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Nov. 12, 2015
PRIMARY HEALTH CARE
Merry Mia-Clamor, M.D.

A. Alma Ata Declaration

TOPIC OUTLINE
I. History  1978: International Conference on Primary Health Care (Alma Ata,
II. Rationale for Primary Health Care USSR)
a. Alma Ata Declaration  Strongly reaffirmed the following points:
b. Health for All by Year 2000 o Health is a fundamental human right. Everybody has a right to
III. Primary Health Care be healthy.
a. Classic Definition (Alma Ata Declaration, 1978) o The attainment of the highest possible level of health is a most
important worldwide social goal whose realization requires
IV. Principles of Primary Health Care
the action of many other social and economic sectors other
V. Aims of Primary Health Care than health.
VI. Strategies of Primary Health Care
 All of the 134 nations represented subscribed to the goal of “Health
VII. Levels of People’s Participation in PHC
for All by the Year 2000”
VIII. Elements of Primary Health Care
IX. Medical Care and Primary Health Care B. Health for All by Year 2000
a. Medical Care  Attainment by all citizens of the world a level of health that will
b. Primary Health Care permit them to lead a socially and economically productive life.
X. Primary Health Care in the Philippines  The world’s nations, WHO, UNICEF, and major funding agencies
a. Letter of Instruction No. 949 pledged to work towards meeting people’s basic needs through a
b. Barangay Health Workers progressive and comprehensive approach called primary health
c. Aquino Administration care.
d. Ramos Administration
XI. Policy on Primary Health Care PRIMARY HEALTH CARE
a. Vision
b. Mission  An approach to health development which is carried out through a
c. Principles set of activities and whose ultimate aim is the continuous
improvement and maintenance of the health status off the
community.
HISTORY  A partnership approach among community, the government, and the
 1948 private sector or NGOs
o Post-war period; focus is on the general welfare of affected
states A. Classic Definition (Alma Ata Declaration, 1978)
o WHO and UN are formed
 Essential health care based on practical, scientifically sound, and
o Health policies of the WHO were first formed and implemented
socially acceptable methods and technology, made universally
o Health defined as the complete state of well-being
accessible to individuals and families in the community, through
 1950-1960
their full participation and at a cost that the community and the
o Prominence of the biomedical approach to health
country can afford and maintain at every stage of their development
o Development of vaccine for small pox, TB, and malaria leading
in spirit of self-reliance and self-determination.
to their eradication in developed countries
o Practical – simple and easy to use
o Discovery of antibiotics
o Scientifically sound – should be evidence based, proving that
o Rise of the pharmaceutical industry
it is effective, efficient and safe
 1970s o Socially acceptable – not conflicting with the community’s
o China’s Barefoot Doctors – “doctors of the barrio” who offered belief; in keeping with the culture
health services in far-flung areas; established during the start o Equitable – delivery of health services are dependent on the
of communism in China needs of the people
o Rise of CBHPs in Asia, Latin America (e.g Cuba), and Africa o High level of community participation – community will be
(1973) able to identify and solve their own particular health problems,
o CBHP – community-based health programs; aims to teach and evaluate it
people to take care of their health o At an affordable cost – may not be absolutely free but should
o Alma Ata Declaration (1978) be affordable
o Self-reliance – ability of the community to provide for
RATIONALE FOR PRIMARY HEALTH CARE themselves; they depend on their own capabilities and
 During the 1970’s, there is a growing demand for improved health resources
 Magnitude of health problems o Self-determination – the community will be the ones to
o High rate of infant and child mortality identify what they want for themselves
o Poor environmental sanitation
 Inadequate and unequal distribution of resources PRINCIPLES OF PRIMARY HEALTH CARE
o Poor health services at rural areas.  Health care is a part of total development (social, educational and
 Increasing cost of medical care economic)
o DOH focused on treatment of disease, rather than prevention  Essential health care means providing those things needed for a
and promotion healthy life (water, food, sanitation, etc.)
 Isolation of health care activities from other developmental  Health care should be: (4 As)
activities o Available and accessible to all people
o Acceptable to the community
o Appropriate and relevant to main health problems

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AIMS OF PRIMARY HEALTH CARE
 Mobilize the community to participate in identifying its basic needs
and in providing appropriate solutions through self-reliance and
self-determination
 Maintain good health in as many of the people as possible by
encouraging patterns of living and habits which are known to
promote good health
 Serve as channel for the total delivery of health and other social
development service, thereby forming an integral part of the
country’s health system through:
o Increasing opportunities for community participation in local
level planning
o Developing intra and intersectoral linkages with other
government and private agencies
o Emphasizing partnership between the health system and the
community so that they view each other as partners rather
than merely providers and receivers of health care
STRATEGIES OF PRIMARY HEALTH CARE
 Intersectoral cooperation/linkages – programs in the context of
integrated development
 Prevention of disease and health promotion
 Basic infrastructure – basic health facility established within reach
of every family
 Referral system/Intrasectoral – from health center to hospital
 Auxiliary health workers – trained to work in health facilities;
serve as link between people and health workers
 Barangay health workers – trained to work with the community
 Traditional medical system – traditional remedies proven
effective by research
 Health education – only through understanding the basis of a
healthy life can people make rational decisions concerning their
needs and lifestyle
 Community participation – active, responsible health committee
should function in a community
 Health care should be relevant to the main problems of each
community
 Essential drugs – provision of drugs for common conditions)
 Cost-effective and self-reliant – should reflect the total
development and should be within the means of the community
LEVELS OF PEOPLE’S PARTICIPATION IN PHC
A. Hospital or clinic-based
 Guiding principle: health to the people
 Decisions are performed by the doctor who defines the
objectives for health care and delivers the health services
B. Community-oriented
 Guiding principle: health for the people
 Decisions are undertaken by the health team and not only
confined to the doctor
 Objectives of primary health care and activities are
predetermined and validated by the community
C. Community-based
 Guiding principle: health with the people
 Decisions are made thru the partnership of health
implementers with the community thru their leaders
D. Community-managed
 Guiding principle: health by the people
 Decisions are initiated by the community
 Objectives, plans and programs including their
implementation, monitoring and evaluation are defined by the
community
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Primary Health Care
ELEMENTS OF PRIMARY HEALTH CARE
 Health Education
 Local/Endemic disease control
 Expanded Program of Immunization
 Maternal and child health
 Provision of Essential drugs
 Nutrition
 Treatment of common diseases
 Environmental Sanitation
MEDICAL CARE AND PRIMARY HEALTH CARE
A. Medical Care
 Vertical
o One-way relationship (ex. Doctor-patient relationship, nurse-
patient relationship)
 Separate from other government departments
 Curative system, emphasizing on treatments and drugs. Doctors and
hospitals or auxiliaries and dispensaries
 Emphasizes improved technology and specialization
 Treats individuals who are sick
 Auxiliaries are regarded as substitutes for doctors
 Health is seen as technology medicine and ignores culture
 Expensive, with a strong bias towards urban areas and hospital
 Often paid for by central government finance
 Causes the patient to be dependent on the doctor, nurse and health
services
B. Primary Health Care
 Horizontal
 Functions best through intersectional cooperation
 Mainly preventive and promotional; emphasizes water, sanitation,
immunization, nutrition and health education
 Emphasizes common conditions, “at risk groups” and reduction of
infant morality
 Helps healthy people in the community to prevent sickness as well
as treating the sick
 Auxiliaries are the main agents of health promotion and change
 Health promotion is a family and community activity
 Encourages the health positive aspects of the traditional medicine
and culture
 Less expensive with a bias towards equitable distribution of health
services in rural areas and the urban poor
 Partly supported by community self-reliance
 Helps the individuals and communities to become more capable of
looking after themselves
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PRIMARY HEALTH CARE IN THE PHILIPPINES C. Principles

A. Letter of Instruction No. 949 1. People as the CENTER for development
o People can make decisions about what courses of action to take
 Mandated the Ministry of Health to adopt PHC as an approach
to respond to their health needs
towards the design, development and implementation of programs
2. Concern for equity
which focus on health development at the community level
o Prioritize marginalized individuals and families
 Nationwide implementation of PHC took effect in 1981
3. Respect for area-based knowledge and capacities
 ‘Community-oriented’ rather than ‘community-based’
o DOH respects indigenous tradition and shall provide financial
 Participation was merely focused on the community as beneficiaries and technical support in propagating and validating them
and less attention was given to their involvement in the delivery and 4. Social accountability to the community
maintenance of services (less involvement, more on benefits) o The DOH is morally responsible in assisting the community
and other sub-national levels in advocacy of the PHC strategy
B. Barangay Health Workers and propagating of quality health services
 Performed services in support of the packaged programs of the 5. Devolution as an opportunity for EMPOWERMENT
Department of Health o LGUs assume the health delivery role with the municipal
 These services included: government tasked to implement this through PHC
1. Mobilization of the community for preventive health care o National government assists in ensuring standards and equity
2. Extending basic curative service o Balancing promotional or preventive care and curative or
3. Serving as a referral channel to the public health delivery rehabilitative care
system o Two-way referral system between public health delivery
4. Assisting the local health workers in service deliver Manning system and the hospital services
the Botica sa Barangay 6. Continuing concern for strengthening the capacity for PHC
o Necessitates the updated knowledge in the status of PHC
C. Aquino Administration implementation among people engaged in mobilization efforts
o Continuous research on appropriate indigenous technology
 Administrative Order 112
o Central to paradigm health care is EDUCATION
o Provided the official policy for collaborative programs with
7. Paradigm shift as a requirement for PHC
public and private sectors
o Change in the role of the DOH from dispenser of public services
o Created a climate for the government to work closely with the
to facilitator for communities to act as responsible partners in
private sector particularly with social development NGOs
health
o Shift from one that considers the community as beneficiaries of
D. Ramos Administration
health services to one who views the community as partners
 PHC was equated with the slogan “Health in the Hands of the and manages in local development efforts
People”
 Devolution of PHC to local government units
o Empowered the local executives to assume responsibility for
TRANSER’S MESSAGE
PHC
o Local executives are responsible in determining their
community’s health needs and the budget for it
 Barangay Health Workers Benefits and Incentives Act of 1995 was
passed which provided monetary and nonmonetary incentives
drawn from the funds of the Local Government Units (ex.
hospitalization benefits, educational scholarship and credits for civil
service eligibility)
 Policy on PHC for Community Health Development by the
Community Health Service of the DOH (1996)
o Represents the official position of the DOH on how it will
advocate and propagate PHC, which is by:
o PHC is a major responsibility devolved to LGUs
o DOH aims to provide assistance to LGUs

POLICY ON PRIMARY HEALTH CARE

 Strategy of implementing health care through participation of
organized members of the community in planning, implementing,
monitoring and evaluation with the support of government and
NGOs

A. Vision
 Health in the Hands of the People

B. Mission
1. Ensure that health is made accessible, available, acceptable and
affordable at all times within the context
2. Strengthen the governmental machinery thru provision of greater
opportunity for local level management (ex. giving trainings for
massage therapy and providing clinics for midwives)

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