to Community Medicine Course 31505201 Primary Health CarePHC الرعاية الصحية الاولية By Hatim Jaber MD MPH JBCM PhD 3010 2017 1 2 3 Presentation outline ID: 731463
Download Presentation The PPT/PDF document "Faculty of Medicine Introduction" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Faculty of Medicine Introduction to Community Medicine Course (31505201) Primary Health Care-PHC الرعاية الصحية الاولية
By Hatim JaberMD MPH JBCM PhD30-10 -2017
1Slide2
2Slide3
3Slide4
Presentation outlineTimeIntroduction and Definitions08:15 to 08:25Levels of health care08:25 to 08:40Principles of PHC
08:40 to 09:00 Elements of PHC09:00 to 09:15
PHC in Jordan
09:15 to 09:30
4Slide5
Introduction to course 31505201 Course ContentWeek 1 Unit 1: Introduction to Health and Community Health Week 2 Unit 2 Nutrition and Nutrition Assessment and Diet Week 3 Unit 2 (cont.) Nutrition and Nutrition Assessment and Diet Week 4 Unit 2 (con..): Infant and Breast Milk Characteristics Week 5 Unit 3: Public Health/Environmental Health
Week 6 Public Health/Environmental Health Week 7 Unit 5: Primary Health care
Week 8 Unit 6:
:
Introduction to
Epidemiology and health indicators
Demography
, Data and
Biostatics
Week
9
Midterm
assessment (Exams.)15-11-2017
Week 10 Unit 8 Public Health SurveillanceWeek 11 Unit 9: Prevention and Control of DiseasesWeek 12 Unit 10: Health Education and CommunicationWeek 13 Unit 11: ScreeningWeek 14 Unit 12: Health Administration and healthcare managementWeek 15 Unit 13: Revision and Health ResearchWeek 16 Final assessment (Exams.)
5Slide6
Week 7 Unit 5: Primary Health Care- PHCPrinciples and elements of PHC 30-10-20172. Maternal and Child Health- MCH 1-11-20176Slide7
Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 Primary Health Care (PHC)PHC is: Essential health care based on 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 community and the country can afford … (Alma-Ata, 1978)7Slide8
HEALTH FOR ALL ATTAINMENT OF A LEVEL OF HEALTH THAT WILL ENABLE EVERY INDIVIDUAL LEAD A SOCIALLY AND ECONOMICALLY PRODUCTIVE LIFE8Slide9
PHC Definition PHC is an essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors.9Slide10
What is Primary Health Care? PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes the following: health promotionillness preventioncare of the sickadvocacy community development10Slide11
Comprehensive primary health careSocial justice and equityCommunity controlSocial changeManages factors that generate ill health Involves an approach to health care over a continuum from health promotion to illness treatment11Slide12
Comprehensive primary health careComplete physical, mental and social wellbeing Addresses issues of equity and social justiceConsiders the impact of education, housing, food and incomeAcknowledges the value of community developmentRecognises the expertise of individuals over their own healthTalbot and Verinder 200512Slide13
Primary Health Care is different in each community depending upon: Needs of the residents; Availability of health care providers; The communities geographic location; & Proximity to other health care services in the area. 13Slide14
Models of primary health careComprehensive
Selective
Medical model
View of health
Positive wellbeing
Absence of disease
Absence of Disease
Locus of control over health
Communities and individuals
Health professionals
Medical practitioners
Major focus
Health through equity and community development
Health through medical interventions
Disease eradication through medical interventions
Health care providers
Multidisciplinary teams
Doctors plus other health professionals
Doctors
Strategies for health
Multi-sectoral collaboration
Medical interventions
Medical interventions
Rogers W. & Veale, B. (2000).
14Slide15
WHO and Primary Health Care PHCThe ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:reducing exclusion and social disparities in health (universal coverage reforms);organizing health services around people's needs and expectations (service delivery reforms);integrating health into all sectors (public policy reforms);pursuing collaborative models of policy dialogue (leadership reforms); andincreasing stakeholder participation.
15Slide16
WHO Strategies of PHC1. Reducing excess mortality of poor marginalized populations: PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations.2. Reducing the leading risk factors to human health: PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations.16Slide17
WHO Strategies of PHC cont..3. Developing Sustainable Health Systems: PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served.4, Developing an enabling policy and institutional environment: PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy.17Slide18
Declaration of the Alma AtaReleased in 1978 and consisted of ten fundamental principles for effective comprehensive primary health care service deliveryPrinciples were in response to the broader community and social issues leading to poor population health18Slide19
The Ottawa CharterBuilding healthy public policyCreating environments which support healthy livingStrengthening community actionDeveloping personal skillsReorientating health careThe Ottawa Charter for Health Promotion was developed in 198619Slide20
Characteristics of Primary Health Care(a) Stresses prevention rather than cure.(b) Relies on home self-help, community participation and technology that the people find acceptable, appropriate and affordable.(c) Combines modern, scientific knowledge and feasible health technology with acceptable, effective traditional healing practices.(d) Should be shaped around the life patterns of the population.(e) Should both meet the needs of the local community and be an integral part of the national health care system.(f) Should be formulated and implemented with involvement of the local population.20Slide21
To Summarize Primary care is an approach that:Focuses on the person not the disease, considers all determinants of healthIntegrates care when there is more than one problemUses resources to narrow differences21Slide22
The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)AppropriatenessAvailability AdequacyAccessibilityAcceptabilityAffordability AssessabilityAccountabilityCompletenessComprehensivenessContinuity22Slide23
23Slide24
Appropriateness Whether the service is needed at all in relation to essential human needs, priorities and policies.The service has to be properly selected and carried out by trained personnel in the proper way.AdequacyThe service proportionate to requirement.Sufficient volume of care to meet the need and demand of a community24Slide25
Affordability The cost should be within the means and resources of the individual and the country.AccessibilityReachable, convenient servicesGeographic, economic, cultural accessibility 25Slide26
AcceptabilityAcceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.26Slide27
Availability Availability of medical care means that care can be obtained whenever people need it.AssessabilityAssessability means that medical care can be readily evaluated.AccountabilityAccountability implies the feasibility of regular review of financial records by certified public accountants.27Slide28
CompletenessCompleteness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.ComprehensivenessComprehensiveness of care means that care is provided for all types of health problems.ContinuityContinuity of care requires that the management of a patient’s care over time be coordinated among providers.28Slide29
29Slide30
Primary Health Care is not Primary care alone.Primary, secondary and tertiary are levels of careDefining primary health care30Slide31
Primary Health CarePreventive servicesCurative servicesGeneral services
Care of vulnerable groups
Outpatient clinic (referral)
Laboratory services
Dispensary
First aid and emergency
services
Health education
Monitoring of
environment
Prev.&control of endemic diseases
Health office services
Maternal &
child health .
School health services
Geriatric health
services
Occupational
health services
31Slide32
Levels of Care Primary health careSecondary health careTertiary health care32Slide33
Levels of Health CarePreventivePrimarySecondaryTertiaryRestorativeContinuing 33Slide34
Preventive and Primary Care SettingsSchool health servicesOccupational health servicesPhysicians’ officesClinicsNursing centers34Slide35
Secondary and Tertiary Care SettingsHospitals/medical centersEmergency departmentsMedical unitsIntensive care Psychiatric facilitiesRural hospitals35Slide36
Restorative Care SettingsHome health careRehabilitation centersExtended care facilities36Slide37
Why PHCPrimary 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.37Slide38
Secondary health care More complex problems are dealt with.Comprises curative servicesProvided by the district hospitalsThe 1st referral levelTertiary health careOffers super-specialist careProvided by regional/central level institution.Provide training programs38Slide39
Primary Health Care39Slide40
Core Activities for PHC There is a set of CORE ACTIVITIES, which were normally defined nationally or locally. According to the 1978 Declaration of Alma-Ata proposed that these activities should include:Education concerning prevailing health problems and the methods of preventing and controlling them Promotion of food supply and proper nutritionAn adequate supply of safe water and basic sanitationMaternal and child health care, including family planningImmunization against the major infectious diseasesPrevention and control of locally endemic diseasesAppropriate
treatment of common diseases and injuriesBasic laboratory services and provision of essential drugs.Training of health guides, health workers and health assistants. Referral services
40Slide41
Elements of PHCEducation concerning prevailing health problems and the methods of preventing and controlling themPromotion of food supply and proper nutritionMonitoring an adequate supply of safe water and basic sanitationMaternal and child health care, including family planningImmunization against the major infectious diseases41Slide42
Elements of PHC (cont.)Prevention and control of locally endemic diseasesAppropriate treatment of common diseases and injuriesBasic laboratory services and provision of essential drugs.Training of health guides, health workers and health assistants. Referral services42Slide43
Elements of PHC (cont.)Mental healthPhysical handicapsHealth and social care of the elderly43Slide44
Principles for PHCPHC based on the following principles :Social equityNation-wide coverageSelf-relianceInter-sectoral coordinationPeople’s involvement in the planning and implementation of health programs44Slide45
Principles of PHC The 1978 Declaration of Alma-Ata proposed a set of PRINCIPLES for primary health care. PHC should:“Reflect and evolve from the economic conditions and socio-cultural and political characteristics of the country and its communities, and be based on the application of the relevant results of social, biomedical and health services research and public health experience”2. “Address the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly”45Slide46
3. “Involve, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works,4. “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”46Slide47
5. “Be sustained by integrated, functional and mutually-supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need”6. “Rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.”47Slide48
The Four Pillars of Primary Health CareCommunity Participation Appropriate Technology Inter-Sectoral Coordination Equitable Distribution 48Slide49
49Slide50
Primary Health Care in JordanPrimary health care services are managed through a wide network of MoH primary health care centers (95 comprehensive health center, 375 primary health care centers and 205 health sub-center in 2013), in addition to providing maternal, childhood and dental health services (448 Motherhood and Childhood Center and 387 dental clinic). The Royal Medical Services is involved in providing primary health care services through field clinics and eight comprehensive medical centers. UNRWA also provides primary health care services through 24 medical clinics. The Jordanian Society for Family Planning and Protection provides services through 19 clinics. This is in addition to the contribution of the private sector in these services through hundreds of general medical clinics.50Slide51
51Slide52
THANK YOU Thank You52