFFECTIVE HEALTH CARE
- 13. The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity
- 14. Attributes of Primary Health care
- 15. Elements of Primary health care
- 16. Elements of Primary health care 1
- 17. Services in Primary Health Care 1. Health Education concerning prevailing health problems and the methods of preventing and controlling
- 19. 3. An adequate supply of safe water and basic sanitation.
- 20. 4. Maternal and child health care, including family planning.
- 21. 5.Immunization against major infectious diseases.
- 22. 6. Prevention and control of locally endemic diseases. 7. Appropriate treatment of common diseases and injuries.
- 24. Principles for primary health carePrinciples for primary health care PHC based on the following principles
- 25. Equitable distribution ‘ Key’ principle of Primary Health Care • Remove social injustice & services must be equally distributed to all people of the community. Irrespective of the cast, religion, community & ability to pay ( rich or poor), urban or rural Services must be accessible to all. Needy & vulnerable group of population like poor rural and urban slum.
- 26. EQUITABLE DISTRIBUTION Access to health care - horizontal equity & vertical equity Horizontal equity - “equal access for equal needs” equal resources equal access to health care equal utilization of health services equal health
- 27. EQUITABLE DISTRIBUTION Vertical equity - unequal should be treated in proportion of their inequality Individuals with more need should have more treatment The central theme of “need” therefore determines equity
- 28. Examples of equitable distribution in access to health care in India: Tripura- helicopter service to reach the remote set of tribal hamlets Andhra Pradesh- free bus passes to pregnant women for the antenatal visits Assam - Akha-ship to provide primary care services in riverine Island through boat clinics Tamil Nadu – concept of birth resorts is introduced in remote and hilly areas for institutional deliveries
- 29. 2) Community Participation “Promote maximum community and individual self- reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develop through appropriate education the ability of communities to participate” Cost effective method. Placing the health of people in their hands – It is by the people, of the people and for the people. ‘Democratization’ of health services
- 30. COMMUNITY PARTICIPATION Involvement of the individuals, families and community Determines both collective needs and priorities Important role in formulating a health problem, make informed choices ,objectives with community priorities Universal coverage cannot be achieved without the involvement of the local community
- 31. Types of community participation Active - co-operation + resources, Passive - cooperation Marginal – limited, transitory participation of people e.g. organization of camp with local support • Substantial – community plays active role in determining priorities & helping carrying out health activities like health education, hygiene maintenance e.g. Panchayati Raj Institutions • Structural – community becomes integral part of program & major basis of health activities
- 32. Planning steps in community participation: Identification and prioritization of the problems Planning together Implementation by community members Evaluation by community members
- 33. Examples of community participation in India: Village health guides, trained dais, ASHA Selected by the local community and trained locally Essential feature of health care in India
- 34. Bare foot doctors: In China, lack of availability of rural health services was addressed from 1965 to 80 by development of bare foot doctors. Rural farm workers were given basic heath training to provide combination of traditional and western medicine. Regarded as model for development of community health workers
- 35. Advantages of community participation Cost effective method of providing health services People begin to view health more objectively, they are more likely to accept the care Greater commitment of the people resulting in the success of health care services Health awareness in village people Health workers get support for their activites Health care services become more relevant to the health needs of the people Quality of health care improves
- 36. 3) Intersectoral co-ordination “Involve, in addition to the health sector, all related sectors and aspects of national and community development agriculture animal husbandry food industry education housing public works Communication Voluntary organisation
- 37. Intersectoral co-ordination Education Voluntary agencies Agriculture Municipal bodies Fisheries Health Sector Transport Animal husbandry Information and broadcasting
- 38. Pre-requisites for Intersectoral Coordination: Proper orientation of policies and programme Formation of joint coordination committee at each level Defining role and responsibilities of participatory agencies Participatory decision making Developing formal system of interaction, discussion and debate Sharing of the problems faced in implementation
- 39. Mechanism of co-ordination: List out names of different sectors Identify the NGOs and voluntary organisation Constitute the district level co-ordination committee Formulate specific task forces Jointly decide the objectives and areas Decide the role and responsibility Development a plan
- 40. Difficulties facing intersectoral co-ordination: Create conflicts of interest and disequilibrium Power struggles Agencies must be able to compromise and impose change on the normal working patterns Cultural changes may occur within organisations Co-ordination may turn out to be more expensive in terms of time, money and manpower
- 41. Irrespective of the disadvantages, intersectoral coordination is the key principle outlined by WHO if Health for All has to be achieved An outstanding example of the intersectoral coordination at the grass root level - Anganwadi as a part of ICDS programme
- 42. 4) Appropriate technology Technology of Health care service provided must be Simple, Scientifically sound, Practically adaptable, Culturally acceptable , Economically cheaper Operationally convenient, Maintainable with local resources Acceptable to users and recipients
- 43. APPROPRIATE TECHNOLOGY “Technology that is scientifically sound, adaptable to local needs and acceptable to those who apply it and those for whom it is used and is maintained by the people themselves in keeping with the principle of self reliance with the resources the country and the community can afford”
- 44. Examples for the appropriate technology Use of coloured tapes for measuring mid upper arm circumference Use of ORS Tender coconut for oral hydration Growth chart maintenance for under five children Low cost mosquito repellent creams Simple water purification
- 45. Informational technological advancements that have been proven to ultimately enhancing the service delivery- Health Management Information System Telemedicine Immunization programs, DOTS , Nutritional supplementation Distribution of DDK for domiciliary midwifery services Distribution of IFA tablets Biogas plant for cooking, heating and lighting. Smokeless chulhas for cooking
- 46. To Summarize Primary care is an approach that: Focuses on the person not the disease, considers all determinants of health Integrates care when there is more than one problem Uses resources to narrow differences Forms the basis for other levels of health systems Addresses most important problems in the community by providing preventive, curative, and rehabilitative services Organizes deployment of resources aiming at promoting and maintaining health.
- 47. “When We talk about capacity, We absolutely must talk about the importance of primary health care. it is the cornerstone of building the capacity of health systems” - dr. margaret chan director general Who
- 48. THANK YOU