Primary Health Care (PHC): History, Principles, Pillars, Elements & Challenges

Table of Contents

What is Primary Health Care (PHC)?
History of Primary Health Care
Objectives of Primary Health Care (PHC)?
Principles of Primary Health Care (PHC):
What are the Pillars of PHC?
Elements/components of PHC
Why is Primary Health Care (PHC) Important?
What are the Challenges for Implementation of PHC?
What are the Mitigation Measures for Ensuring Effective PHC?
References and For More Information

What is Primary Health Care (PHC)?

Primary Health Care (PHC) is the health care that is available to all the people at the first level of health care.
According to World Health Organization (WHO), ‘Primary Health Care is a basic health care and is a whole of society approach to healthy well-being, focused on needs and priorities of individuals, families and communities.’
Primary Health Care (PHC) is a new approach to health care which integrates at the community level all the factors required for improving the health status of the population.
Primary health care is both a philosophy of health care and an approach to providing health services.
It addresses the expansive determining factor of health and ensures whole person care for health demands during the course of the natural life.
It is developed with the concept that the people of the country receive at least the basic minimum health services that are essential for their good health and care.

History of Primary Health Care:

Before 1978, globally, existing health services were failing to provide quality health care to the people.
Different alternatives and ideas failed to establish a well-functioning health care system.
Considering these issues, a joint WHO-UNICEF international conference was held in 1978 in Alma Ata (USSR), commonly known as Alma-Ata conference.
The conference included participation from government from 134 countries and other different agencies.
The conference jointly called for a revolutionary approach to the health care.
The conference declared ‘The existing gross inequality in the health status of people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable’.
Thus, the Alma-Ata conference called for acceptance of WHO goal of ‘Health for All’ by 2000 AD.
Furthermore, it proclaimed Primary Health Care (PHC) as a way to achieve ‘Health for All’.
In this way, the concept of Primary Health Care (PHC) came into existence globally in 1978 from the Alma-Ata Conference.

Objectives of Primary Health Care (PHC):

To increase the programs and services that affect the healthy growth and development of children and youth.
To boost participation of the community with government and community sectors to improve the health of their community.
To develop community satisfaction with the primary health care system.
To support and advocate for healthy public policy within all sectors and levels of government.
To support and encourage the implementation of provincial public health policies and direction.
To provide reasonable and timely access to primary health care services.
To apply the standards of accountability in professional practice.
To establish, within available resources, primary health care teams and networks.
To support the provision of comprehensive, integrated, and evidence-based primary health care services.

Five (5) Principles of Primary Health Care (PHC):

Social equity
Nation-wide coverage/wider coverage
Self- reliance
Intersectoral coordination
People’s involvement (in planning and implementation of programs)

What are the Pillars of Primary Health Care (PHC)?

FIG: PILLARS OF PRIMARY HEALTH CARE

Primary health care consists of an integrative group of health care professionals coordinating to provide basic health care services to a particular group of people or population.
The Primary Health care outline is built on four key pillars.
These pillars are reinforcement for the delivery of safe health care.

The four major pillars of primary health care are as follows:

Community Participation
Inter-sectoral Coordination
Appropriate Technology
Support Mechanism Made Available

1. Community Participation

Community participation is a process in which community people are engaged and participated in making decisions about their own health.
It is a social approach to point out the health care needs of the community people.
Community participation involves participation of the community people from identifying the health needs of the community, planning, organizing, decision making and implementation of health programs.
It also ensures effective and strategic planning and evaluation of health care services.
In lack of community participation, the health programs cannot run smoothly and universal achievement by primary health care cannot be achieved.

2. Inter-sectoral Coordination

Inter-sectoral coordination plays a vital role in performing different functions in attaining health services.
The involvement of specialized agency, private sectors, and public sectors is important to achieve improved health facilities.
Intersectoral coordination will ensure different sectors to collaborate and function interdependently to meet the health care needs of the people.
It also refers to delivering health care services in an integrated way.
Therefore, the departments like agriculture, animal husbandry, food, industry, education, housing, public works, communication, and other sectors need to be involved in achieving health for all.

3. Appropriate Technology

Appropriate healthcare technologies are an important strategy for improving the availability and accessibility of healthcare services.
It has been defined as ‘’technology that is scientifically sound, adaptable to local needs and acceptable to those who apply it and to whom it is applied and that can be maintained by people themselves in keeping with the principle of self-reliance with the resources the community and country can afford.’’
Appropriate technology refers to using cheaper, scientifically valid and acceptable equipment and techniques.
It is also necessary to ensure that the technology is:
- Scientifically reliable and valid
- Adapted to local needs
- Acceptable to the community people
- Accessible and affordable by the local resources

4. Support Mechanism Made Available

Support Mechanism is vital to health and quality of life. Support mechanism in primary health care is a well-known process focused to develop the quality of life.
Support mechanism includes that the people are getting personal, physical, mental, spiritual and instrumental support to meet goals of primary health care.
Primary health care depends on adequate number and distribution of trained physicians, nurses, community health workers, allied health professions and others working as a health team and supported at the local and referral levels.

Elements/Components of PHC:

There are eight (8) elements of Primary Health Care.
These 8 elements are also known as ‘essential health care’. They are:

Why is Primary Health Care (PHC) Important?

Primary Health Care focuses more on quality health service and cost-effectiveness.
Primary Health Care focuses on “Health for all”
Primary Health Care integrates preventive, promotive, curative, rehabilitative and palliative health care services.
Primary Health Care encourages new connection and community participation.
It includes services that are readily accessible and available to the community.
Primary Health Care can be easily accessible by all as it includes services that are simple and efficient with respect to cost, techniques and organization.
Primary Health Care promotes equity and equality.
Primary Health Care improves safety, performance, and accountability.
Primary Health Care advocates on health promotion and focuses on prevention, screening and early intervention of health disparities.
Primary Health Care is also perceived as an integral part of country’s socio-economic development.

What are the Challenges for Implementation of PHC?

Poor staffing and shortage of health personnel
Inadequate technology and equipment
Poor condition of infrastructure/infrastructure gap, especially in the rural areas
Concentrated focus on curative health services rather than preventive and promotive health care services.
Challenging geographic distribution
Poor quality of health care services
Lack of financial support in health care programs
Lack of community participation
Poor distribution of health workers/health workers concentrated on the urban areas.
Lack of intersectoral collaboration

What are the Mitigation Measures for Ensuring Effective PHC?

Encouraging community participation through rapport building, effective communication and sharing objectives and benefits of PHC.
Developing quality assurance mechanisms through the development of various indicators and standards.
Development of clinical guidelines including the implementation of Essential drugs list
Allocating resources as per the need of the central, provincial/state and local level.
Develop a planning process to define objectives and set targets by giving priority on those families and communities most at risk.
Promoting problem-orientated research in health management system.
Creating pathways to give health higher priority on the agenda of district development and collaboration of health departments to perform its role in health activities.
Develop guidelines and framework that specify the roles and responsibilities of the provincial states.