Dr Abdelrahim Mutwakel

CONCEPT OF HEALTH,HEALTH FOR ALL AND

PRIMARY HEALTH CARE

Concept, principles and dimensions of

health Causatives factors and effects on human

life Concepts of ‘health for all’ and ‘primary

health care’ Role of different stakeholders. Challenges for PHC

LEARNING OBJECTIVES

HEALTH“a state of complete

physical, mental and social well-being

and not merely absence of the disease or infirmity”

WHO, 1947

SIGNIFICANCE OF HEALTH

Fundamental human right.

Central to quality of life and human development

Essence of a productive life

An intersectoral issue and an integral part of socioeconomic system

Involves individuals, community, state and international responsibilities

A major social investment

Worldwide a social goal

PHYSICALFunctioning of body

organsAbility to do daily

tasks

MENTALBalance with surroundings

Self- esteemKnow problems and goals

Self controlFaces problems.

SOCIALHarmony with society

Involvement with community

Social skills

DIMENSIONS OF HEALTH

INTERNAL

DETERMINANTS OF HEALTHEXTERNA

LBiological and cognitive

Genetics, race, sex, ageDiabetes, breast cancer are genetic

in natureDiarrhoea more common in children

Psychological and spiritualLife stress causes mental

disorders, hypertension, heart attack, diabetes, gastric ulcer

EnvironmentalSocioeconomic

conditionsWelfare servicesFood and nutritionEducationOccupationCulture

DISEASE AFFECTS

INCOME JOBPHYSICAL ACTIVITY

ANXIETY

LIFE STYLESOCIAL

CONTACTS

SADNESS

Attainment by all people of the world of a level of health that can permit them to lead a socially and

economically productive life .

“30th World health assembly, Alma Ata, 1977”

HEALTH FOR ALL

PRIMARY HEALTH CARE “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 the country can afford to maintain at every stage of their development in the spirit of

self-determination ” .“WHO, 1978”

PRINCIPLES OF PRIMARY HEALTH CARE

Equity Acceptable Accessible Affordable Community participation Appropriate technology Intersectoral coordination

COMPONENTS OF PRIMARY HEALTH CARE

1. Health education2. Food supply and nutrition3. Safe drinking water and sanitation4. Maternal and child health, family planning5. Expanded Programme on Immunization

(EPI)6. Prevention and control of endemic diseases7. Appropriate treatment of common

diseases, injuries and accidents8. Provision of essential drugs

COMMUNITY HEALTH CARE SYSTEM

Health facility accessible to all Clear responsibility – individuals, family and

community Linkage – community and community health workers Community involvement in

Realizing needs/prioritiesImplementation and management

Active women groups, nongovernmental organizations Community organizations Intersectoral coordination

Individual

RIGHTS AND RESPONSIBILITIES

Personal hygiene Healthy lifestyles Vaccination and preventing diseases Medical examination/treatment Healthy environment Safe water, sanitation Family planning and population

management

Community

RIGHTS AND RESPONSIBILITIES

Utilizing health facilities Supporting and strengthening health centres Activist for health promotion and protection Community health workers training Improving sanitation and environment Food safety, adequate water Promoting family planning, breastfeeding,

healthy life styles Restricting causative factors of ill health like

poverty

RIGHTS AND RESPONSIBILITIES

Policies and plans Resources Accessibility Awareness-building Human resources development Monitoring/support Outbreak control Exchanging of experiences

Government

RIGHTS AND RESPONSIBILITIES

International Human resources development Capacity building Technical cooperation among developing countries South-to-south cooperation Information sharing Technical support Building partnerships Financial support

Introduction and Overview

• Responding to the challenges of a changing world

• Growing expectations for better performance • From the packages of the past to the reforms

of the future• Four sets of PHC reforms• Seizing opportunities

The PHC reforms necessary to refocushealth systems towards health for all

The challenges of a changing world

• Unequal growth, unequal outcomes – Longer lives and better health, but not everywhere – Growth and stagnation

• Adapting to new health challenges – A globalized, urbanized and ageing world – Little anticipation and slow reactions

• Trends that undermine the health systems’ response – Hospital-centrism: health systems built around hospitals and specialists – Fragmentation: health systems built around priority programmes – Health systems left to drift towards unregulated commercialization

• Changing values and rising expectations – Health equity – Care that puts people first – Securing the health of communities – Reliable, responsive health authorities – Participation

• PHC reforms: driven by demand

The shift towards noncommunicable diseases and accidents as causes of death*

Five common shortcomings ofhealth-care delivery

• Inverse care. People with the 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 and fragmenting care. The excessive specialization of health-care providers and the narrow focus of many disease control programmes 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.

Primary care: putting people first

• Good care is about people • The distinctive features of primary care

– Effectiveness and safety are not just technical matters – Understanding people: person-centred care – Comprehensive and integrated responses – Continuity of care – A regular and trusted provider as entry point

• Organizing primary-care networks – Bringing care closer to the people – Responsibility for a well-identified population – The primary-care team as a hub of coordination

• Monitoring progress

How experience has shifted the focus of the PHC movement