PRIMARY HEALTH CARE

Rhenier S. Ilado RN

Primary Health Care

As a Strategy

PRIMARY HEALTH CARE APPROACH

CONCEPTUALIZES HEALTH AS A
Fundamental

right Individual and collective responsibility An equal opportunity concept Essential component of socio-economic development

(McMurray, pg.31; Besner, J. (2004), p. 352)

3

HEALTH as a Basic Health Right

Article XXV, Section I (The Universal Declaration of Human Rights) states that:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Article XIII, Section II of our Constitution states that:

The state shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled women, and children. The state shall endeavor to provide free medical services to paupers.

What is PRIMARY HEALTH CARE?

World Health Organization (WHO)

An 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

at a cost that the community can afford to maintain at every stage of their development in the spirit of selfreliance and self- determination.

PHC was first declared in the International Conference in Alma-Ata, USSR on Sept. 6-12, 1978, as a strategy to community health development

Adopted in the Philippines through Letter of Instruction (LOI) 949 signed by President Marcos on October 19, 1979

Framework
Peoplesempowermentandpartnership is the Key Strategy to achieve the GOAL

GOAL
Health for all Filipinos by the year 2000 and Health in the Hands of the People by the year 2020.

PRIMARY HEALTH CARE APPROACH

CONCEPTUALIZES HEALTH AS A
Fundamental

right Individual and collective responsibility An equal opportunity concept Essential component of socio-economic development

(McMurray, pg.31; Besner, J. (2004), p. 352)

11

Rationale for PHC?

Increasing mortality and morbidity rates

Inadequate health care delivery service

Less empowered people/community

Burden of diseases is heaviest in the poor

1. 2. 3. 4. 5. 6.

7.
8. 9. 10.

Acute lower RTI & Pneumonia Bronchitis / Bronchiolitis Acute watery diarrhea Influenza Hypertension TB - respiratory Chickenpox Diseases of the heart Malaria Dengue fever

CAUSES
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

OF

MORTALITY (PHILS)

Leading Causes of Mortality among Filipinos in 2004

Disease of the heart Diseases of the vascular system Malignant Neoplasm Accidents Pneumonia TB all forms Ill defined and unknown causes of mortality Chronic lower respiratory diseases Diabetes Mellitus Certain conditions originating in the perinatal period

CAUSES
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

OF

MORTALITY (PHILS)

Leading Causes of Mortality among Filipinos in 2004

Disease of the heart Diseases of the vascular system Malignant Neoplasm Accidents Pneumonia TB all forms Ill defined and unknown causes of mortality Chronic lower respiratory diseases Diabetes Mellitus Certain conditions originating in the perinatal period

MATERNAL MORTALITY
1.

2. 3. 4. 5.

Normal delivery and other complications related to pregnancy occurring in the course of labor, delivery and puerperium Hypertension Postpartum hemorrhage Pregnancy with abortive outcomes Hemorrhage related to pregnancy

4 As of Primary health Care

A - ccessibility

A - vailability
A - cceptability A - ffordability

Mission of PHC
PHC aims to strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care.

Principles of PHC
1. Partnership and empowerment as the core strategy.

2. Focuses responsibility for health on the individual, his family and the community.

3. Full participation and active involvement of the community towards the development of self-reliant people.

Principles of PHC
4. Interrelationship between health and the overall political, socio-cultural and economic development of society

Objectives of PHC
1. Improvement in the level of health care of the community. 2. Favorable population growth structure.

3. Reduction in the prevalence of preventable, communicable and other diseases.

4. Reduction in morbidity and mortality rates especially among infants and children.

Objectives of PHC
5. Extension of essential health care services with priority given to the underserved sectors.

6. Improvement in basic sanitation

7. Development of the capability of the community aimed to the underserved sectors.

Objectives of PHC
8. Development of the capability of the community aimed at self-reliance.

9. Maximizing the contribution of the other sectors for the social and economic development of the community.

Four Cornerstone or Pillars in PHC

active community participation

intra and inter sectoral linkages

use of appropriate technology support mechanism made available

Strategies
Reorientation and reorganization of the national health care system in support of the mandate of devolution under the Local Government Code of 1991

Effective preparation and enabling process for health action at all levels. Mobilization of the people to know their communities and identifying their basic health needs.

Strategies
Development and utilization of appropriate technology focusing on local indigenous resources available.

Organization of communities arising from their expressed needs.

Increase opportunities for community participation in local level planning, management, monitoring and evaluation within the context of regional national objectives.

Strategies
Development of intra-sectoral linkages with other government and private agencies

Emphasizing partnership.

Elements of Primary Health Care

E
L E

ducation on prevailing health problems

ocally endemic Disease Prevention and Control xpanded Program of immunization

M
E N

aternal and Child Health and Family Planning

nvironmental Sanitation and Safe Water Supply

nutrition and Food Supply

reatment of Communicable & Non-communicable Diseases supply and proper use of Essential Drugs and Herbal Medicine

D
A M

ental Health Promotion ccess to and use of hospitals as centers of wellness

ental health promotion

Primary Health Care Workers

Various categories of health care workers make up the primary health care team The types vary in different communities depending upon:
Available health manpower resources
Local health needs and problems

Political and financial feasibility

PHC Team
Consist of:

Physician Nurses Midwives

Nurse Auxiliaries
Locally trained community health workers Traditional birth attendants and healers

Types of Primary Health Care Team

1. Village or Barangay Health Workers (V/ BHWs)
refers to trained community health workers or health auxiliary volunteer or a traditional birth attendant or healer

2. Intermediate Level Health Workers

General medical practioners or their assistants, Public Health Nurse, Rural Sanitary Inspectors and Midwives

Levels of Health Care Services

Health problems that are beyond the capability of PHC units and beyond the competence of the PHC workers are referred to an Intermediate health facility or Rural health Units (RHU)

The higher the level the more qualified the health personnel and the more sophisticated the health equipment

RHU team
Generally consist of:

Physician
Dentist

Public health nurse

Midwife Sanitarian Other health workers

3 levels:
Primary level
Barangay Health station, Community Hospitals, Health Centers and Rural Health Unit

Secondary Level
Emergency/ District Hospitals, Provincial/ City Hospitals and Provincial/ City Health Services

Tertiary Level
Teaching and Training Hospitals, Medical Centers and National Health Services

National Health Services Medical Centers Teaching and Training Hospitals Regional Health Services Regional Medical Centers And Training Hospitals

Provincial/City Health Services Provincial / City Hospitals

Emergency District Hospitalas

RHUs Community Hospitals and Health Centers Private Practitioners/Puericulture Centers

BHS

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

Health Care Delivery System

Totality of all policies, infrastructures, facilities, equipment, products, human resources, and services that address the health needs, problems, an concerns of all people

DOH remainstobethenationalgovernments biggest health care provider

The Health Care Delivery System (Major players)

2 sectors

1. PUBLIC SECTOR
financed with a tax based budgeting system at both national and local levels and where health care is generally given for free at the point of service

Consists of the national and local government agencies providing health services A. Department Of Health
The national level lead agency in health Maintains specialty hospitals, regional hospitals and medical centers

B.LGUs
it now run the local health system because of the devolution of health care services

Provincial government: manages provincial and district hospitals

City/Municipal Government: manages health centers, RHU and BHSs

Every province, city or municipality has a Local Health Board chaired by Local Chief Executive

Local Health Board

Chaired by the local chief executive

Serves as advisory body to the local chief executive and the sanggunian or local legislative council on health related matters.

2. PRIVATE SECTOR
market oriented and where health care is paid through user fees at the point of service Includes providing health services in the clinics and hospitals, health insurance, manufacture of medicines, vaccines, medical supplies, equipment, nutrition products and other health related services

DOH has control and supervision over:

Before: (before devolution) 1. All Barangay Health Stations 2. Rural Health Units 3. Hospitals (special & specialty hospitals, medical centers, regional, provincial, district and municipal hospitals)

Today: (after devolution) Regional hospitals Medical centers Special and specialty hospitals

DOH Functions
DOH exercises regulatory powers over health facilities and products Formulates policies and standards related to health facilities, health human resources

Provides local government units (LGUs) the necessary support in managing their local health system

DEVOLUTION OF HEALTH SERVICES

What is DEVOLUTION?

Answer Devolution is the transfer of power and authority from the national government to Local Government Units (LGUs)astheterritorialandpolitical subdivision of the state to enable them to perform specific functions and responsibilities

R.A. 7160 or Local Government Code

aims to transform local government units into self reliant communities and active partners in the attainment of national goals through a more responsive and accountable local government structure instituted through a system of decentralization

1993
All health services were devolved or transferred from the DOH to the LGUs

Provincial, district, municipal hospitals to the provincial government

Rural health units and barangay health stations to the municipal government

What is the objective of devolving health services to LGUs?

Answer Devolution of health services is an integral part of the process of transforming LGUsintoself-reliant communities and active partners in nation building by giving them more powers, authority and resources and corresponding responsibilities and obligations

What is its advantage to the community?

Answer It will allow people to participate more in policy and decision making relative to the delivery of quality health care in their community

Who benefits most from the devolution of health services?

Answer With health services becoming more aligned to local needs, people who ordinarily would have difficulty getting such services will now be more easily reached

What are the public health programs and projects that shall be devolved and made more accessible to the community?

Answer These include public health programs and projects in: Primary Health Care

Maternal and Child Health Care

Dental health Nutrition Family Planning Environmental health Communicable and Non-Communicable disease control

What is the legal basis for devolving health services to LGUs?

Devolution of health services to LGU is mandated by Local Government Code of 1991 or RA 7160

What assets are to be transferred by the DOH to the LGUs?

Answer The DOH shall transfer assets such as land and buildings, equipment, record, drugs, medicines, materials and supplies