PRIMARY HEALTH CARE
•Primary Health Care 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 the community
and country can afford to maintain at every stage of their development in the spirit of
selfreliance and self-determination (Alma Ata 1978)
•Primary refers to the most important/central concept of health care services.
•It is the first level of contact of individuals, the family, and community with the national
health system bringing health care as close as possible to where people live and work, and
constitutes the first elements of a continuing health care process.
•PHC is the approach to achieve Health for All (HFA) by year 2000 and beyond.
•Health refers to a state of enough physical, mental, and social wellbeing to enable people to
work productively and participate actively in social and economic life of the community in
which thy live
•The development of PHC has been stimulated by several important events of which Kenya is
a signatory. These events include:
a) Adoption of 1977 World Health Assembly worldwide social objective of 'The
attainment by all people of the world by the year 2000 of a level of health that will
permit them to lead a socially and economically productive life' (WHO, 1977)
b) Adoption of Alma- Ata declaration by the 1978 international health conference in
which “Primary Health Care" was seen as the strategy for achieving “Health for
all “
c) Adoption at the 1981 World Health Assembly of the global strategy for “health for
all by the year 2000 and beyond”. The global strategy stated in details that PHC
approach is the key issue in achieving Health for all goal.
d) The Bamako (Mali) initiative (1987), for Sub-Saharani Africa (A joint initiative
by WHO/UNICEF which aimed at increasing access to PHC by raising the
effectiveness, efficiency, financial viability and equity of health services
e) Global Conference on Primary Health Care (25-26 October 2018) - Astana,
Kazakhstan
The Alma-Ata Declaration – International Conference on Primary Health Care (1978)
•The Declaration of Alma-Ata was adopted at the International Conference on Primary Health
Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist
Republic), 6–12 September 1978.
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•It expressed the need for urgent action by all governments, all health and development
workers, and the world community to protect and promote the health of all people.
•It was the first international declaration underlining the importance of PHC
•The PHC approach has since then been accepted by member countries of the WHO as the
key to achieving the goal of "Health for All" but only in developing countries at first. This
applied to all other countries five years later.
•The Alma-Ata Declaration of 1978 emerged as a major milestone of the 20th century in the
field of public health, and it identified PHC as the key to the attainment of the goal of
"Health for All" around the globe.
•The following are some of the key excerpts from the Declaration:
•The Conference strongly reaffirms that health, which is a state of complete physical, mental,
and social well-being, and not merely the absence of disease or infirmity, is a fundamental
human right and that the attainment of the highest possible level of health is a most important
world-wide social goal whose realization requires the action of many other social and
economic sectors in addition to the health sector.
•The existing gross inequality in the health status of the people, particularly between
developed and developing countries as well as within countries, is politically, socially, and
economically unacceptable and is, therefore, of common concern to all countries.
•The people have a right and duty to participate individually and collectively in the planning
and implementation of their health care.
7.2.2 Purpose of PHC
The purpose of PHC can be summarised to include:
1. To increase coverage and accessibility of health services in rural areas.
2. To improve comprehensive health services both in urban and rural
3. To increase emphasis on MCH/FP services in order to reduce morbidity, mortality &
fertility rates.
4. To increase inter-ministerial co-ordination (intersectoral collaboration)
5. To increase alternative financing mechanisms for healthcare
7.2.3 The Concept of PHC
•The concept of PHC are ideas about the implementation of health care for all.
•The concept of PHC, basically rereferred to as “characteristics of PHC” constitute five
'A’s
1. Accessible: PHC Services should be geographically, financially and culturally
within easy reach to the whole community.
2. Acceptable: The quality of health services offered should be appropriate,
adequate, and able to satisfy the health needs of people; and technology within
their social cultural norms.
3. Affordable: At a cost that the community can pay.
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4. Available: The health structures and services are easily present when/where
required
5. Appropriate Technology: Utilising existing methods, techniques, and resources
within the community which are scientifically sound i.e. effectiveness based on
evidence
7.2.4 Pillars of PHC
• There are 7 essential/anchors for the effective functioning of PHC strategy
1. Health System: PHC is integral part of health care system.
2. Priority: Addresses essential and major health problems
3. Science: Services offered are based on practical, scientifically sound research findings 4.
Culture: Socially acceptable methods and technology to be used in providing services.
5. Equity: Services made universally accessible to individuals and families depending on
their needs.
6. Participatory: Individuals and families have the right and duty to participate in the
planning and implementation
7. Sustainability: PHC services provided at a cost community is able to maintain at every
stage of its devt.
7.2.5 Fundamentals of PHC
• These are the basic rules or beliefs that are essential to the existence, development or success
of Primary Health Care.
The following are the fundamentals of PHC
1. PHC reflects and evolves along the economic, socio-cultural and political characteristics
of the country.
2. PHC addresses the main health problems
3. PHC includes, at least 8 elements as per the Alma Ata declaration
4. PHC involves multisectoral approach.
5. PHC requires maximum community participation, including resource mobilization
6. PHC depends on functioning referral systems.
7. PHC relies on health workers, including PHOs, CHAs, CHVs, Nurses, etc.
7.2.6 Elements of PHC
•Elements are basically services offered through the PHC strategy
•There are 8 essential elements that were identified in the Alma Ata conference in 1978
•Individual countries were however allowed to add others elements based on local context
The PHC elements listed at the Alma Ata Declaration
1. Education concerning prevailing health problems and the methods of preventing and
controlling them
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2. Local disease control
3. Expanded programme of immunisation
4. Maternal and child health care and family planning (MCH/FP)
5. Essential drug supply
6. Nutrition and adequate food supply
7. Treatment and prevention of common diseases and injuries
8. Safe water supply and good sanitation
The Kenya government added elements
9. Mental health
10. Dental health
11. Community based rehabilitation (of the disabled persons )
12. Malaria control
13. STI & HIV/AIDS Prevention and control 14. Eye care
1) Health Education
•It is a process of dialogue with community members to find out appropriate
responses/solutions to health problems.
•Is intended to have a positive impact on health.
•To empower with knowledge and skills on how behaviour affects their health.
2) Nutrition and Adequate Food Supply
•Prevent and treat nutrition related illness; (diarrhoea diseases, diseases which leads to
intestinal parasites & nutritional deficiency)
•Support health promotional measures; (child spacing, nutrition education, kitchen garden and
food hygiene.
•Encourage to grow more foods, prevent post-harvest spoilage through construction of simple
food stores, and to keep poultry and dairy cattle.
3) Water Supply and Basic Sanitation
•Ensure Access to safe water
•Proper refuse and faecal disposal
•Identify sources of safe water through intersectoral-collaboration.
•Educate community members on how to protect wells and springs, how to construct latrines,
compositing facilities.
4) Maternal and Child Health and Family Planning (MCH/FP) •
Children and mothers are the majority by number in the Community.
•They run a great risk of injury and disease because their lives are concerned with
beginnings and growth.
•MCH/FP services promote the health of mothers and children by:
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•Reducing the maternal and child mortality rates
•Enabling women of childbearing age to plan their families
•Child growth monitoring
•Exclusive breastfeeding
•ANC services
5) Immunisation
•Provide immunization services through the Kenya Expanded Programme on Immunisation
•Motivate and encourage mothers to bring their children for immunisation - Educate on
benefits
•Identify suspected cases of immunizable diseases such as measles and report
6) Local Disease Control
• Refers control of endemic disease.
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Examples of endemic diseases in Kenya (Malaria, Schistosomiasis, Filariasis, Hookworm,
Trachoma, Onchocerciasis)
7) Treatment and Prevention of Common Diseases and Injuries
•Rationale Use of drugs
•Skilled personnel
•Common Diseases and Injuries in Kenya include Diarrhoea diseases; Skin diseases; Worm
infestation; Common accidents requiring first aid; burns; wounds; bites and stings; allergic
shock; Eye conditions; Acute respiratory infections
8) Supply of Essential Drugs
•Essential drugs are basic drugs used to treat minor ailments or conditions at the dispensary
and health centre levels.
•Community pharmacies have been established in remote rural areas to improve access to
drugs in the community.
•Examples of essential drugs in kenya paracetamol, amoxyl, albendazole, clotrimazole,
septrin etc
9) Mental Health
•Part and parcel of holistic health
•Promote good mental health practices ....non substance abuse, avoiding stressful working
environment
•Provide facilities in all health institutions and service delivery points for education, detection,
treatment or referral of mental health problems.
10) Dental Health
•Focuses on the promotive and preventive care of teeth and the oral cavity.
•Regular dental checks
11) Community Based Rehabilitation
•For management and prevention of disabilities arising from;
•Congenital defects (e.g. Autism)
•Chronic non-communicable diseases such as cancers, and accidental injuries.
12) HIV/AIDS/STI Prevention and Control
•Adequate and equitable provision of health care to the growing numbers of HIV infected
people falling sick
•Treatment of other STI that increase peoples biological vulnerability to HIV infection
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•Reduction of women’s vulnerability to HIV infection by improving their educational, legal
status and economic prospects
A supportive socio-economic environment for HIV/AIDS prevention...social fund to the
orphans
13) Malaria Control
• Four levels of malaria control.
Level 1
•The objective is to prevent malaria mortality/Death arising from malaria.
•The strategy is to make chemotherapy available as close as possible to every family.
Level 2
•The objective is to control mortality and morbidity
•The strategy is to use chemotherapy as close to each family as possible and
chemoprophylaxis with simple anti-mosquito measures (e.g use of fansidar).
Level 3
•The objective is to control malaria mortality, morbidity and prevalence.
•The strategy is to use chemotherapy and chemoprophylaxis with effective mosquito control
measures.
Level 4
•The objective is to eradicate malaria completely
•The strategy is effective preventive measures, chemotherapy, chemoprophylaxis, legislations.
7.2.8 Principles of PHC
•These are rules or guidelines that govern the implementation of PHC activities.
•There are five basic principles which govern the implementation of PHC and they include;
1. Equity
2. Manpower development
3. Community participation
4. Appropriate technology
5. Multi-sectoral approach
1) Equity
•Equity is the fair and reasonable distribution of available resources to all individuals, families
and communities.
•Services should be physically, socially and financially accessible to everyone.
•People with similar needs should have equal access to similar health services.
•PHC services should be greatest in those areas with the greatest need.
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•This principle should be taken into account when deciding on the location of new health
facilities, outreach services points, or during introduction of new health programmes.
2) Manpower Development
• Provision of PHC services need health personnel
Identification, training and development of new categories of health workers to serve the
community e.g CHWs
3) Community Participation
•Is the process by which individuals, families and communities assume responsibility in
promoting their own health and welfare, especially in health decision making.
•Community members must be engaged actively in PHC activities right from planning
4) Appropriate technology
•Is the kind of technology that is scientifically sound and adaptable to local needs, and which
the community can afford to maintain at every stage of their development in the spirit of
selfreliance and self-determination.
•It includes issues of costs and affordability of services, type of equipment and their pattern of
distribution throughout the community.
•Care givers should be trained to deliver services using the most appropriate and cost-effective
methods and equipment for their level of care.
5) Multi-Sectoral or Intersectoral Approach
•PHC requires a coordinated effort with other health related sectors whose activities
impact on health
•Health sector cannot achieve much in isolation.
•Examples of other sectors;
•Agriculture
•Housing
•Transport and communication
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