Primary Health Care (PHC) 

Primary Health Care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford.

Principles of Primary Health Care

A. Equitable distribution: The first key principle in the primary health care strategy is equity or equitable distribution of health services. Health services must be shared equally by all people irrespective of their ability to pay, and all (rich or poor, urban or rural) must have access to health services. At present, health services are mainly concentrated in the major towns and cities, resulting in inequality of care for people in rural areas.

B. Community participation: Primary health care is for the people, of the people, and by the people. PHC must be built on the principle of community involvement or participation in any health program. To have full community participation, community people should participate in the planning, implementation, monitoring, evaluation, and maintenance of health services.

C. Intersectoral coordination: There is an increasing realization that the components of primary health care cannot be provided by the health sector alone. The Declaration of Alma-Ata states that "primary health care involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication, and other sectors."

D. Appropriate technology: Appropriate technology is defined as "technology that is scientifically sound, adaptable to local needs, acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self-reliance with the resources the community and country can afford." The term "appropriate" is emphasized because in some countries, large, luxurious hospitals that are totally inappropriate to the local needs are built, absorbing a major part of the national health budget and effectively blocking any improvement in general health services. This also applies to using costly equipment, procedures, and techniques when cheaper, scientifically valid, and acceptable ones are available.

Elements of Primary Health Care (PHC)

Although the Alma Ata declaration has stated 8 essential elements of PHC, the elements are modified in different countries to fit local circumstances. In Nepal, there are 10 elements of PHC, with mental health and dental health added in recent years according to the country's needs. They are:

1. Education about prevailing health problems

2. Prevention and control of locally endemic diseases

3. Expanded program on immunization against infectious diseases

4. Maternal and child health care, including family planning

5. Environmental sanitation and adequate supply of safe water

6. Promotion of food supply and proper nutrition

7. Treatment of common diseases and injuries

8. Supply of essential drugs

 

● Education about prevailing health problems

a. Focuses on educating communities about prevailing health problems and effective prevention and control methods.

b. Emphasizes practical knowledge, such as safe water usage, proper food hygiene, handwashing, and the use of ORS for diarrhea.

c. Community health nurses are instrumental in organizing and delivering need-based health education programs collaboratively with multi-disciplinary teams.

● Prevention and Control of Locally Endemic Diseases:

○ Targets diseases common to specific geographical areas (e.g., diarrhea, common cold, tuberculosis, malaria in Nepal).

○ Involves educating communities on disease transmission, prevention, control, and treatment.

○ Includes active participation in government-launched disease control programs, data collection, surveillance, and follow-up.

 

● Expanded program on immunization against infectious diseases

○ A cornerstone of disease prevention, aiming to protect against major vaccine-preventable diseases (e.g., measles, diphtheria, poliomyelitis, tuberculosis).

○ Ensures adequate vaccine supply, maintenance of the cold chain, and accessible immunization services to reduce morbidity, disability, and mortality.

 

● Maternal and Child Health (MCH) Care, including Family Planning:

○ Seeks to optimize the health outcomes for mothers, infants, and children throughout the childbearing period.

○ Covers comprehensive care: antenatal, intranatal, perinatal, postnatal care, newborn and infant care.

○ Provides family planning advice and methods to help parents plan the number and spacing of their children, enhancing family well-being.

 

● Environmental sanitation and adequate supply of safe water

○ Crucial for preventing waterborne and infectious diseases.

○ Involves teaching communities water purification methods, preventing contamination of water sources, and encouraging the construction and proper use of household and community latrines.

○ Promotes effective waste disposal, composting facilities, and improved overall environmental sanitation.

 

● Promotion of Food Supply and Proper Nutrition:

○ Aims to combat malnutrition and promote healthy dietary practices, addressing issues like stunting, underweight, and nutritional deficiencies (e.g., Vitamin A, iodine).

○ Involves counseling on balanced diets, appropriate food preparation, storage, and the cultivation of diverse local foods.

○ Includes promoting adequate child spacing, extended breastfeeding, safe weaning practices, and ensuring the supply of essential supplements like iodized salt, Vitamin A, and iron.

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● Treatment of Common Diseases and Injuries:

○ Focuses on providing timely and effective primary care for prevalent illnesses and minor injuries at local health facilities (e.g., health posts).

○ Requires trained health workers and the consistent availability of essential equipment and medicines to reduce the burden of disease.

● Provision of Essential Drugs:

○ Ensures that a standardized list of necessary and essential drugs is readily available to treat common ailments and manage health emergencies at the primary level.

○ Health workers are educated on drug utilization, and facilities are equipped with both routine and emergency medications.

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● Mental Health:

○ Recognizes mental well-being as integral to overall health.

○ Community nurses educate on stress management, mental illness prevention, and appropriate care for mentally disturbed individuals.

● Dental Health:

○ Incorporated to promote complete health, addressing prevalent dental problems.

○ Includes conducting school dental programs, providing health education on oral care, and offering treatment for oral and tooth disorders.


Role of Nurses in Primary Health Care (PHC):

Nurses are fundamental to PHC, extending their roles beyond traditional hospital settings to provide essential health services directly within communities, aiming for "Health for All." Their key roles include:

● Health Educator/Promoter:

○ Educates individuals, families, and communities on prevailing health problems, prevention methods, and healthy lifestyles.

○ Teaches self-care practices (e.g., breast self-examination) and promotes health through various community and home-based programs.

● Health Care Provider / Preventer of Illness:

○ Delivers direct care, including implementing physician's orders during home visits, treating minor ailments, and providing first-aid/emergency nursing.

○ Focuses heavily on illness prevention through immunization clinics, nutrition counseling, and assisting in case finding during epidemics.

○ Applies epidemiological skills to address communicable diseases.

● Advocate:

a. Protects and defends patients' rights in relation to their care.

b. Provides sufficient information to enable informed healthcare decisions and supports patients' choices.

c. Guides individuals to appropriate food, drugs, and necessary referrals.

● Coordinator / Collaborator:

○ Works collaboratively with patients (individuals, families, groups) and other health team members.

○ Engages in assessing, planning, implementing, and evaluating health interventions to ensure integrated and holistic care.

● Consultant / Manager:

○ Serves as a source of information and expertise for authorities in planning and organizing health programs (e.g., immunization).

○ Shares nursing knowledge to help solve problems or meet community health needs.

● Change Agent:

○ Guides individuals and communities in decision-making related to health.

○ Stimulates interest in health promotion and influences health policy.

○ Helps people adopt new, healthier patterns of living through education, skill development, and attitude shifts.

● Researcher:

○ Engages in systematic investigation, data collection, and analysis to solve community health problems.

○ Applies evidence-based findings from literature to enhance and modify nursing practice as needed, ensuring continuous improvement.

● Supervisor / Good Observer:

○ Monitors individuals, families, and the community for any deviations in health, growth, development, or response to treatments.

○ Alertly observes and reports unusual disease occurrences, environmental threats, or community stressors that could impact health.

● Facilitator:

○ Empowers individuals and communities by simplifying access to care and resources.

○ Helps people understand health information and actively participate in their own health journeys.