Primary health care – This book covers the entire syllabus of “Community Health Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate latest information and topics.
This book is examination friendly setup according to the teachers’ lectures and examination’s questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.
Primary health care
Concepts:
Primary health care is considered essential health care that is 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. Primary-health care is a new approach to health care, which integrates at the community level all the factors required for improving health status of the population. It integrates promotive, preventive & curative services It is also conceived as an integrate part of the country plan for socio economic development. Health care delivery system in Bangladesh is based on primary-health care (PHC) concept that has got various levels for service delivery.
Definition of Primary Health Care (PHC)
According to WHO (World Health Organization)
“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 the country can afford to maintain at every stage of their development in the spirit of self-determination”.
Or
The international Conference defined primary health care as follows:
“Primary health care is considered essential health care that is 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”. (WHO)
Or
According to the NINR definition
“Primary Health-Care not only includes the concepts of primary care and community oriented primary care, but also brings in public health delivery along with epidemiological principles. Community residents and health care professionals and partners in the goal of improve health.
Component/Element of PHC
- Education about prevailing health problems and methods of preventing and controlling them.
- Promotion of food supply and proper nutrition.
- An adequate supply of safe water and basic sanitation.
- Maternal and child health care, including family planning.
- Immunization against infectious disease.
- Prevention and control of endemic disease.
- Appropriate treatment of common diseases and injuries.
- Provision of essential drugs.
Principle of PHC
- Equitable Distribution
- Community Participation
- Intersectoral coordination
- Appropriate Technology
A. Equitable Distribution
- Health services must be shared equally by all people irrespective of their ability to pay.
- Rich or poor urban or rural must have access to health services.
- PHC services should be given according to priority of needs that the needy and vulnerable groups of the population in rural areas and urban slums.
B. Community Participation:
- Community participation is defined as the process by which individuals and families assumeresponsibility fortheirownhealthandwelfareandfrothoseofthecommunity and develop the capacity to contribute to their and the community developments.
C. Intersectoral coordination:
The component of PHC cannot be provided by the health sector alone.
- PHC involves in addition to health sector, all heath related sector
- Animportantelemento fintersectoralapproachisplanningwithothersectorstoavoid unnecessary duplication of activities.
- To provide adequate supply of safe water and basic sanitation of a community the coordinated approach of health department public health engineering department and information department are needed.
D. Appropriate Technology:
- It is Scientifically sound
- Adaptable to local needs
- Acceptable to those who the community as well as country resources.
Sectors involved for an effective primary health care:
- Agriculture
- Animal husbandry
- Food
- Industry
- Education
- Housing
- Public works
- Communication
- Public health engineering
- Social welfare, etc.
Strategies of PHC:
1. National strategy: All Government should formulate national policies, strategies, and plans to lunch and sustain PHC.
2. International strategy: All countries should co-operate in a spirit of partnership to ensure PHC.
WHO/UNICEF report on PHC constitutes a solid basis for further development of PHC world-wide.
3. Intervention strategies:
➤ Training and retraining of health and related personnel,
➤ Provision of facilities and equipment necessary for implementing primary health care activities.
➤ Providing supportive supervision to facilitate on the job training as a step to guarantee quality PHC services.
Required facilities for implementation of PHC
1. Institutional facilities:
➤ Increase bed occupancy rate in district hospital, medical college ‘hospital, post-graduate institute hospital and UHCS.
➤ Increase community involvement, competent supervision, willingness of all health personnel to serve in the rural areas.
2. Adequate coverage of health service:
➤ Improve inter- action betweenservice providers and consumers.
➤ Improve referral and follow-up system at all level.
➤ Proper distribution of manpower.
➤ Adequate communications and transport facilities for worker and consumers.
3. Provision of quality of health services:
➤ Adequatemanagement of health services delivery.
➤ Adequate supply of medicine.
➤ Adequate diagnostic and laboratory facilities
➤ Adequate awareness of job responsibilities and technical skill etc.
➤ Increase training facilities.
4. Improve Epidemiological surveillance and monitoring system.
5. Develop modernized health information system.
Bangladesh practice of primary health care
Bangladesh as a member state of WHO has endorsed the HFA strategy and has adopted a comprehensive PHC programme as the basic tool for health development plans as component of five year socioeconomic development plan. As a result
- Priority has been given to development of Upazilla Health complex and union health sub- centres, with a view to strengthen the health infrastructure. So as to ensure comprehensive primary health care to the entire population.
- Stress to training of auxiliaries and health team
- Referral level institutions are being strengthened to provide appropriate support services at primary health care level.
- To introduce decentralized district level planning under the leadership of the Civil
- Surgeon. Government initiatives, a good number a NCOS have programmes covering different elements of PHC
- Integration of health and family planning services.
- Adoption of a team approach at the operational levels to deliver both the services under the package of PHC.
- Community organization and organization through the involvement of village health volunteers including TBA (SBA).
- Intersectoral action by activating action committees at different levels.
- Strengthening of project management at union, thana and district levels.
- Service provided – service provided a the village health care posts (VHCP) 8 in each ward at its monthly session including immunization growth monitoring nutrition education, vitamin distribution, treatment of minor ailments and injuries, family planning services,antenatal and postnatal, blood smear collection for malaria, health education and recording birth and death.
International practice of PHC
The midway reports of 15 countries from different region representing various stages of development, complied by WHO in 1990 provide evidence of achievements and setbacks with regard to implementation of HFA strategy The reports show how individual countries have adopted the primary health care approach to meet their own situation.These country experiences have indicated that strengthening of health infrastructure in support of PHC encompasses two phases
1. Increase of health facilities of varies type (government level; NGO and private sector) at different level; and
2. Efficient operation of these facilities including the referral system.
Some of the innovative approach tried in the countries for improving he operations are mentioned below-
a. Integrated approach-
- Integrated health and family planning posts- posysndu in Indonesia;
- Integrated approach for intensification of action programine for PHC in Bangladesh;
b. Emphasis outreach programmes:
- Women’s family welfare movement to develop a system of care based on the concept every ten families- dasawisma – Indonesia;
- Thailand’s village health communicators and health volunteers.
- Village health guide’s scheme in India; Mechanism to bring out the concerns of PHC beyond the walls of health sectors and involve other sectors;
c. Mechanism to bring out the concerns of PHC beyond the walls of health sectors and involve other sector: Approach, tried in Indonesia- Panchakarsa’ five objectives to be attained by the year 2000; Basic minimum needs programs in Thailand’s.
d. Formation of Health Consumer’s Group;e.g empowering the community to have more say in the planning and implementation of health programme.
e. More emphasis on planning and management to ensure maximum use of scarce resources and avoid waste.
f. Operation room approach in Malaysia to ensure accountability and improving monitoring and review.
g. Increasing emphasis on health promotion through formal and informal health education programme in risk-oriented services.
Role of Nurse in PHC
Nurses working as unified forces in primary health care can effect changes in the health system to correct these deficiencies and available all peoples of the World to attain a healthy productive life. Nurses must aim to bring health within the reach of all:
1. Primary health care concepts must be applied to all types nursing practice and education.
2. Making nursing relevant to the social, economic, cultural and health needs of the community. The priorities should be identified and tackled.
3. Nurse must work in all areas. At present, health care services are concentrated in the urban centers, out of the reach of rural population where most people live.
4. Nurses must be active in policy making at all levels. They must be prepared to standup and express their informed views on what is needed to ‘Provided Health For All’.
5. Nurses must work with other people, health worker, teachers, community development workers, and with people they serve.
6. The nurse in a hospital or community must now aim to work in partnership with patient/clients and communities, sharing knowledge and skills and always endeavoring to promote health and preventive illness, at the same times caring disease.
This requires a quite different approach and an appreciation of the great importance of primary health care.
Policy & Approach of PHC
Policy of PHC :
Policies are general statements based on human aspirations of values, commitments, assessment of current situation and an image of a desired future situation.A national health policy is an expiration of goals for improving the health situation, the priorities among these goals and the main direction for attaining them.
Approach of PHC
Primary health care is a new approach to health care, which integrates at the community level all the factors required for improving health status of the population. It integrates promotive, preventive & curative services. It is also conceived as an integrate part of the country plan for socio economic development.
Primary health care approach is radically new approach starting from the people with their full participation and active involvement in the planning and delivery of health services based on principles of primary health care e.g., Community involvement and intersectional co-ordination. The underlying objective is to help individuals to become self-reliant in matter of health. This is turn can be done if the people receive the necessary guidance from health care providers inidentifying workable solutions. This approach has been described as “Health by the people” and “placing people’s health in people’s hands”. This approach is a fundamental shift from the earlier approach.
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