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ƌThe main goal of Governments and

World Health Organization in the coming
decades should be the attainment by all
people of the world by the year 2000, a
level of health that would permit them to
lead a socially and economically
productive lifeƍ
 Themes Leading to
Alma Ata
1. Changing theories of health &
development: shift away from GNP
(u

 

  ) as measure
of development towards recognition of
the need of social development
2. Concerns about poverty & population
control
3. Increasing confidence upon alternative
approaches to medical care model
4. Success of CHWs & associated
importance on community participation
5. Revival of interest in public health;
tackling causes of ill health rather than
symptoms
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PHC is 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 affordƕ It forms an integral part of 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
 PRINCIPLES OF PHC
1. Health Prevention & Promotion

2. Equity

3. Appropriate Technology

4. Community Participation

5. Intersectoral Coordination

6. Decentralization*
 


1. Education concerning prevailing health problems &
the methods of preventing & controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic
sanitation
4. MCH including FP
5. Immunization against major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and
injuries
8. Provision of essential drugs
 PHC: EXTENDED ELEMENTS IN THE 21st CENTURY

1. Expanded options of immunization

2. Reproductive health needs
3. Provision of essential technologies for health
4. Health promotion as defined in Ottawa Charter
and authorized by resolution ¢

5. Prevention and control of non-communicable
diseases
6. Food safety and provision of selected food
supplements0

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1. All people in every country will have ready access at least to
essential health care & to first-level referral facilities

2. All people will be actively involved in caring for themselves &

their families, as far as they can, in community action for health

3. Communities throughout the world will share governmentƍs

responsibility for the health care of their members

4. All governments will assume the overall responsibility for

the health of their people

5. Safe drinking water & sanitation will be available to all

people 
 !

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]. All people will be passably nourished

7. All children will be immunizes against the major

diseases of childhood

8. Communicable diseases in the developing countries

will be of no greater public health significance in the
year 2000

9. All possible ways will be applied to prevent &

control non-communicable diseases & promote mental

health through influencing the life styles &

controlling the physical & psychological environment

10. Essential drugs will be available to all

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1. Health equity: childhood act
2. Survival: MMR, CMR, life expectancy
3. Reverse global trends of five major pandemics
4. remove and eliminate certain diseases
5. Improve access to water, sanitation, food and shelter
]. Measures to promote health
7. Develop, implement and monitor national HFA policies
8. Improve access to comprehensive essential, quality
health care
9. Implement global and national health information and
observation systems
10. Support research for health
 Obstacles ` `


 ``  
`` 
1. Misinterpretation of the PHC Concept
2. Misconception that PHC is a 2nd rate
health care for the poor
3. Selective PHC Strategies
4. Resistance to Change
5. Lack of political will
]. Centralized Planning & Management
Infrastructure
  

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PHC involve that if one cannot afford to
offer universal coverage for even the
most basic of health care, one could
would offer treatment & preventive
strategies for the few diseases
identified as having the greatest threat
to humanity, & which are amenable to
prevention / cure at low cost.
 
ADVANTAGES DISADVANTAGES
1. More costly to
1.Looks at total health implement
care 2. Takes long time
2.Involvement of to see impact
community 3. Long time to
3.Covers all elements of process
PHC 4. Lack of
specialized
4.Ensures equitable treatment
distribution of 5. Expensive
resources ]. Inefficient
5.Facilitates effective referral system
referral system ???-- misuse
].Government goal
 
DISADVANTAGES
ADVANTAGES
1. Disease rather than
1.Donor friendly health oriented
2.Elimination of selected 2. Doesnƍt ensure equity
disease 3. Top down decision
making
3.Easy to plan & implement 4. Neglect other
4.Is focused & have more problems
5. Leads to outbreak
impact
]. Resources (tight)
5.Easy to manage & might not be available
measure output for urgent needs
(emergencies)
].Require limited resources 7. Less community
7.Improve quality of involvementƊ donor
priority
services
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Reasons for slow progress towards HFA
1. Insufficient Political commitment to
implementation of HFA
2. Failure to achieve equity in access to all
PHC elements
3. The continuing low status of women
4. Slow socioeconomic development
5. Difficulty in achieving intersectoral action
for health
]. Unbalanced distribution of, and week
support for, human resources
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7. Widespread inadequacy of health promotion

activities
8. Weak health information systems and no
baseline data
9. Pollution, poor food safety, and lack of safe
water supply and sanitation
10. Rapid demographic and epidemiological
changes
11. Inappropriate use of, and allocation of
resources for, high cost technology
12. Natural and man-made disaster
  
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1. PHC as an approach has provided impetus and
energy to progress towards HFA
2. Some progress has been made in ensuring
access to the original eight PHC elements
3. PHC remains valid as the point of entry into a
comprehensive health care system
4. Interconnect oral action for health has not
been fully achieved
5. Reorientation of health services and
personnel to PHC principles remains elusive
]. Community participation takes time and
dedication by all

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&+!-.
1. Widespread absolute and relative poverty
2. Demographic changes: aging and growth of
cities
3. Epidemiological changes: continuing high
incidence of infectious diseases; increasing
incidence of non- communicable diseases,
injuries and violence
4. Global environmental threats to human survival
5. New technologies: information and
telemedicine services
]. Advances in biotechnology
7. Globalization of trade, travel and spread of
values and ideas
 u m m
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1. An increase in life expectancy and in the
quality of life for all
2. Improved quality in health between and
within countries
3. Access for all to sustainable health systems
and services

An initial set of targets will guide the

implementation of the HFA policy and define
priorities for action for the first two decades
of the 21st century
 
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1. Building a healthy public policy

2. Creating supportive environment
3. Developing personal skills
4. Strengthening community action
5. Reorienting health services
 +! -.
. 23-
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1. Make health central to development and
enhance prospects for intersect oral
action
2. Combat poverty as a reflection of PHCs
concern for social justice
3. Promote equity in access to health care
4. Build partnerships to include families,
communities and their organizations
5. Reorient health systems towards
promotion of health and prevention of
disease
 -&&2& . 
&

Attach greater emphasis to

comprehensive quality health care
throughout the life span
Ensure equitable access to the original
eight PHC elements
Expand PHC elements in response to
identification of new threats of health,
and opportunities to tackle these
threats
 && .-
&&* -

Provide sustainable financing of PHC

Invest in human and institutional capacity for
health
Optimize private and public sector support for
PHC through appropriate regulations
Strengthen research to support and advance
PHC
Implement global, national and local
surveillance and monitoring systems