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Primary Health Care In Pakistan- Approach-Implementation and Constrains

Primary Health Care

¨  It is the 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 a country can afford to maintain at every stage of their development in the spirit of self determination.
¨  It is also called Al Mata declaration. Because the declaration  came at Al Mata, a city of Qazakistan,  in 1978  following an international conference.

Concepts Of PHC

          PHC is for all, especially for the needy, so regardless of economic status every individuals should have access to good health care
          Service should be acceptable to the community and there must be active enrollment of the community.
          The health service must be effective, promotive, preventive and  curative.
          The service should form an integral part of the country health system
          The program must be efficient and multisectoral

Elements / Components OF PHC

¨  Health Education, concerning the prevailing health problems and the method of identifying, preventing and controlling them
¨  Immunization against major infectious diseases
¨  MCH care And Family Planning
¨  Prevention and control of locally endemic diseases
¨  Promotion of food supply and proper Nutrition
¨  Appropriate treatment of common diseases
¨  Sanitation and Safe Water Supply
¨  Provision of Essential drugs

Principles Of PHC

¨  Equitable distribution
¨  Appropriate technology
¨  Multi sectoral approach
¨  Community participation

Planning of PHC

¨  It includes the following stages
  1. Preparatory phase
  2. Planning phase
  3. Implementation phase
  4. Monitoring and evaluation phase
Preparatory stage. This includes Community assessment , which in turn is carried out to explore,
  • Social, cultural and political factors
  • Health services assessment
  • Demographic profile of community
  • Identification of felt needs of community
Assessment of Community involves
Ø  Survey of Health and demographic features
Ø  Assessing the existing health services
Ø  Identification of social ,cultural and political parameters

Identification of a Problem

¨  After assessment the problem is identified, and the following information is available.
  1. The Population of concern
  2. Characteristics of the population
  3. Age and sex distribution
  4. Occupation and type of living
  5. Felt needs of the community
  6. Prevailing health problem
  7. Morbidity pattern and mortality

Setting Goals

¨  Then Goals are set for the future line of action to improve the health status by
  1. Reduction of maternal deaths
  2. Reduction of infant mortality
  3. Reducing morbidity due to diarrhea

Prioritization:

¨  The problem is prioritized on the basis of scoring e.g.
Health problem
Preva-lence
Serious-ness
Suscepti-bility to control
Comm-unity concern
score
Malnutrition
++
+++
+++
++
10
Neonatal Tetanus
++
++++
++++
++++
14
Cancers
+
++++
0
++
7
Diarrhea
+++
+++
+++
+++
12
Common Illness
+++
++
+++
+++
11

Primary Health Care In Pakistan

¨  There is an integrated rural health complex working under PHC.
¨  This means The link of BHU, RHC, Tehsil Hospital and district headquarter Hospital
¨  The basic unit of PHC is BHU, which cover 5000-10,000 population, with a service of immunization. MCH services, child care, diarrheal disease control, malaria control, child spacing, and out reach facilities.
¨  5-10 BHU,s are linked to one RHC
¨  The RHC is then linked to tehsil and to DHQ. 

Selective Approach

The idea put forward by Walsh and warren
1. It is applied on children under three years of age and women of childbearing age.
2. It is applied to certain disease depending upon.
--- their prevalence
--- their morbidity
---  their mortality rate
--- the feasibility and effectiveness of the control measures.
--- the cost of interventions
¨  It have five components
   1. Measles and DPT Vaccination for children over 9 months old.
   2. TT Vaccination for pregnant ladies to prevent tetanus.
   3. Encouragement of long term breast feeding
   4. Chloroquine treatment  during febrile episodes for children under three years in malaria regions
   5. provision of ORS in diarrhea

Selective approach by UNICEF

The UNICEF proposes a selective approach with emphasis on mothers and child health,
        which is GOBI FF
      - Growth monitoring
      - ORS
      - breast feeding
      - Immunization
      - Family planning
      - Female Education

Implementing PHC at various level

¨  At Village or Union council level.  
   Where a BHU is built to run all those activities relating to PHC  .All the facilities like outreach, home visits, vaccination and treatment of the disease are carried out.
    ---  Village Health committees are mobilized to strengthens the community involvement.
The other link of the structure is RHC where the cases are referred for further management 
At Tehsil Level and Distt Level
--- the serious patients are referred to THQH and DHQH  at tehsil and Distt level

Programs working to promote PHC

¨  The Vaccination process at Village ,UC , tehsil and Distt level
¨  The Lady health worker Program, having a strong network at lower level.
¨  The Community midwifery program under the control of Maternal, newborn and child health (MNCH) Project

Constrains in PHC

  1. The political climate.
  Most of our budget goes to defense. While health receive negligible amount. So health became at lower priority. The goal;;health for all;; that’s why fail to achieve till the targeted time upto year 2000.
 2. Disregard of Human rights.
    There is ethnic violence, social evils and terrorism, a great disregard to humanity. so most of the amount spent on law and order
3. Commitment of the leaders. It is more to spent money on sophisticated and modern technology in fields other than health
4. Lack of appreciation of multisectoral approach.--- health department cant only control the matters. Other issues like scanty rain falls, pollution, deforestation, soil erosion, poverty and illiteracy all are health related matters so needs concentration

Advantages of multisectoral approach

¨  Charles Boelen, a scientist said that The today doctor should be a five star doctor, who at the same time should be,
¨  Manager
¨  Communicator
¨  Care provider
¨  Decision maker
¨  leader



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