howMed Know Yourself
Primary health care 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 country and community can afford.
Global Targets
• All people in every country will have ready access at least to essential health care and to first level referral facilities
• All people will be actively involved in caring for themselves and their families, as far as they can, in community action for health
• Communities will share responsibility for their health
• Safe drinking water and sanitation will be available to all people.
• All people will be adequately nourished
• All children will be immunized against major diseases
• All possible ways will be applied to prevent and control non-communicable diseases and promote mental health through influencing life styles, and controlling the physical and psychological environment
Obstacles to implement PHC Strategy
• Misinterpretation of the PHC Concept
• Misconception that PHC is 2nd rate health care for the poor
• Resistance to Change
• Lack of political will
• Centralized planning and Management infrastructure
Causes of Failure
1. Managerial Deficiencies
2. Service Delivery Failure
3. Community Causes
Managerial Deficiencies
• Lack of trained managers
• Lack of selection and training criteria for managers
• Lack of proper performance evaluation of health managers
• Lack of motivation leading to professional and financial corruption
Service Delivery Failure
a) Accessibility problems
b) Utilization Failure
c) Efficiency problems
Accessibility Issues
25 – 30 % of PHC facilities have been ill-planned and care usually out of reach of the rural community where logistics problems is as big issue as is poverty.
Such facilities are a big problem for non-resident PHC staff, which further augments the problem, and promotes quackery in such areas.
Utilization Failure
Since its inception, PHC has been promoted as an alternative for curative care. This image has been promoted by professional as well as political forces.
The result is that the concept of PHC has been buried and PHC has been synonymously taken as 2nd degree medical care for the poor.
PHC has been down looked upon resulting in the vacuum being filled by virtually non-committed untrained staff, which has offered a parallel system of tertiary care in PHC facilities at minimal or no cost. Lack of training and proper monitoring / check and balance on the PHC staff has also contributed to the downfall. Other issues include:
• Not being a government priority
• Lack of quality of care yardsticks for Primary Health Care
• No active research in this field
• Government one step forward, two steps backward approach to PHC, resulting in lack of consistency in various PHC program.
Efficiency Problems
• Lack of standardized management protocols for common PHC problems
• Off and on and un-rational drug policy of the Health Department
• Lack of clear cut policy, regulatory and organizational mechanisms resulting in haphazard experimentation.
Community Causes
• Community participation has been virtually non-existent in PHC
• Gap in Community and Public sector has widened the bridge.
• Health education has been given a backseat in PHC.
• Low literacy levels and economic deprivation has forced people to shift entire responsibility of their health on state shoulders.
Five Common Shortcomings of Health – Care Delivery
Inverse Care
People with most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least.
Public spending on health services most often benefits the rich more than the poor in high and low income countries alike.
Impoverishing Care
Wherever people lack social protection and payment for care is largely out of pocket at the point of service, they can be confronted with catastrophic expenses.
Over 100 million people annually fall into poverty because they have to pay for health care.
Fragmented Care
The excessive specialization of health care providers and the narrow focus of many disease control program discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care.
Health services for poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation.
Unsafe Care
Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital – acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill – health.
Misdirected Care
Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden.
At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.
Ways to Move Ahead
• Health has to be linked with education and poverty alleviation
• PHC has to be redefined in Government books
• Managerial competencies needs to be developed through intensive training and very strict monitoring.
• Ongoing PHC training for all PHC staff with proper monitoring and evaluation and made must for all promotions in PHC.
• Financial investment in PHC needs to be increased with help of donors.
• Health should further be de-centralized with involvement of community and mechanism be made for partly community funding of PHC.
• Precise, clear cut and unambiguous, policy, regulatory and organizational paradigms should be constructed for PHC.
• Health department should be prepared for change management with clear and unconditional backing of NGO’s, political forces, and Government.
