Primary health care
Encyclopedia
Primary health care, often abbreviated as “PHC”, has been defined as "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-reliance and self-determination". In other words, PHC is an approach to health
beyond the traditional health care system
that focuses on health equity-producing social policy.
This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration
"), and became a core concept of the World Health Organization
's goal of Health for all
. The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the “politically, socially and economically unacceptable” health inequalities
in all countries.
for all. The WHO has identified five key elements to achieving that goal:
Behind these elements lies a series of basic principles identified in the Alma Ata Declaration
that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors:
and child mortality
. Respectively they include
, such as diabetes and osteoporosis
. According to WHO, dealing with this increasing burden requires health promotion
and disease prevention intervention at community level as well as disease management strategies within health care system
s.
conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
based on practical, scientifically sound and socially acceptable methods and technology made universally accessible
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
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-reliance and self-determination". In other words, PHC is an approach to health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
beyond the traditional health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
that focuses on health equity-producing social policy.
This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration
Alma Ata Declaration
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care , Almaty , currently in Kazakhstan, 6-12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the...
"), and became a core concept of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
's goal of Health for all
Health For All
Health For All is a programming goal of the World Health Organization , which envisions securing the health and well being of people around the world that has been popularized since the 1970s...
. The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the “politically, socially and economically unacceptable” health inequalities
Health equity
Health equity refers to the study of differences in the quality of health and health care across different populations....
in all countries.
Goals and principles
The ultimate goal of primary health care is better healthHealth
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
for all. The 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 policyPublic policyPublic policy as government action is generally the principled guide to action taken by the administrative or executive branches of the state with regard to a class of issues in a manner consistent with law and institutional customs. In general, the foundation is the pertinent national and...
reforms); - pursuing collaborative models of policy dialogue (leadership reforms); and
- increasing stakeholder participation.
Behind these elements lies a series of basic principles identified in the Alma Ata Declaration
Alma Ata Declaration
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care , Almaty , currently in Kazakhstan, 6-12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the...
that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors:
- EquitableEquity (economics)Equity is the concept or idea of fairness in economics, particularly as to taxation or welfare economics. More specifically it may refer to equal life chances regardless of identity, to provide all citizens with a basic minimum of income/goods/services or to increase funds and commitment for...
distribution of health care - according this principle, primary carePrimary carePrimary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class. - Community participation - in order to make the fullest use of local, national and other available resources.
- Health workforce development - comprehensive health care relies on adequate numbers and distribution of trained physicians, nurses, allied health professions, community health workerCommunity health workerCommunity health workers are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community...
s and others working as a health team and supported at the local and referralReferral (medicine)In medicine, referral is the transfer of care for a patient from one clinician to another.Tertiary care is usually done by referral from primary or secondary medical care personnel....
levels. - Use of appropriate technologyAppropriate technologyAppropriate technology is an ideological movement originally articulated as "intermediate technology" by the economist Dr...
- medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community (e.g. the use of refrigerators for vaccineVaccineA vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
cold storage). - Multi-sectional approach - recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local governmentLocal governmentLocal government refers collectively to administrative authorities over areas that are smaller than a state.The term is used to contrast with offices at nation-state level, which are referred to as the central government, national government, or federal government...
s, voluntary organizations, etc.).
Approaches
Different primary health care approaches have evolved in different contexts to account for differences in availability of resources and local priority health problems.GOBI-FFF
One selective PHC approach is referred to collectively under the acronym “GOBI-FFF”. These are strategies that are being adopted to improve maternal and child health as part of primary care, especially in low income countries burdened with high infantInfant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
and child mortality
Child mortality
Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five. In 2010, 7.6 million children under five died , down from 8.1 million in 2009, 8.8 million in 2008, and 12.4 million in 1990. About half of child deaths occur in Africa....
. Respectively they include
- Growth monitoring - to prevent most child malnutrition before it begins
- Oral rehydration therapyOral rehydration therapyOral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...
- to combat dehydration associated with diarrhea - BreastfeedingBreastfeedingBreastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
- ImmunizationVaccinationVaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
- Family planningFamily planningFamily planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
(birth spacing) - Female educationFemale educationFemale education is a catch-all term for a complex of issues and debates surrounding education for females. It includes areas of gender equality and access to education, and its connection to the alleviation of poverty...
- Food supplementation - e.g. iron and folic acid fortification/supplementation to prevent deficiencies in pregnant women
PHC and population ageing
Given global demographic trends, with the numbers of people aged 60 and over expected to double by 2025, PHC approaches have taken into account the need for countries to address the consequences of population ageing. In particular, in the future the majority of older people will be living in developing countries that are often the least prepared to confront the challenges of rapidly ageing societies, including high risk of having at least one chronic non-communicable diseaseNon-communicable disease
A non-communicable disease, or NCD, is a medical condition or disease which is non-infectious. NCDs are diseases of long duration and generally slow progression. They include heart disease, stroke, cancer, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and...
, such as diabetes and osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
. According to WHO, dealing with this increasing burden requires health promotion
Health promotion
Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...
and disease prevention intervention at community level as well as disease management strategies within health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
s.
PHC and mental health
Some jurisdictions apply PHC principles in planning and managing their health care services for the detection, diagnosis and treatment of common mental healthMental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care.
See also
- Emergency healthcare
- Global healthGlobal healthGlobal health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized...
- Health policy
- Health promotionHealth promotionHealth promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...
- Healthy cityHealthy cityHealthy city is a term used in public health and urban design to stress the impact of policy on human health. Its modern form derives from a World Health Organization initiative on Healthy Cities and Villages in 1986, but has a history dating back to the mid 19th century...
/ Alliance for Healthy CitiesAlliance for Healthy CitiesThe Alliance for Healthy Cities is a cooperative international alliance aimed at protecting and enhancing the health and health care of city dwellers. It is composed of groups of cities, urban districts and other organizations from countries around the world in exchanging information to achieve...
- Millennium Development GoalsMillennium Development GoalsThe Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...
- Primary Health Care and Resource CentrePrimary Health Care and Resource CentreThe Primary Health Care and Resource Center is in the rural village of Chapagaun, Lalitpur in Nepal. Chapagaun is in the wider Kathmandu Valley. The health centre was first established in 1972 as an Maternal and Child Health clinic by the United Mission to Nepal...
(Nepal) - Primary Health OrganisationPrimary Health OrganisationPrimary Health Organisations , in New Zealand, are health care providers that are funded on a capitation basis by the New Zealand Government via District Health Boards...
s (New Zealand) - Primary Health Care (magazine)
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
Further reading
- Gatrell, A.C. (2002) Geographies of Health: an Introduction, Oxford: Blackwell.
External links
- Declaration of Alma-Ata.
- Declaration of Alma-Ata at the Center for a World in Balance.
- People's Charter for Health at the Center for a World in Balance.
- WHO European Observatory on Health Systems and Policies.