Definition of Primary Health Care

Official Definition (Alma-Ata, 1978)

"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."

Background

• The concept of Primary Health Care came into the limelight in 1978 following the International Conference at Alma-Ata, USSR, jointly organized by WHO and UNICEF.
• Governments of 134 countries and many voluntary agencies participated.
• The conference declared that the gross inequality in health status between developed and developing countries was "politically, socially and economically unacceptable".
• PHC was proclaimed as the way to achieving "Health for All by 2000 A.D."

Core Principles of PHC

1. Social equity - equitable distribution of health services
2. Nation-wide coverage - available to all people
3. Self-reliance - community sustainability
4. Intersectoral coordination - collaboration across sectors
5. People's involvement - full participation in planning and implementation

Eight Essential Elements of PHC (Alma-Ata Declaration)

1. Education about prevailing health problems and methods of preventing and controlling them
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against infectious diseases
6. Prevention and control of endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

Key Characteristics

• PHC is a new approach that integrates at the community level all the factors required for improving health status.
• It is available to all people at the first level of health care.
• It integrates promotive, preventive, and curative services.
• It is an integral part of the country's plan for socio-economic development.
• It involves "deprofessionalization" of medicine - community health workers, anganwadi workers, multipurpose workers play prominent roles.

Functions of Primary Health Care (Primary Health Centre)

10 Functions of the PHC

Details of Each Function (as per IPHS 2012 Standards)

1. Medical Care

• OPD services: 4 hours morning + 2 hours afternoon/evening (minimum 40 patients per doctor per day)
• 24-hour emergency services: injuries, accidents, first-aid, dog bite/snake bite/scorpion bite, other emergencies
• In-patient services: 6 beds
• Referral services

2. Maternal and Child Health Care

• Early registration + minimum 4 antenatal check-ups
• Minimum lab investigations (Hb, blood grouping, Rh typing, urine albumin/sugar, RPR for syphilis)
• Nutrition and health counselling
• Iron/folic acid supplementation + tetanus toxoid immunization
• Identification of high-risk pregnancies and referral

• 24-hour services for normal delivery
• Promotion of institutional delivery
• Assisted deliveries (forceps/vacuum)
• Management of PPH, eclampsia, sepsis with prompt referral
• Labour management using Partograph
• Minimum 48 hours stay after delivery

• Post-natal care on day 0 and day 3 at facility; 7th and 42nd day home visits
• Additional visits for low birth weight babies (day 14, 21, 28)
• Early breastfeeding initiation within 1 hour of birth

• Essential Newborn Care (ENBC) and resuscitation facilities
• Kangaroo Mother Care (KMC) for hypothermia
• Cord care and identification of sick newborns

• IMNCI (Integrated Management of Neonatal and Childhood Illness)
• Full immunization against vaccine-preventable diseases
• Vitamin A prophylaxis
• Growth and development monitoring
• Management of severe acute malnutrition

3. Family Planning

• Full range of family planning services including counselling
• Appropriate referral for infertility
• Medical Termination of Pregnancy (MTP) using manual vacuum aspiration (where trained personnel available)

4. Safe Water Supply & Sanitation

• Health education for prevention and management of RTI/STI
• Nutrition services

5-10. (Other Functions)

• Collection and reporting of vital statistics
• Health education
• Implementation of National Health Programmes
• Training of health workers, dais, health guides, health assistants
• Basic laboratory services

Types of PHC (Based on Delivery Load - IPHS 2012)

Objectives of IPHS for PHCs

1. To provide comprehensive primary health care to the community
2. To achieve and maintain an acceptable standard of quality of care
3. To make services more responsive and sensitive to the needs of the community

8 Essential Elements of Primary Health Care (Alma-Ata Declaration)

Mnemonic: "E-PW-MIP-E"

Education - Promotion of nutrition - Water & sanitation - MCH/FP - Immunization - Prevention of endemic diseases - Appropriate treatment - Essential drugs

The 8 Elements in Detail

1. Education Concerning Prevailing Health Problems

• Education about what health problems exist in the community and the methods of preventing and controlling them
• This is the foundational element - an informed community is better equipped to protect its own health
• Includes health education at individual, family, and community levels
• Covers topics such as hygiene, sanitation, disease transmission, and self-care
• Delivered through community health workers, ANMs, health guides, and ASHA workers

2. Promotion of Food Supply and Proper Nutrition

• Ensuring adequate food supply to the community and promoting balanced nutrition
• Addresses malnutrition, which is a major public health problem in developing countries
• Includes:
  • Supplementary nutrition programmes
  • Nutritional counselling for mothers and children
  • Management of severe acute malnutrition (SAM)
  • Promotion of breastfeeding
  • Vitamin A and iron/folic acid supplementation
• Closely linked with agriculture, food production, and intersectoral coordination

3. Adequate Supply of Safe Water and Basic Sanitation

• Access to clean drinking water and basic sanitation is a prerequisite for good health
• Waterborne diseases (cholera, typhoid, diarrhoea) are major killers in developing countries
• Includes:
  • Construction and maintenance of safe water sources (hand pumps, standpipes)
  • Sanitary latrines and sewage disposal
  • Solid waste management
  • Promotion of personal and domestic hygiene
• Note: K. Park emphasizes that standpipes are socially acceptable and financially more feasible than house-to-house water connections (an example of appropriate technology)

4. Maternal and Child Health Care, Including Family Planning

• MCH services form the core of PHC, as mothers and children are the most vulnerable groups
• Includes:
  • Antenatal care: minimum 4 check-ups, iron/folic acid, tetanus toxoid, high-risk identification
  • Intranatal care: institutional delivery, emergency obstetric care
  • Postnatal care: mother and newborn care up to 42 days
  • Child health: immunization, growth monitoring, IMNCI, management of malnutrition
  • Family planning: spacing of births, counselling, contraceptive services
• Reduces maternal mortality, infant mortality, and under-5 mortality

5. Immunization Against Major Infectious Diseases

• Immunization is one of the most cost-effective public health interventions
• Protects individuals and creates herd immunity at community level
• Under PHC, immunization is provided against:
  • Tuberculosis (BCG)
  • Diphtheria, Pertussis, Tetanus (DPT)
  • Poliomyelitis (OPV/IPV)
  • Measles, Mumps, Rubella (MMR)
  • Hepatitis B
  • Others as per Universal Immunization Programme (UIP) of India
• Includes tracking of missed and left-out children

6. Prevention and Control of Locally Endemic Diseases

• Endemic diseases are those that are constantly present in a community/region
• PHC must address diseases prevalent in the local area, not just nationally common ones
• Examples of endemic diseases targeted:
  • Malaria, Kala-azar (Leishmaniasis), Filariasis
  • Fluorosis, Goitre (iodine deficiency)
  • Japanese encephalitis in endemic zones
• Measures include: vector control, prophylaxis, early case detection and treatment, environmental sanitation

7. Appropriate Treatment of Common Diseases and Injuries

• PHC must provide basic curative care for common illnesses and injuries at the community level
• "Appropriate" means treatment that is:
  • Scientifically sound
  • Adapted to local needs and resources
  • Accessible and affordable
• Includes:
  • OPD management of fever, diarrhoea, ARI, wounds, minor injuries
  • First aid and stabilization before referral
  • 24-hour emergency services at PHC level
  • Referral to higher centres when needed
• Reduces unnecessary deaths from treatable conditions

8. Provision of Essential Drugs

• Essential drugs are those that satisfy the priority health care needs of the population
• They must be available at all times in adequate quantities, in appropriate dosage forms, at prices affordable to individuals and the community
• The WHO Essential Medicines List guides selection
• At PHC level, this includes drugs for:
  • Malaria, TB, diarrhoea, ARI
  • ORS, antibiotics, analgesics, antihelminthics
  • Vaccines, vitamins, iron/folic acid
• Ensures that treatment decisions are not limited by drug unavailability

Summary Table

4 Principles Underlying PHC (K. Park)

1. Equitable distribution - health services for all, regardless of ability to pay
2. Community participation - involvement of people in planning and delivery of care (e.g., ASHA, Anganwadi workers)
3. Intersectoral coordination - collaboration with agriculture, education, housing, public works, communication sectors
4. Appropriate technology - "scientifically sound, adaptable to local needs, and maintainable by the people themselves at a cost the community can afford"