McMurray, A. & Clendon, J. (2015). Community Health and Wellness Primary

Health Care in Practice. (5th.ed. pp. 4, 11-16, 62, 92-127). Sydney.

Elsevier AustraliaKEY READING FOR THIS SESSION

Public Health in New Zealand

Epidemiology

PHC and Disability

Awareness

Determinants of Health

Health Promotion

LocalEnvironmental Health Issues

Youth Health New family SexualHealth

Application to Nursing

Relates to HEAL6012 and HEAL6024 Learning Outcomes:

2.Outline selected national and international health care issues and systems, structures and policies in relation to nursing practice.3. Examine concepts of Primary Health Care (PHC) and apply to community nursing practice. CHECK THIS lo 2015.See also Conceptual Map of this course

Learning Objectives. Part One.1. Distinguish between Primary Health Care

and Primary Care2. Outline brief history in development of

PHC (WHO)3. Explain Primary, Secondary and Tertiary

Prevention4. Discuss PHC as a Philosophy: (social

justice and equity) as a Strategy, as a Set of Activities and as a First level of Care.

5. Outline barriers to accessibility of PHC and role of the RN.

Part Two6. Outline PHC in New Zealand :

The Vision of N.Z PHC Strategy (2001) and the role of PHOs.

7. Discuss development of PHC nursing in NZ and the role of the PHC RN.

References.College of Nurses Aotearoa NZ., & New

Zealand Nurses Organisation. (2007). Investing in Health 2007: an update to the recommendations of Investing in health: a Framework for Activating primary Health Care Nursing (2003), Ministry of Health.

Retrieved fromhttp://www.health.govt.nz/our-work/nursing-new-zealand/nursing-resources/nursing-publications/investing-health-2007

College of Nurses Aotearoa NZ. (n.d.). Nurse Practitioners New Zealand.

Retrieved from: http://www.nurse.org.nz/npnz-nurse-practitioners-nz.html

Continued: Ministry of Health ( 2001). The Primary Health

Care Strategy. Wellington : Author.Retrieved from:

http://www.health.govt.nz/system/files/documents/publications/phcstrat.pdf

Ministry of Health (2008). Nurse Practitioners. [DVD].

Retrieved from: http://www.r2.co.nz/20080909/dhb-nurses.asx

Continued.Ministry of Health (2011). Better, Sooner, More Convenient Health Care in the Community. Author Wellington. Retrieved fromhttp://www.health.govt.nz/publications/better-sooner-more-convenient-health-care-community

Ministry of Health (2014). Care closer to Home. Author .Wellington.Retrieved fromhttp://www.health.govt.nz/system/files/documents/publications/care-closer-to-home-feb14.pdf

New Zealand College of Practice Nurses, NZNO: Linking opportunities inter-professional collaboration: (LOGIC). (3 Issues a year). Retrieved from http://www.nzno.org.nz/groups/colleges/college_of_primary_health_care_nurses/logic#LOGIC

Waitemata DHB. PHC Plan 2010-2017Many of you may work for our local

Waitemata DHB when you are registered.

Check out their Primary Health Care Plan.

http://www.waitematadhb.govt.nz/LinkClick.aspx?fileticket=9pHUanIFwI0%3d&tabid=85

See pgs. 7-18

Stop Press 2014. Who is the new Minister of Health?

http://nursingreview.co.nz/news-feed/august-to-december-2014/new-health-minister-line-up-in-cabinet-reshuffle/?

Why should you know this? Discuss with your neighbour. Write your answer in your notes.

Part One: Obj. 1.Distinguish between Primary Care and Primary Health Care. (see text 12-13)Primary Care: when people require health care

because of illness or injury, the FIRST line of care is primary. It is an element of PHC. May include only one intervention or treatment over a period of time.

Primary Health Care (PHC) includes primary or initial care to address a problem, BUT ALSO encompasses the broader activities of govt. and other sectors of society. It is intersectorial. (E.g. Food industry, education, housing, transport etc.).

It is a philosophy of care, a strategy, a set of activities and a level of care).

Goal of PHC is to help communities and the people in them to achieve lasting improvements in the quality of their lives.

Obj. 2. History and Definitions: Primary Health Care: (Alma Ata declaration. (1978.WHO).essential health care that is:Practical, and scientifically soundSocially acceptableTechnology universally accessible to individuals

and familiesAt a cost country can affordFirst level of contactBrings health care close to where people live

and workFirst element of a continuing care process.

(WHO & UNICEF 1978)

Primary Health Care (PHC): Definition from The Ministry of Health (MOH) NZ PHC Strategy (2001).

1.Quality PHC means essential health care based on practical, scientifically sound, culturally appropriate and socially acceptable methods that is:

2. universally accessible to people in their communities

3. involves community participation4. integral to, and a central function of, NZ’s

health system5. the first level of contact with our health

system

Selective versus Comprehensive Primary Health Care

Selective: expressed in language of economics: ‘best investments in health,’ ‘targets’ and ‘outcome focused’.

Comprehensive approach: Key ideas include:Underpinned by notion of Social justiceEmpowerment framework achieved through

partnership with populations served

The Ultimate Aim of PHCTo build community capacity to enable sustainable health and wellbeing.

Community capacity is based on fundamental values of:Social justice and EquityCommunity participation and self determinationThese all embody human rights and shared social expectations.

Brief History of PHC.Primary Health care approach conceptualises health as:

Fundamental right

Individual and collective responsibility

An equal opportunity concept

Image: http://www.picturesnow.com/stock-images/results.aspx?src=keyword&page=1&parent=all&search=new&taxiid=0&keyword=Mother%20and%20child

ContinuedEssential component of socio/economic development.

Image: https://www.google.co.nz/search?q=Popular+images+of+Mother+and+children+from+1940s&client=firefox-

Brief History of the development of PHC. WHOAlma AtaOttawa CharterJakarta DeclarationBangkok Charterhttp://www.who.int/healthpromotion

/conferences/6gchp/bangkok_charter/en /

Why adopt a PHC approach?Inadequate management systems were not creating healthier societies.

Response by the World Health Organisation (WHO) to address the issues of unjust suffering was/is occurring world wide, especially in the poorer countries.

Obj. 3. Primary, Secondary and Tertiary Prevention

Examples of Primary, Secondary and Tertiary Prevention in PHC.Primary prevention: strategies to maintain

health and wellbeing and prevent illness.Secondary prevention: treating and

limiting illness or injuryTertiary prevention: rehabilitation or

restorative actions.

For SDL, identify 2 examples for each of the above.

Obj. 4. PHC as Philosophy, Strategy, Set of Activities and Level of Care. (must know)Emphasis on principles of:1. Social justice, equity, community

participation, socially acceptable and affordable technology.

2. The provision of services on the basis of needs of the population, health education and work to address the root causes of ill-health.

3. Emphasizes working WITH people to enable them to make decisions about their health.

4. PHC philosophy uses approaches that are accessible, affordable, and appropriate (cultural sensitivity) to local needs and are therefore sustainable.

So what is Social Justice?Social justice implies equal rights for all,

regardless of gender, race, class, ethnicity, citizenship, religion, age or sexual orientation.

It implies economic justice – which means governments must take active steps to alleviate poverty and redress past injustices.

 

.

Social Justice ContinuedThe principles (or values) of social justice and

equity underpin Public Health, Primary Health Care and the Millennium Goals.

Implies a commitment to fairness or equity of access to health opportunities for all members of society. ‘Equity for all’ must supersede individual goals(notion of greatest good for the greatest number: Unitarianism)

Is the collective expression of equity. Means governments must stand for the benefit of all members of society.

Poverty is the single most important determinant of health, BUT relative poverty is also significant

Equity.Defined as striving to reduce

systematic disparities in health between more and less advantaged social groups within and between countries.

Some health disparities are unfair, social characteristics such as disparities in wealth, put some at a disadvantage and lack opportunities to be well. E.g. unemployed, low wage, mental illness.

Equity continuedIs about the degree of sharing available resources in order to provide fair access.

Means that some may require additional support. E.g. isolated communities may need transport, childcare, or culturally sensitive programmes. Examples to address this include the Plunket Bus, Marae based, and Pacifika health facilities.

PHC as a strategy for organising care. When the philosophy of PHC is

implemented, the organisation of health care reflects a :

Balanced system of illness treatment with Rehabilitation and Disease prevention and Health promotion (How does the NZ PHC Strategy measure up?)

PHC as a set of activities.The Alma Ata (WHO 1978) highlights a

minimum set of activities:Education of prevailing health problems, prevention and controlPromotion of food supply and proper nutritionProvision of adequate safe water supply and basic sanitationProvision of maternal and child health care including family

planning Immunisation against the major infectious diseasesPrevention and control of locally endemic diseasesAppropriate treatment of common diseases and injuriesProvision of essential drugs

How well are we doing in New Zealand?

PHC as a LEVEL of careIs often described as the first point of

contact with the health system.BUT

Cannot be described as a PHC unless the service offered is comprehensive AND

is underpinned by the Principles of PHC. including collaboration with other health and welfare workers to deal effectively with health issues in their local area (see also slide on PHC as Strategy).

Obj. 5. But: Many people experience barriers to accessing PHC. Some barriers are: Multiple and include: Poverty, socio/economic

status. Wealthy usually have better access to food and a better lifestyle.

Need to provide services that are responsive to poor and help then cope and avoid the worst effects of poverty

Cultural minorities. Cultural bias can provide a barrier to appropriate health care

GeographicalStigmaLack of education

Nurses role : AccessibilityAct as entry point for accessIdentify and facilitate use of resourcesProvide health informationCare should be appropriate in content

and amount to satisfy essential needs of people

Must be delivered in a culturally sensitive and appropriate way

How can you as a RN improve Access?Questions to ask yourself. Include:

How does the client get here? How much does it cost?

Are the services and programmes available in the appropriate language?

Are the hours user friendly?How much do the drugs cost? Can

they afford to fill the prescription. Are there cheaper choices of drugs?

Is the site wheel-chair accessible?

PART TWO. Objectives6. Outline PHC in New

Zealand : The Vision of N.Z PHC Strategy (2001) and the role of PHOs.

7. Discuss development of PHC nursing in NZ and the role of the PHC RN.

PART TWO. Obj. 6. PHC in New Zealand :Two Key MOH documentsMinistry of Health. (2002).The New Zealand

Health Strategy. Author.Aim is to reduce inequalities in health and

improve the overall health status of the population.

Retrieved from: http://www.health.govt.nz/system/files/documents/publications/ne

wzealandhealthstrategy.pdf

The Primary Health Care Strategy (2001) sets out how this will happen in a primary care setting.

Retrieved from:http://www.marlboroughpho.org.nz/downloads/PHCStrategy.pdf

PHC Strategy(2001).The VisionPeople will be part of local primary health

care services that improve their health, keep them well, are easy to get to and co-ordinate their ongoing care.

Primary health care services will focus on better health for a population, and actively work to reduce health inequalities between different groups.

Ministry of Health (2010) Primary Health Care Strategy. p vii. Wellington. Author.

NZ PHC Strategy:Old and New PHC Strategies (see p. 6. PHC Strategy 2001).

OldFocus on individualsProvider focused

Doctors principle providers

Fee for serviceService delivery

monoculturalProviders tend to work

alone

New Population based Community/people focused Education and prevention

important Teamwork-nursing too Needs based funding for

population Cultural competence Connection to other health

and non-health agencies

PHC Workforce: Team Work: Image: http://www.health.govt.nz/publication/better-sooner-more-convenient-health-care-community

Structure of the Health System

http://www.health.govt.nz/new-zealand-health-system/overview-health-system/structure-health-and-disability-sector

What are Primary Health Care Organisations (PHO’s)?The DHBs over see the Primary Health

Organizations established throughout the country.

These were first set up in July, 2002, with a mandate to focus on the health of communities.

They are funded by DHBs, and are required to be entirely non-profit, democratic bodies that are responsive to their communities' needs.

Almost all New Zealanders are enrolled in a PHO, as there are financial incentives for the patients to become enrolled.

How does Whanau Ora(2010)relate to Primary Health Care?Supports Maori aspirations to lead own

health development.Govt. is working with collaboratively with

whanau, hapu and iwi.Strengthening families and participation.Recognises real needs of families. Will be delivered through Maori PHOs and

other Maori health care providers.

Obj. 7.Development of PHC nursing in NZ.Government MOH with New Zealand NursesPHC Nursing is critical to implementing the PHC

Strategy.

The NZ Govt. realizes that nurses have a critical role in the development of health policy at all levels and has developed a: MEMORANDUM of UNDERSTANDING (MOU) (2001) between the MOH and NZ Nursing Organisations.

Objectives of MOU include, leadership and nursing perspectives in health policies, and facilitation of the development of nursing profession to improve health and well being of New Zealanders.

What is needed to develop the PHC Nursing Workforce?

Greater population focus and wider range of services, will increase need for well-trained PHC nurses

Will have generalist knowledge and skills plus:

developing advanced skills in particular areas of practice.

Some key roles: New Zealand Community Nurse’s in PHC delivery.

Key Community Nurses who Provide PHC include:Nurse Practitioners (p. 95-96 begins ½ way down

p.95)Rural Nurse specialists (p. 99 see bottom of page).Home visiting: Highlight role of District Nurse (p.

105)Practice Nursing (p. 103)Plunket Nurse ( top of p. 111)Public Health Nurses(top of pg.111)School Nurse. (begins bottom of pg.113-114)Community Mental Health Nurse( p. 117)Occupational Health Nurses (121)

Your turn. In groups of 3 Select one of these Community based RNs. First select one person in your triad to feed

back to the class.You have 5 minutes to read your section in

your text.Note as many key points about this role as you

can.Feedback to the rest of the class.(I suggest as people feed back, that you all take brief

notes about each of these roles).Go back and re-read Chapter 5 for SDL today). TO

HERE)

Evolving Models of PHC Practice. Two examples.The Hub. Youth Health in Waitakerehttp://healthwest.co.nz/services/view/yout

h-health

AND Public Health Nursing.http://www.publichealthworkforce.org.nz/careers-health-jobs-public-health-nurse%20_156.aspx

Continued

Nurse Led Clinics. (E.g. Youth Health)

Nurse Practitioners.(see DVD next slide)

Their shared goal is to provide primary health care based on PHC philosophy.

Chief Nurse at the Ministryhttp://www.health.govt

.nz/our-work/nursing/nursing-about-us/chief-nurse

DVD clip: Nurse Practitioners. (2008). Focus: Primary Health Care.

http://www.r2.co.nz/20080909/dhb-nurses.asx

The next 3 slides are for Interest Only: what do Nurses Earn?

Check this out:http://www.health.govt.nz/system/files/

documents/publications/newzealandhealthstrategy.pdf

See the priorities of the NZNO for the 2014 election:

http://www.nzno.org.nz/get_involved/campaigns/election_2014/nursing_matters

LOGIC. The journal of the NZ College of Practice Nurses

http://www.nzno.org.nz/groups/colleges/college_of_primary_health_care_nurses/logic#LOGIC

Note the Position Statement in the Guest Editorial June 2012 Journal. In particular also note;

The strong political statements about the RN role and how you can be an effective advocate.

Check out the College at:http://www.nzno.org.nz/groups/colleges/

college_of_primary_health_care_nurses/cphcn_join_the_college

What do I need to Know?Definition of PHC.Distinguish between PHC and Primary CareDiscuss PHC as a philosophy, of care including social

justice and equity, accessibility, affordability and appropriate care and give examples.

PHC as a set of activities, as a Strategy and as a first point of care.

Identify barriers to accessibility and describe the nurses role to improve accessibility.

Compare and contrast he old and new approaches to PHC.Whanau Ora and PHC.The community nurses role in PHC delivery

Don’t know about the OECD? Then check this out.http://www.mfat.govt.nz/Go to Search window on Ministry of Foreign Affairs and Trade, type in OECD

This will give you a one page history and NZ involvement

Health Improvement and Innovation Centre NZ. PHC

Check this site for regular updates in NZ PHC

http://www.hiirc.org.nz/section/9097/primary-health-care/

NZ Primary Care Handbook 2012.

This resource is intended for Medical practitioners, but also useful for Nurse Practitioners and Practice Nurses. For your interest only. See Rheumatic Fever.

http://www.health.govt.nz/system/files/documents/publications/nz-primary-care-handbook-2012.pdf

MOH Update: 2011. Better, sooner more convenient Health Care in the CommunityThis is for interest only.

http://www.health.govt.nz/publication/better-sooner-more-convenient-health-care-community

NB. Type in ‘PHC Better sooner’ in search window, select community document.

(Note story about man’s wife dying from influenza)