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Dr.Mohammed Jasim
PHC
Levels of Care
• Primary health care
• Secondary health care
• Tertiary health care
1. Primary health care:
This is the essential health care provided at the first level of contact of the
individual or the family with the National Health System. It is provided at the level
of the primary Health Care of the Community health center and sub center by the
medical officer and the health worker (Male and Female) respectively.
2. Secondary health care:
This refers to an intermediate level of health care where specialist facilities are
available to deal with the complex health problems referred from the primary
level. The community health centers and the district hospitals represent the
secondary health care level.
3. Tertiary level:
This is the highest level where super specialties are available and sophisticated
investigations and therapeutic procedures can be performed. Tertiary health care
is available at medical college hospitals specially .
Definition:
• The Alma Ata Conference(1978) defines Primary Health Care 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 by means of
acceptable to them, through their full participation and at a cost that 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 both the country’s health
system, of which it is the central function and the main focus and of the overall social and
economic development of the community. A vital feature of primary health care is that it
is based upon participation of the people themselves.
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The Declaration of Alma-Ata was adopted at the International Conference on Primary
Health Care (PHC), Almaty (formerly AlmaAta), Kazakhstan (formerly Kazakh Soviet
Socialist Republic),
• 6-12 September
• 1978.
CHARACTERISTICS OF PRIMARY HEALTH CARE
1. It is essential health care which is based on practical, scientifically sound and
socially acceptable methods and technology.
2. It should be rendered universally, acceptable to individuals and the families in
the community through their full participation.
3. Its availability should be at a cost which the community and country can afford
to maintain at every stage of their development in a spirit of self-reliance and self-
development.
4. In requires joint efforts of the health sector and other health-related factors,
viz., education, food and agriculture, social welfare, animal husbandry, housing,
rural reconstruction, etc.
)
8 Essential Health Services in Primary Health Care (ELEMENTS
1. E – Education for Health
2. L – Locally endemic disease control
3. E – Expanded program for immunization
4. M – Maternal and Child Health including responsible parenthood
5. E – Essential drugs
6. N – Nutrition
7. T – Treatment of communicable and non-communicable diseases
8. S - Safe water and sanitation
There is a set of CORE
Core Activities for PHC or COMPONENTS OF PRIMARY HEALTH CARE
ACTIVITIES, which were normally defined nationally or locally. According to the 1978
include:
Ata proposed that these activities should
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Declaration of Alma
1. Education concerning prevailing health problems and the methods of preventing and
controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against the major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Basic laboratory services and provision of essential drugs
9. Training of health guides, health workers and health assistants.
10. Referral services
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The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
• Appropriateness • Availability • Adequacy • Accessibility • Affordability •
Assessability • Accountability • Completeness • Comprehensiveness • Continuity
Appropriateness
• Whether the service is needed at all in relation to essential human needs,
priorities and policies.
• The service has to be properly selected and carried out by trained personnel in
the proper way.
Adequacy(enough)
• The service proportionate to requirement.
• Sufficient volume of care to meet the need and demand of a community
Affordability
ould be within the means and resources of the individual and the
• The cost sh
country.
Accessibility
• Reachable, convenient services
• Geographic, economic, cultural accessibility
Acceptability
• Acceptability of care depends on a variety of factors, including satisfactory
communication between health care providers and the patients, whether the
patients trust this care, and whether the patients believe in the confidentiality and
privacy of information shared with the providers.
Availability
• Availability of medical care means that care can be obtained whenever people
need it.
Assessability
• Assessebility means that medical care can be readily evaluated.
Accountability
• Accountability implies the feasibility (practicality)of regular review of financial
records by certified public accountants.
Completeness
• Completeness of care requires adequate attention to all aspects of a medical
problem, including prevention, early detection, diagnosis, treatment, follow up
measures, and rehabilitation.
ness
Comprehensive
• Comprehensiveness (completeness) of care means that care is provided for all
types of health problems.
Continuity
• Continuity of care requires that the management of a patient’s care over time be
coordinated among providers
.
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To Summarize
Primary care is an approach that:
• Focuses on the person not the disease, considers all determinants of
health
• Integrates care when there is more than one problem
• Uses resources to narrow differences
• Forms the basis for other levels of health systems
• Addresses most important problems in the community by providing
preventive, curative, and rehabilitative services
• Organizes deployment of resources aiming at promoting and
maintaining health.