Primary Health Care (Review Notes)

7/28/2019 Primary Health Care (Review Notes)

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PRIMARY HEALTH CARERhenier S. Ilado RN


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Primary Health Care

As a Strategy


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PRIMARY

HEALTH

CARE

APPROACH

CONCEPTUALIZESHEALTHASA

Fundamental right

Individual and collective responsibility

An equal opportunity concept

Essential component of socio-economicdevelopment

(McMurray, pg.31; Besner, J. (2004), p. 352)


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HEALTH as a Basic Health RightArticle XXV, Section I (The Universal Declaration of

Human Rights) states that:

Everyone has the right to a standard of living adequate

for the health and well-being of himself and of his family,including food, clothing, housing, and medical care and

necessary social services, and the right to security in the

event of unemployment, sickness, disability, widowhood,

old age or other lack of livelihood in circumstances

beyond his control.


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Article XIII, Section II of our Constitution statesthat:The state shall adopt an integrated and comprehensive

approach to health development which shall endeavor

to make essential goods, health and other social

services available to all people at affordable cost. There

shall be priority for the needs of the underprivileged,sick, elderly, disabled women, and children. The state

shall endeavor to provide free medical services to

paupers.


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What is PRIMARY HEALTH

CARE?


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World Health Organization (WHO)

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 through their fullparticipation


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at a cost that the community can afford to maintain at

every stage of their development in the spirit of self-

reliance and self- determination.


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PHCwas first declared in the International Conference

in Alma-Ata, USSR on Sept. 6-12, 1978, as a strategy

to community health development

Adopted in the Philippines through Letter of Instruction

(LOI) 949 signed by President Marcos on October 19,

1979


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FrameworkPeoples empowerment and partnership is the Key

Strategy to achieve the GOAL

GOAL

Health for all Filipinos by the year2000 and Health in

the Hands of the People by the year 2020.


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PRIMARY

HEALTH

CARE

APPROACH

CONCEPTUALIZESHEALTHASA

Fundamental right

Individual and collective responsibility

An equal opportunity concept

Essential component of socio-economicdevelopment

(McMurray, pg.31; Besner, J. (2004), p. 352)


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Rationale for PHC?

Increasing mortality and morbidity rates

Inadequate health care delivery service

Less empowered people/community

Burden of diseases is heaviest in the

poor


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1. Acute lower RTI & Pneumonia

2. Bronchitis / Bronchiolitis

3. Acute watery diarrhea

4. Influenza

5. Hypertension

6. TB - respiratory

7. Chickenpox

8. Diseases of the heart

9. Malaria

10. Dengue fever


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CAUSESOF MORTALITY (PHILS)

Leading Causes of Mortality among Filipinos in 20041. Disease of the heart

2. Diseases of the vascular system

3. Malignant Neoplasm

4. Accidents

5. Pneumonia6. TB all forms

7. Ill defined and unknown causes of mortality

8. Chronic lower respiratory diseases

9. Diabetes Mellitus

10. Certain conditions originating in the perinatal period


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CAUSESOF MORTALITY (PHILS)

Leading Causes of Mortality among Filipinos in 20041. Disease of the heart

2. Diseases of the vascular system

3. Malignant Neoplasm

4. Accidents5. Pneumonia

6. TB all forms

7. Ill defined and unknown causes of mortality

8. Chronic lower respiratory diseases

9. Diabetes Mellitus10. Certain conditions originating in the perinatal period


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1. Normal delivery and other complications related to

pregnancy occurring in the course of labor, delivery and

puerperium

2. Hypertension3. Postpartum hemorrhage

4. Pregnancy with abortive outcomes

5. Hemorrhage related to pregnancy

MATERNAL MORTALITY


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4 As of

Primary health Care

A - ccessibility

A - vailability

A - cceptability

A - ffordability


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Mission of PHC

PHC aims to strengthen the health care system by

increasing opportunities and supporting the

conditions wherein people will manage their own

health care.


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Principles of PHC

1. Partnership and empowerment as the core strategy.

2. Focuses responsibility for health on the individual, his

family and the community.

3. Full participation and active involvement of the

community towards the development of self-reliant

people.


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Principles of PHC

4. Interrelationship between health and the overall

political, socio-cultural and economic development of

society


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Objectives of PHC

1. Improvement in the level of health care of thecommunity.

2. Favorable population growth structure.

3. Reduction in the prevalence of preventable,

communicable and other diseases.

4. Reduction in morbidity and mortality rates

especially among infants and children.


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Objectives of PHC

5. Extension of essential health care services with priority

given to the underserved sectors.

6. Improvement in basic sanitation

7. Development of the capability of the community aimed

to the underserved sectors.


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Objectives of PHC

8. Development of the capability of the communityaimed at self-reliance.

9. Maximizing the contribution of the other sectors for

the social and economic development of the community.


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Four Cornerstone or Pillars in

PHC

active community participation

intra and intersectoral linkages

use of appropriate technology

support mechanism made available


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Strategies

Reorientation and reorganization of the national health

care system in support of the mandate of devolutionunder the Local Government Code of 1991

Effective preparation and enabling process for health

action at all levels.

Mobilization of the people to know their communities

and identifying their basic health needs.

St t i


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Strategies

Development and utilization of appropriate technology

focusing on local indigenous resources available.

Organization of communities arising from their

expressed needs.

Increase opportunities for community participation in

local level planning, management, monitoring andevaluation within the context of regional national

objectives.


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Strategies

Development of intra-sectoral linkages with other

government and private agencies

Emphasizing partnership.


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Elements of Primary

Health Care


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E ducation on prevailing health problems

L ocally endemic Disease Prevention andControl

E xpanded Program of immunization

M aternal and Child Health and Family Planning

E nvironmental Sanitation and Safe Water Supply

N nutrition and Food Supply


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T reatment of Communicable & Non-communicableDiseases

S supply and proper use of Essential Drugs andHerbal Medicine

D ental Health Promotion

Access to and use of hospitals as centers of

wellness

M ental health promotion


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PHC TeamConsist of:

Physician

Nurses

Midwives

Nurse Auxiliaries

Locally trained community health workers

Traditional birth attendants and healers


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Types of Primary Health Care Team

1. Village or Barangay Health Workers (V/

BHWs)

refers to trained community health workers or health

auxiliary volunteer or a traditional birth attendant or healer


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2. Intermediate Level Health Workers

General medical practioners or their assistants,

Public Health Nurse, Rural Sanitary Inspectors and

Midwives


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Levels of Health Care Services

Health problems that are beyond the capability of PHC

units and beyond the competence of the PHC workers are

referred to an Intermediate health facility orRural

health Units (RHU)

The higher the level the more qualified the healthpersonnel and the more sophisticated the health

equipment


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RHU team

Generally consist of:

Physician

Dentist

Public health nurse

Midwife

Sanitarian

Other health workers


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3 levels:

Primary level

Barangay Health station, Community Hospitals,

Health Centers and Rural Health Unit

Secondary Level

Emergency/ District Hospitals, Provincial/ City

Hospitals and Provincial/ City Health Services


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Tertiary Level

Teaching and Training Hospitals, Medical

Centers and National Health Services


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National

Health Services

Medical Centers

Teaching and

Training Hospitals

Regional Health ServicesRegional Medical Centers

And Training Hospitals

Provincial/City Health Services

Provincial / City Hospitals

Emergency District Hospitalas

RHUs

Community Hospitals and Health CentersPrivate Practitioners/Puericulture Centers

BHS


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THE PHILIPPINE HEALTH CARE

DELIVERY SYSTEM


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Health Care Delivery System

Totality of all policies, infrastructures, facilities, equipment,

products, human resources, and services that address the

health needs, problems, an concerns of all people

DOHremains to be the national governments

biggest health care provider

Th H lth C D li S t


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The Health Care Delivery System

(Major players)

2 sectors

1. PUBLIC SECTOR

financed with a tax based budgeting system at both

national and local levels and where health care is generally

given for free at the point of service


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Consists of the national and local government agencies

providing health services

A. Department Of Health

The national level lead agency in health

Maintains specialty hospitals, regional hospitals and medicalcenters

B. LGUs

it now run the local health system because of the devolutionof health care services


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Provincial government:

manages provincial and district hospitals

City/Municipal Government: manages health centers,

RHU and BHSs

Every province, city or municipality has a Local Health

Board chaired by Local Chief Executive


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Local Health Board

Chaired by the local chief executive

Serves as advisory body to the local chief executiveand the sanggunian or local legislative council on

health related matters.


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2. PRIVATE SECTOR

market oriented and where health care is paid through

user fees at the point of service

Includes providing health services in the clinics and

hospitals, health insurance, manufacture of medicines,vaccines, medical supplies, equipment, nutrition products

and other health related services

DOH has control and supervision over:


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DOH has control and supervision over:

Before: (before devolution)1. All Barangay Health Stations

2. Rural Health Units

3. Hospitals (special & specialty hospitals,

medical centers, regional, provincial, district andmunicipal hospitals)


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Today: (after devolution)

Regional hospitals

Medical centers

Special and specialty hospitals

DOH F ti


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DOH Functions

DOH exercises regulatory powers over health facilities

and products

Formulates policies and standards related to health

facilities, health human resources

Provides local government units (LGUs) the necessary

support in managing their local health system


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DEVOLUTIONOF HEALTHSERVICES


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What is DEVOLUTION?


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Answer Devolution is the transfer of

power and authority from the national

government to Local Government Units(LGUs) as the territorial and political

subdivision of the state to enable them to

perform specific functions andresponsibilities

R A 7160 or Local Government Code


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R.A. 7160 or Local Government Code

aims to transform local government units into self reliantcommunities and active partners in the attainment of

national goals through a more responsive and

accountable local government structure instituted through

a system of decentralization


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1993

All health services were devolved or transferred fromthe DOH to the LGUs

Provincial, district, municipal hospitals to theprovincial government

Rural health units and barangay health stations to the

municipal government


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What is the objective of devolving

health services to LGUs?

Answer Devolution of health services is an


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Answer Devolution of health services is an

integral part of the process of transforming

LGUs into self -reliant communities and active

partners in nation building by giving them more

powers, authority and resources and

corresponding responsibilities and obligations


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What is its advantage to the

community?


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Answer It will allow people toparticipate more in policy and decision

making relative to the delivery of quality

health care in their community


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Who benefits most from the

devolution of health

services?


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Answer With health services becoming

more aligned to local needs, people who

ordinarily would have difficulty getting

such services will now be more easily

reached


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What are the public health

programs and projects that shallbe devolved and made more

accessible to the community?

Answer These include public health programs and


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p p g

projects in:

Primary Health Care

Maternal and Child Health Care

Dental health

Nutrition

Family Planning

Environmental health

Communicable and Non-Communicable disease control


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What is the legal basis fordevolving health services to

LGUs?


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Devolution of health services to LGU is

mandated by Local Government Code

of 1991 or RA 7160


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What assets are to be

transferred by the DOH to the

LGUs?


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Answer The DOH shall transfer assets

such as land and buildings, equipment,record, drugs, medicines, materials and

supplies


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