World Health Organization (WHO)
The WHO defines Primary Health Care an essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country and afford at every stage of development.
Alma Ata Declaration
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
Eight essential elements based on the Alma Ata on PHC: 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 by means of acceptable to them, through their full participation and at a cost that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
- Health Education
- Treatment of Locally Endemic Diseases
- Expanded Program on Immunization
- Maternal and Child Health
- Provision of Essential Drugs
- Treatment of communicable and non-communicable diseases
- Safe water and good waste disposal
The 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); and
- Increasing stakeholder participation.
A brief history of Primary Health Care is outlined below:
- May 1977. The 30th World Health Assembly adopted resolution which decided that the main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life.
- September 6-12, 1978. International Conference in PHC was held in this year at Alma Ata, USSR (Russia)
- October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued Letter of Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an approach towards design, development, and implementation of programs which focus health development at the community level.
Adopting primary health care has the following rationales:
- Magnitude of Health Problems
- Inadequate and unequal distribution of health resources
- Increasing cost of medical care
- Isolation of health care activities from other development activities
- Improvement in the level of health care of the community
- Favorable population growth structure
- Reduction in the prevalence of preventable, communicable and other disease.
- Reduction in morbidity and mortality rates especially among infants and children.
- Extension of essential health services with priority given to the underserved sectors.
- Improvement in basic sanitation
- Development of the capability of the community aimed at self- reliance.
- Maximizing the contribution of the other sectors for the social and economic development of the community.
Types of PHC workers
There are two types of primary health care workers in the Philippines:
- Barangay Health Worker or Village Health Worker
- Intermediate level Primary Health Worker
- Active Community Participation
- Intra and Inter-sectoral linkages
- Use of appropriate technology
- Support mechanism made available
1. Elevating health to a comprehensive and sustained national effort
Attaining health for all Filipinos will require expanding participation in health and health-related programs whether as service provider or beneficiary. Empowerment to parents, families and communities to make decisions of their health is the desired outcome.
Advocacy must be directed to national and local policy making to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations.
2. Promoting and supporting community managed health care
The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels.
3. Increasing efficiency in health sector
Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable.
The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC.
The Department of Health (DOH) continue to support and assist both public and private institutions particularly in faculty development, enhancement of relevant curricula and development of standard teaching materials.
4. Advancing essential national health research
Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery.
The following are the eight (8) essential elements of primary health care:
1. Education for Health
This is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.
2. Locally Endemic Disease Control
The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria control and Schistosomiasis control
3. Expanded Program on Immunization
This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning
The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in man’s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country.
7. Treatment of Communicable Diseases and Common Illness
The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.
8. Supply of Essential Drugs
This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted. It includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine
Primary health care is run with the following principles:
1. 4 A’s = Accessibility, Availability, Affordability and Acceptability, Appropriateness of health services.
The health services should be present where the supposed recipients are. They should make use of the available resources within the community, wherein the focus would be more on health promotion and prevention of illness.
2. Community Participation
Community participation is the heart and soul of primary health care.
3. People are the center, object and subject of development.
- Thus, the success of any undertaking that aims at serving the people is dependent on people’s participation at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must also be based on the people’s needs and problems (PCF, 1990)
- Part of the people’s participation is the partnership between the community and the agencies found in the community; social mobilization and decentralization.
- In general, health work should start from where the people are and building on what they have. Example: Scheduling of Barangay Health Workers in the health center
Barriers of Community Involvement
- Lack of motivation
- Resistance to change
- Dependence on the part of community people
- Lack of managerial skills
Through community participation and cohesiveness of people’s organization they can generate support for health care through social mobilization, networking and mobilization of local resources. Leadership and management skills should be develop among these people. Existence of sustained health care facilities managed by the people is some of the major indicators that the community is leading to self reliance.
5. Partnership between the community and the health agencies in the provision of quality of life.
Providing linkages between the government and the non-government organization and people’s organization.
6. Recognition of interrelationship between the health and development
- Health is defined as not merely the absence of disease. Neither is it only a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents
- Development is the quest for an improved quality of life for all. Development is multidimensional. It has political, social, cultural, institutional and environmental dimensions (Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs.
7. Social Mobilization
It enhances people’s participation or governance, support system provided by the government, networking and developing secondary leaders.
This ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level political structures with more substantive responsibilities for development initiators. This also facilities proper allocation of budgetary resources.