Public health care

CONCEPT OF PHC

Introduction

All people, everywhere, have the right to achieve the highest attainable level of health. This is the fundamental premise of primary health care (PHC). Primary health care is a whole-of-society approach to organize and strengthen national health systems to bring services for health and wellbeing closer to communities .

Primary health care is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. It has 3 components:

integrated health services to meet people’s health needs throughout their lives

addressing the broader determinants of health through multisectoral policy and action

empowering individuals, families and communities to take charge of their own health.

Primary health care enables health systems to support a person’s health needs – from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. This strategy also ensures that health care is delivered in a way that is centred on people’s needs and respects their preferences.

Primary health care is widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health coverage. It is also key to strengthening the resilience of health systems to prepare for, respond to and recover from shocks and crises.

Primary healthcare providers

Primary healthcare is a term used to describe a range of healthcare providers who work in the community. Any healthcare professional who is the first point of contact for the health system can be a primary healthcare provider.

Most people visit their GP (sometimes referred to as the 'local doctor') as a first step when they have a health problem that is not an emergency. The primary healthcare system also includes allied health professionals, such as dentists and physiotherapists.

Primary healthcare services

Services delivered by primary healthcare providers include:

diagnosis, treatment and care of people with health problems

promoting good health

preventing health problems

early intervention

managing ongoing and long-term conditions.

HISTORY OF PHC

The concept of Primary Health Care (PHC) was first introduced in the Declaration of Alma-Ata in 1978, which was a significant milestone in global health . The declaration emphasized the importance of providing accessible and affordable health care to all people, regardless of their socio-economic status. It also highlighted the need for a whole-of-society approach to strengthen national health systems and bring health services closer to communities .

PHC is a strategy that enables health systems to support a person’s health needs throughout their life, from health promotion to disease prevention, treatment, rehabilitation, palliative care, and more . It has three components: integrated health services to meet people’s health needs throughout their lives, addressing the broader determinants of health through multisectoral policy and action, and empowering individuals, families, and communities to take charge of their own health . PHC is widely regarded as the most inclusive, equitable, and cost-effective way to achieve universal health coverage .

In Nigeria, the first attempt at implementing PHC was between 1975 and 1980, which saw the introduction of the Basic Health Services Scheme (BHSS) . The second attempt was led by late Professor Olukoye Ransome-Kuti between 1986 and 1992, which witnessed the development of model primary health care in fifty-two (52) Local Government Areas .

DEFINITON

Definition according to Alma Ata Declaration: Primary health care was 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 country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”It forms an integral part of the country’s health care system and is the central function and main focus and of the over all social and economic development of the community.

The concept of PHC has been repeatedly reinterpreted and redefined in the years since 1978, leading to confusion about the term and its practice. A clear and simple definition has been developed to facilitate the coordination of future PHC efforts at the global, national, and local levels and to guide their implementation:

"PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment," WHO and UNICEF.

PHC entails three inter-related and synergistic components, including:

i. comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces;

ii. multi-sectoral policies and actions to address the upstream and wider determinants of health;

iii. and engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health.

PHC is rooted in a commitment to social justice, equity, solidarity and participation. It is based on the recognition that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction.

For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.

PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in-all-policies, a strong focus on equity and interventions that encompass the entire life-course.

PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.

It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases.

Primary health care ensures people receive quality comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care – as close as feasible to people’s everyday environment.

The importance of PHC

Member States have committed to primary health care renewal and implementation as the cornerstone of a sustainable health system for UHC, health related Sustainable Development Goals (SDGs) and health security. PHC provides the 'programmatic engine' for UHC, the health-related SDGs and health security.

PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being. Evidence of wide-ranging impact of investment in PHC continues to grow around the world, particularly in times of crisis such as the COVID-19 pandemic.

Across the world, investments in PHC improve equity and access, health care performance, accountability of health systems, and health outcomes.

While some of these factors are directly related to the health system and access to health services, the evidence is clear that a broad range of factors beyond health services play a critical role in shaping health and well-being.

These include social protection, food systems, education, and environmental factors, among others.

PHC is also critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services. 

Although the evidence is still evolving there is widespread recognition that PHC is the “front door” of the health system and provides the foundation for the strengthening of the essential public health functions to confront public health crises such as COVID-19.

ALMA ATA DECLARATION

The international conference on primary health care, met in Alma Ata on 12th Sept 1978 and made the following declaration:

Health is a fundamental human right and that the attainment of the highest possible level of health is a most important world wide social goal.

The existing gross inequality in the health status of the people particularly between developed and developing countries is politically, socially and economically unacceptable.

Economic and social development, based on a new international economic order is of basic importance to the fullest attainment of health for all.

The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

Government have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social; measures.

All government should formulate national policies, strategies and plans of action to launch and sustain primary health care.

All countries should cooperate in a spirit of partnership and service to ensure PHC for all people.

An acceptable level of health for all the people of the world by the year 2000 can be attained through a further and better use of the world’s resources.

BASIC PRINCIPLES OF PRIMARY HEALTH CARE

These include:

Community participation

Intersectoral collaboration

Integration of health care programmes

Equity

Self-reliance.

COMMUNITY PARTICIPATION

Is the whole mark of primary health care, without which it will not succeed. Community participation is a process by which individuals and family assume responsibility for their own health and those of the community and develop the capacity to contribute to their/and the community development. Participation can be in the area of identification of needs or during implementation.

The community needs to participate at village, ward, district or local government level. Participation is easier at the ward or village level because the issue of heterogeneity is eliminated.

 ADVANTAGES OF COMMUNITY PARTICIPATION

-It addresses the felt health needs of the people

-It ensures social responsibility among the community

-It ensures sustainability

-It ensures cost sharing

-It ensures enhancement of knowledge

-It encourages intersectoral collaboration

INTER SECTORAL Collaboration

This is the coordination of health activities with other sectors; such sectors include Education, Finance, Agriculture, Information etc. There should be a working relationship these bodies and the health ministry.

ADVANTAGES

-Overall human development

-It ensures economic development

-It ensures affordability

Integration OF HEALTH SERVICES

This is defined as coordination of various primary health care components into a whole programme and made available at all times including referrals.

ADVANTAGES

-It ensures efficient use of all resources and removes areas of wastage.

-It ensures sustainability of programme

-It ensures bye pass phenomenon

-It reduces opportunity cost

-It grantees clients confidentiality

EQUITY

The health care resources available in a given community should not be in the handle of a few. And resources should be accessible and affordable to all. Addressing the issue of equity in Nigeria. It is divided in 3 components:

Decentralization of health of services into federal state-local government-ward levels.

The essential drug services and the national drug formulae. making drugs available at all levels and at low cost.

National health insurance scheme-where people contribute to the health services of those who don’t have or cannot afford.

 Self Reliance

This involves the use of technological methods and scientifically sound and maintain by the community .It can be in terms of human resources, money or materials. Human resources in Nigeria-medical officer of health, community health officer, nurses midwives, community health extension work, community health Aid etc

Money-Is to ensure that there is financial backing.

Material- can be in form of physical facilities, drugs or other biological.

ADVANTAGES OF SELF RELIANCE

-Affordability

-Sustainability

-Acceptability

-Authenticity

PRINCIPLES OF PUBLIC HEALTH NURSING

Public health nursing is a specialty area of nursing that focuses on promoting and protecting the health of populations through the delivery of quality health services . The principles of public health nursing are based on the core functions of public health, which include assessment, policy development, and assurance . Here are some of the key principles of public health nursing:

Population focus: Public health nurses work with communities to identify health needs and develop strategies to improve health outcomes .

Prevention: Public health nurses emphasize prevention and early intervention to reduce the incidence and prevalence of disease .

Community engagement: Public health nurses work collaboratively with community members to promote health and prevent disease .

Equity: Public health nurses strive to reduce health disparities and ensure that all individuals have access to quality health care .

Interdisciplinary approach: Public health nurses work with other health professionals and community partners to address complex health issues .

Components/Elements of Primary Health Care

1. Health education The journey to achieving healthcare provision for everyone begins with the creation of awareness amongst the public. Through education, the public is made aware of the existing diseases and health challenges, ways to prevent them, and steps to take in case one falls ill. Once the population is well educated on matters of health, they can participate better in the prevention and control of diseases.

2.Availability, accessibility, and affordability of health services If a population is well educated on health matters but does not have the requisite health facilities, then the journey to universal health care becomes impossible. Societies must have available, accessible, and affordable healthcare facilities. The first element touches on existence, and the last two on possible access even by the poor people in the community.

3. Proper food and nutrition

One of the pillars on which primary healthcare is based is proper food and nutrition. By ensuring that communities have access to nutritious food, authorities can do away with a wide range of diseases that often plague societies. Diseases such as marasmus and kwashiorkor are easily preventable through proper nutrition.

4. Maternal and child healthcare /family planning

This component of primary healthcare is aimed at reducing the menace of maternal and child mortality, which is quite prevalent in some developing countries. Services such as antenatal care, postnatal care, and safe delivery are all meant to deal with the problem.

5. Water and sanitation

Gastrointestinal diseases such as cholera, typhoid and diarrhoea are extremely common in communities with poor access to usable and drinkable water. The concept of primary health care aims to equip communities with the necessary knowledge, tools, and funds to access clean water.

6. Immunization

Effective immunization programs are crucial for the achievement of primary health care. Immunization is the primary means through which the spread of most infectious diseases is minimized. Some infections such as polio, yellow fever, and diphtheria have pretty much been controlled through immunization.

7. Provision of essential drugs

Primary healthcare cannot be provided if the necessary medicines are unavailable in health centres. These medicines are essential for the treatment of common ailments and diseases. Healthcare workers can only do their jobs effectively if the facilities they work in are equipped with these essential medicines.

8. Treatment of communicable diseases

Communicable diseases are those that can be easily transmitted from one person to another. If not dealt with, these diseases can lead to increased mortality and morbidity rates. Primary health care aims to find solutions to these diseases. Most times through prevention and cure.

9. Promotion of mental health and rehabilitation

the World Health Organization defines health as the complete physical, mental, social, and emotional well-being of an individual. This then makes mental health an important aspect of PHC. Today, there are numerous campaigns and awareness programs designed to improve communities’ awareness of mental health and enhance the uptake of rehabilitation services.

10. Prevention and control of locally endemic diseases

Endemics are diseases prevalent in specific localities or regions. Common endemic include dengue fever, Lassa fever, and Ebola. The effective prevention and control of pandemics are key in the implementation of primary health care.These diseases include malaria, schistosomiasis, TB, onchocerciasis, guinea worm, leprosy, meningitis etc. in Nigeria.

11. Prevention and control of non-communicable diseases

While non-communicable diseases are not easily transmittable among humans, they still pose a huge challenge to PHC. These diseases can easily result in increased mortality rates if not dealt with. This makes it important to find ways to prevent and control these ailments. The most common ones include cardiovascular diseases, diabetes, and arthritis.

 Problems Of Implementation Of Primary Health Care Programme At Lga Level In Nigeria.

To achieve primary health care in Nigeria, Nigeria was divided into wards of 10.000 people. This ward is the same as political ward that makes up district and then local government. However problems experienced during implementation of primary health care in Nigeria include the following:

1. Shortage of funds

2 Lack of materials and equipment

3. Shortage of appropriate stuff

4. Lack of commitment which can be at the individual or government level.

5. Lack of incentive

6. Lack of information

7. Inadequate community participation

8. Inadequate intersectoral collaboration

9 .Rapid turnover of policy makers

10. Lack of manpower training and development

11. Inadequate utilization of services

12. In appropriate staff recruitment

13. Ill defined responsibilities that is poor job description

14.

Conclusion.

Public health care was founded to help out individual around the world in all aspects of life and ensure good health and growth .