Concepts of Primary Health Care phc and cbhc





In 1978 world leaders, international organizations and health authorities (WHO & UNICEF gathered in Alma-Ata (Almaty), Kazakhstan, and released the Declaration of Alma-Ata on Primary Health Care, which remains a landmark document in the history of global health. This was to get way forward to the health problems faced by people of the whole world.

The Alma-Ata Declaration established a standard of public commitment to making community-driven, quality health care accessible, both physically and financially, for all.
134 governments ratified the WHO Declaration of Alma-Ata, asserting that:
    (a) Health for all could be achieved by 2000.
    (b) Governments have a responsibility for the health of their people that can be fulfilled only by
the provision of adequate health and social measures.
    (c) Primary health care is the key to attaining a level of health that will permit their citizens to lead a socially and economically productive life.
The Alma-Ata Declaration of 1978 emerged as a major milestone of the 20th century in the field of public health and it identified Primary Health Care (PHC) as the key to the attainment of the goal of Health for All (HFA).

HFA is defined as “the attainment by all peoples of the world by a particular date (kept at that time as the year 2000), of a level of health that will permit them to lead a socially and economically productive life”.

The Global Strategy for Health for All by the Year 2000 (HFA2000) set the following guiding targets to be achieved by year 2000:

  •  Life expectancy at birth above 60 years
  • Infant mortality rate below 50 per 1000 live births
  • Under-5 mortality rate below 70 per 1000 live births.
  • About 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of there household budget.
  • Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
  • Achieving the targets for PHC requires an additional investment of around US $ 200 to US$ 370 billion a year for a more comprehensive package of health services.
  • At the UN high level UHC meeting in 2019, countries committed to strengthening primary health care.
  • WHO recommends that every country allocate or reallocate an additional 1% of GDP to PHC from government and external funding sources.

What is primary health care?

  • The concept of PHC has been repeatedly reinterpreted and redefined in the years since 1978, leading to confusion about the term and its practice..
  • A clear and simple definition has been developed to facilitate the coordination of future PHC efforts at the global, national, and local levels and to guide their implementation:

PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment. “WHO and UNICEF”

✔A Vision for primary health care in the 21st century: Towards UHC (Universal Health coverage) and the sustainable development goals(SDGs).

  • UHC Means that all individuals && communities receive the health services they need without suffering financial hardships.

 PHC entails three inter-related and synergistic components, including:

  • Comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces
  • Multi-sectoral policies and actions to address the upstream and wider determinants of health:
  • Engaging and empowering individuals. families, and communities for increased social participation and enhanced self-care and self-reliance in health.
  1. For universal health coverage (UHC) to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.
  2. PHC is rooted in a commitment to social justice, equity, solidarity and participation.
  3. PHC requires governments at all levels to underscore the importance of action beyond the health sector in order to pursue a whole-of government approach to health, including health-in-all-policies, a strong focus on equity and that encompass the entire life-course.
  4. PHC addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
  5. It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases.
  6. Primary health care ensures people receive quality comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care as close as feasible to people’s everyday environment
  7. In May 1998, the World Health Organization adopted a resolution in support of the new global Health for All policy.
  8. The new policy, Health for All in the 21st Century, succeeds the Health for All by the Year 2000 strategy launched in 1977
  9. In the new policy, the worldwide call for social justice is elaborated in key values, goals, objectives and targets.
• The l0 global health targets are the most concrete end points to be pursued.
 They can be divided into three subgroups, Health outcome targets (total four targets). targets on determinants of health (two) and targets on health policies and sustainable health systems (four targets).

Global Health Targets

Health Outcome
  1.  Health equity: Childhood stunting-By 2005, health equity indices will be used within and between countries as a basis for promoting and monitoring equity in health. Initially equity will be assessed on the basis of a measure of child growth.
  2. Survival: Maternal mortality rates, child mortality rates, life expectancy-By 2020, the targets agreed at world conferences for maternal mortality rates (<100/100,000 live births). under 5 years or child mortality rates (<45/1000 live births) and life expectancy (>70 years) will be met.
  3. Reverse global trends of five major pandemics: By 2020, the worldwide burden of disease will be reduced substantially. This will be achieved by implementing sound disease control programs aimed at reversing the current trends of increasing incidence and disability caused by tuberculosis, HIV/AIDS, malaria, diseases related to tobacco and violence or trauma.
  4.  Eradicate and eliminate certain diseases
  • Measles will be eradicated by 2020. Lymphatic filariasis will be eliminated by the year 2020.
  •  The transmission of Chagas’ discase will be interrupted by 2010. 
  • Leprosy will be eliminated by 2010 and trachoma will be eliminated by 2020. In addition, vitamin A and iodine deficiencies will be eliminated before 2020.
Determinants of Health
       5. Improve access to water, sanitation, food and shelter: By 2020, all countries, through intersectoral action, will have made major progress in making available safe drinking water, adequate sanitation and food and shelter in sufficient quantity and quality and in managing risks to health from major environmental determinants, including chemical, biological

and physical agents.

       6. Measures to promote healthBy 2020, all countries will have introduced and be actively managing and monitoring, strategies
those strengthen health enhancing lifestyles and weaken health damaging ones through a combination of regulatory, economic, educational, organizational and community based programs
Health Policies and Sustainable Health Systems
       7. Develop, implement and monitor national Health for All policies: By 2005, all member states will have operational mechanisms for developing, implementing and monitoring policies that are consistent with this Health for All policy.
       8. Improve access to comprehensive essential health care: By 2010, all people will have access throughout their lives to comprehensive, essential, quality health care, supported by essential public health functions.
       9. Implement global and national health information and surveillance systems: By 2010, appropriate global and national health information, surveillance and alert systems will be established.

       10. Support research for health:

  • By 2010, research policies and institutional mechanisms will be operational at global, regional and country levels.
  • The Member States of WHO have to translate the Regional Health Policy into realistic national policies backed up by appropriate implementation plans.
  • WHO, on its part, will provide support to the Member States based on countries’ realities and needs, especially community health problems, the strengthening of health systems and services and the mobilization of countries and the international community for concerted action in the harmonization of national policies with regional and global policies.

Why is primary health care important?

  • Member States have committed to primary health care renewal and implementation as the cornerstone of a sustainable health system for UHC, health related Sustainable Development Goals (SDGs) and health security.
  • PHC provides the ‘programmatic engine’ for UHC, the health-related SDGs and health security.
  • This commitment has been codified and reiterated in the Declaration of Astana, the accompanying World Health Assembly Resolution, the 2019 Global Monitoring Report on UHC, and the United Nations General Assembly high-level meeting on UHC.
  • UHC, the health-related SDGs and health security goals are ambitious but achievable.
  • Progress must be urgently accelerated, and P1C provides the means to do so.
  • PHC is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being.
  • Evidence of wide-ranging impact of investment in PHC continues to grow around the world, particularly in times of crisis such as the COVID-19 pandemic.
  • Across the world, investments in PHC improve equity and access, health care performance, accountability of health systems, and health outcomes.
  • While some of these factors are directly related to the health system and access to health services,
  • The evidence is clear that a broad range of factors beyond health services play a critical role in shaping health and well-being.
  • These include social protection, food systems, education, and environmental factors, among others.
  • PHC is also critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.
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