Transcript Dysfunctional uterine bleeding (DUB)

NUR 473-Lecture 4+5
Concept of Primary Health Care
outlines
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The current health care system.
Trends affecting the health care system.
Definition of primary care & primary health care.
The PHC workforce.
Primary health care movement.
DECLARATION OF ALMA-ATA
Principles of Primary Health Care
Eight essential elements of PHC.
Aims of primary health care
Applying three levels of preventive care.
PRIMARY HEALTH CARE IN SA
Health For All
Objectives
After completion of this lecture the students should be
able to:
 - Describe three trends that are affecting health care.
 - Describe five trends that affecting the health care
system.
 - Define primary care & primary health care.
 - Identify the PHC workforce.
 - Discuss primary health care movement.
 - Discuss eight essential elements of PHC.
 - Applying three levels of preventive care.
The current health care system
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Health Care system can take credit for
improving the life span of people through
advances
in
medical
technology,
science, and the pharmaceutical industry
in relation with the issues related to cost,
quality and access to health care
Three trends that affecting health care:
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Cost
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Access
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Quality
Trends affecting the health care system:
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Demographic trends
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Social trends
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Economic trends
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Health workforce trends
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Technology trends
Primary health care (PHC)
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The PHC movement officially began in 1977 .
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Is essential health care; based on practical,
scientifically sound, and socially acceptable method
and technology; universally accessible to all in the
community through their full participation; at an
affordable cost; and geared toward self-reliance and
self-determination (WHO & UNICEF, 1978).
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The setting for primary health care is within all
communities of country and permeates all aspects of
society.
The PHC workforce:
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Team members include many professionals
such as generalist and public health physician,
nurses, dentists, pharmacists, optometrists,
nutritionists, community outreach workers,
mental health counselors, and other allied
health professionals, and community members
are considered to the team.
The PHC encourage:
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Self-care and self management in the health and
social welfare aspects of daily life.
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People are educated to use their knowledge, attitudes,
and skills in activities that improve health for
themselves, their families, and their neighbors.
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The desired outcome from the PHC strategy is
individual, family and community self reliance and
competence.
Principles of Primary Health Care
Equitable distribution
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Health services should be shared or distributed
equally to all areas irrespective of city (urban/village
(rural), rich/poor, caste/ color etc
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Accessibility - People should have reasonable access
to essential health services with no financial or
geographical barriers.
Principles of Primary Health Care
Community participation
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Involving individual, family and community in
promotion of their own health is an essential aspect of
PHC.
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The public should be encouraged to participate in
planning and making decisions about their own health
care.
Principles of Primary Health Care
Inter-sectoral coordination
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Alone, health sector or department can not work out for the
benefit of the community health. E.g. Agricultural, animal
husbandry, food, industry, education, housing, public
works, communication. To get all of these sectors to work
for the common goal like health care system strong political
involvement is needed.
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Professionals from various sectors, including the health
sector, work independently with community members to
promote the health of the community.
Principles of Primary Health Care
Appropriate technology:
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The meaning of the term “Appropriate technology" is :
 Scientifically sound
 Adaptable to local needs and acceptable to those
who uses
 Maintained by people
 Resources that community and country can afford
Focus on prevention
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The focus of care should be on prevention rather than cure
Elements/ essential components of
primary health care (WHO & UNICEF, 1978)
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Education concerning prevailing health problems and methods of
preventing and controlling them
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Promotion of food supply and proper nutrition
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An adequate supply of safe water and basic sanitation
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Maternal and child health care, including family planning
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Immunization against the major infectious diseases
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Prevention and control of locally endemic diseases
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Appropriate treatment of common diseases and injuries
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Provision of essential drugs
PHC – element No.1
Health education
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Education for promotion of health and prevention of
disease is an essential factor mentioned in Alma-Ata
declaration
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The individual should decide to be healthily or not , to
accept health measures and to create a healthily
environment .
PHC – element No.2
Promotion of food supply and proper nutrition
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Nutrition is a basic factor influencing the quality of human life.
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Under nutrition is still one of the greatest health hazards. Child
and maternal malnutrition is widespread.
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Community health workers should be responsible for the
promotion of better nutrition.
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Correction of faulty feeding practices and prevention infectious
diseases which are nutrition – related , eg. Diarrhea
PHC – element No.3
An adequate supply of safe water and basic sanitation
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The main objectives of this PHC elements are to prevent
diseases and improve the quality of life and well-being of
the population by promoting personal and community
hygiene
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Ensuring the availability of safe water supply and sanitation
facilities through self reliant, community action and also by
associating water supply and sanitation with other health
and/or development programs
PHC – element No.4
Maternal and child health care, including family planning
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Maternal and child health care (MCH/FP) as part of
PHC aims at promoting and protecting the health of
children and women of childbearing age
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So that all children have the possibility for healthily
growth and development
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and so that reproductive life of women is compatible
with a state of health and well being
PHC – element No.4
Maternal and child health care, including family planning
MCH/FP (Maternal and Child Health/Family
Planning) care includes at five main functions
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Antenatal care
Delivery care
Post natal care
Child care
Family planning care
PHC – element No.5
Immunization against the major infectious diseases
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Immunization programs seeks to reduce morbidity and
mortality by providing immunization against the major
killers of children.
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In the developing world, priority is usually given to the
following diseases:
Diphtheria, Whooping cough, Tetanus
Measles, Rubella, Poliomyelitis
Tuberculosis, Hepatitis B
Tetanus immunization for pregnant mothers
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PHC – element No.6
Prevention and control of locally endemic diseases
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Malaria
Malaria remains one of the most important
widespread endemic diseases. There are about 120
-150 million cases annually
The objectives may range from reduction of mortality
in some areas to full-scale country wide malaria
eradication
PHC – element No.6
Prevention and control of locally endemic diseases
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Hypertension
High blood pressure is another health problem and
form 8 – 18 % of adults in most countries both
developed and developing, have pressures above
160mm/Hg systolic and 95mm/Hg diastolic.
The long term objectives are;
-To prevent hypertension if possible
-To reduce the mortality and morbidity due the
consequences of high blood pressure
PHC – element No.7:
Appropriate treatment of common diseases and injuries
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Diarrheal disease:
Prevention of diarrheal morbidity and mortality is a vital
part of national strategies for PHC. Diarrheal disease
control itself includes at least main functions, namely:
Diagnosis of diarrheal disease
Provision of appropriate treatment
Management of outbreaks of diarrheal
diseases and its prevention
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PHC – element No.7:
Appropriate treatment of common diseases and injuries
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Accidents are among the highest causes of death in most
countries
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The aims, therefore must be not only to provide first aid on
the spot and adequate treatment at the appropriate level of
care, but also to prevent the occur of similar accidents in the
future and to provide program for active rehabilitation of
disabled persons, children as well as adults
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Three types of home accidents have been chosen as
examples; Cuts, Burn, and Poisoning
PHC – element No.8
Provision of essential drug
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The provision of essential drugs aims at making these
drugs available to the users of the health systems at
all levels of PHC, all over the country, at all times by
instituting an efficient system of drug acquisition,
storage, distribution and utilization
Aims of primary health care
•Promotion of health
•Prevention of diseases
(primary, secondary and tertiary levels)
Aims of primary health care
Promotion of health
 Action related to lifestyles and choices that maintain or
enhance a populations health
 (WHO) "Any combination of educational, organizational,
economic, and environmental supports for behavior and
conditions of living conductive to health".
 Health promotion includes all efforts that seek to move people
closer to optimal well-being or higher levels of wellness.
Nursing, in particular, has a social mandate for engaging in
health promotion.
Aims of primary health care
Promotion of health
The goal of health promotion is to raise levels of wellness for
individuals, families, populations, and communities.
Community health efforts accomplish this goal through a threepronged effort to:
1. Increase the span of healthy life for all citizens
2. Reduce health disparities among population groups
3. Achieve access to preventive services for everyone
Aims of primary health care
Promotion of health
Health promotion programs and activities include many forms of
health education—for example,
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Physical activity and fitness.
Nutrition.
Tobacco use.
Teaching the dangers of alcohol and drug use.
Family planning
Mental health and mental disorders
Violent and abusive behavior
Educational and community-based programs
Aims of primary health care
Prevention of diseases
 Nursing care oriented to health promotion, wellness
and illness prevention can be understood in terms of
health activities on primary, secondary and tertiary
levels.
 Prevention means anticipating and averting problems
or discovering them as early as possible to minimize
potential disability and impairment
Aims of primary health care
Prevention of diseases-Primary Prevention
 Any effort done before or to prevent the problem to occur.
 Primary prevention obviates the occurrence of a health
problem; it includes measures taken to keep illness or injuries
from occurring. It is applied to a generally healthy population
and precedes disease or dysfunction.
 It can be provided to an individuals or to general population,
or it can focus on individuals at risk for developing specific
diseases. Wellness activities are synonymous with the
activities identified for primary prevention.
Aims of primary health care
Prevention of diseases-Primary Prevention
Primary prevention includes Health promotion activities
such as:
 Health education
 Good standard for nutrition adjusted to
developmental phases of life
 Attention of personality development
 Provision of adequate housing and
recreation , as well as agreeable
working condition
 Marriage (genetic ) counseling
 Genetic screening
 Periodic selective examinations
Aims of primary health care
Prevention of diseases-Primary Prevention
Specific protection activities in order to improving the
general health of individuals, families and communities,
activities such as:
 Use of specific immunization
 Attention to personal hygiene
 Use of environmental sanitation
 Protection against occupation
hazards
 Protection from accidents
 Use of specific nutrients
 Protection form carcinogens
 Avoidance of allergen
Aims of primary health care
Prevention of diseases-Secondary Prevention
It focuses on individuals who are experiencing
health problems or illness and who are at risk for
developing complications or worsening conditions.
Aims of primary health care
Prevention of diseases-Secondary Prevention
 Early diagnosis and prompt treatment:
 Involves efforts to detect and treat existing health
problems at the earliest possible stage when disease or
impairment already exist.
 Hypertension and cholesterol screening programs in many
communities help to identify high-risk individuals and
encourage early treatment to prevent heart attacks or
stroke.
 Other examples are teaching breast and testicular selfexamination, encouraging regular mammograms and Pap
smears for early detection of possible cancer
Aims of primary health care
Prevention of diseases-Secondary Prevention
 Disability limitation
 Secondary prevention attempts to discover a health
problem at a point when intervention may lead to its
control or eradication.
 This is the goal behind testing of water and soil samples for
contaminants and hazardous chemicals in the field of
community environmental health.
 It also prompts community health nurses to watch for early
signs of child abuse in a family, emotional disturbances in a
group of alcohol and drug abuse among adolescents
Aims of primary health care
Prevention of diseases- tertiary Prevention
 Involves efforts to reduce disability and, as much as possible,
restore function.
This focuses on helping people manage complicated, long-term
health problems such as diabetes, heart disease, cancer and
chronic musculoskeletal pain. The goals include preventing further
physical deterioration and maximizing quality of life. For example:
cardiac or stroke rehabilitation programs
chronic pain management programs
patient support groups
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PRIMARY HEALTH CARE IN Saudi Arabia
 Primary health care (PHC) is defined by the
World Health Organization (WHO) as 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 the community and
the country can afford
 Saudi Arabia started implementing this approach
in 1980 by the Ministry of Health (MOH).
PRIMARY HEALTH CARE IN Saudi Arabia
 The MOH provides primary health care (PHC)
services through a network of health care
centers throughout the kingdom.
 It also adopts the referral system which provides
curative care for all members of society from the
level of general practitioners at health centers to
advanced technology specialist curative services
through a broad base of general and specialist
hospitals
Health For All
 In 1977, it was decide in the world health assembly to lunch a
movement known as "health for all by the year 2000".
 The fundamental principle of HFA strategy is equity , that is an
equal health status for people and countries, ensured by an
equitable distribution of health resources.
 The member countries of WHO at the World Health Assembly
defined health for all as:
Attainment of a level of health that will enable every individual to
lead as socially and economically productive life
Health For All
In 1981, after identifying the goal of HFA and the
PHC strategy for realizing that goal, the WHO
established global indictors for monitoring and
evaluating the achievement of HFA.
These indicators are grouped into four categories.
 Health Policies
 Social and Economic Development
 Provision of Health Care
 Health Status.
Health Indicator
A health indicator is a characteristic of an
individual, population, or environment which is
subject to measurement (directly or indirectly)
and can be used to describe one or more aspects
of the health of an individual or population
(quality, quantity and time). (WHO, 1998)
Health Indicator
Health policy indicators
Policy commitment to Health for all (HFA)
Resource allocation
Degree if equity of distribution of health
resources
Community involvement attaining HFA.
Health Indicator
Social and Economic Development
Rate of population
Income distribution
Gross national product
Work condition
Adult literacy rate
Housing
Food availability.
Health Indicator
Provision of Health Care
Coverage by PHC
Coverage by referral system.
Health Indicator
Health Status
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Nutritional status &psychological development
Infant mortality rate
Child mortality rate
Life expectancy at birth or at other specific age
Maternal mortality rate.
General Indicator-related definitions
 Proportion: The relation of a subgroup to the entire
group; that is the subgroup divided by the entire group.
 Rate: The frequency of events in a population during a
specified time period (usually a year) divided by the
population ‘at risk’ of the event occurring during that time
period.
Or a rate is: A statistical measures expressing the
proportion of persons with a given health problem among a
population at risk.
General Indicator-related definitions
 Ratio: The relation of one population subgroup to the
total population or to another subgroup; that is, one
subgroup divided by another.
Which is simply the comparison of one number with
another
A ratio: is often used to compare one at-risk population with
another.
The number of females: The number of males
General Indicator-related definitions
Incidence and Prevalence Rates
 Incidence: Refers to the rate at which a specific disease
develops in a population.
An incidence rate is the number of new cases of an illness or
injury that occurs in a specific time.
 Prevalence: The number of cases in a defined population at
a specified point in time.
Prevalence: measures all of the existing cases at a given point
of time.
Prevalence includes the incidence (new cases) plus all of the
existing cases.
General Indicator-related definitions
 Life expectancy at birth: The average number of
additional years a person could expect to live if current
mortality trends were to continue for the rest of that
person’s life.
 Maternal mortality ratio: The number of women who
die as a result of childbearing or within 42 days of
termination of pregnancy in one year, per 100 000 live
births during that year.