Introduction to primary health care

Definition of terms used in PHC

• Equity in PHC is a term used to describe the even distribution of health services to the people irrespective of their financial strength, class, race etc.
• Control means putting an already existing disease / health hazard to an end.
• Prevention is used to describe the strategies that are meant to stop an hazard from occurring.
• Appropriate technology is a method that is scientifically viable and adopted to local needs and can be sustained at all stages.
• Community participation refers to the meaningful involvement of the people in the planning, implementation and maintenance of health service.
• Community base approach means the method employed in PHC whereby resources facilities and equipment are stationed in the host communities which they are meant to service.
• Entering point though health education is the medium through which health workers enter the various communities. The entry media are the leaders of the communities.

Evolution of health service in Nigeria

Origin: Africans including Nigeria practiced traditional medicine. The medical men were trained on herbs and roots on the different type of disease / ailment and how to cure them as well as to administer them to the client. These methods were also handed to generation past before civilization come.

Pre – colonial period

In the time past or previous years back before Berlin conference of 1885 in Germany. There were different empire existing then before the Europeans portioned Africa. The strong empire, financial and social – political system were use to abate the societal problem including health. The advent of the slave trade in the early 19^th century also destroyed all existing structures including health. These lead to the fall in nutritional and health standard of the people. This period lasted till 1900 when colonial rule was introduced.

Colonial period

Lord Luggard in 1914 amalgamated the north and southern protectorate to form an entity called the Nigeria state. The British Army medical services provide medical and health services for the colonial officials, native civil servant and their relatives. It has also extended to the population in Nigeria. Earlier in 1946, the 1^st health development plan of was conceived by the colonial officers but did not succeed due to poor community participation.

Post independence period

After independence in 1960, the administrator in Nigeria trained different foreign climes who returned home to take over health care system. In 1962 national development plans took off and the community participated greatly.

1^ST & 2^ND national development plan

The 1^st national development plan (1962 – 1968) it was done to establish the state responsibility on health services etc.  The 2^nd national development plan (1970 – 1974) was also for state responsibility services.

1. Man power objective of doctors
2. Control on communicable diseases.
3. Contraction of mobile units
4. Creation of research facilities etc.

3^RD national development plan

The national development plan was launched in (1975 – 1980)

Objectives

1. For the expansion of the federal health facilities
2. Relocation of health professional
3. Creation of middle – levels man power
4. Establishment of hospital management e.g. laboratory
5. Federal health planning & research unit.

4^TH national development plan

In 1981 – 1985 they establish 23 tier comprehensive health care system of primary, secondary and tertiary levels. The plans involve decision making in health care issues, its effectiveness and efficiency of services for eradication of disease and it was achieved late Prof. Olikoye Ransome – Kuti introduce it.

5^TH national development plan

This plan commends from (1988 – 1992) the structural adjustment program (s.t.p.) affected the health care. They intended to develop naira and reduce govt. spending in the economic including health. This affected the people, leading to ill health, and diseases due to lack of professional who flee away etc.  In 1989, 3 years rolling plan brought by Gen. IBB Babangida failed due to curative, urban and elicit.

1993 – 1999

General Sani Abacha reign in 1993 brought another set back to the country on health service in general Abubakar regime in 1999 brought sanction from united state as a result, they withdraw their support from the country.

1999 – till date

Nigeria return to dramatic rule. The problem faced by the nation are inadequate and poor physical infrastructures,  corruption, lack of drugs etc. govt. are making effort on improving of these issues.

The national health policy

The main purpose of national health policy and strategy is to achieve health for all Nigerians. The WHO / UNICEF. 1978. In 1988 global was declared and reviewed in 2004..

Its goals

1. Its to bring about comprehensive health care services for the people
2. For promoting, curative, preventive & rehabilitation with the available resources on primary health care.

The 1996 national health development plan

In 1996. The Abuja health care declaration was made. Its purpose to appraise the national health system and to examine the factors hindering the progress in the sector

The period 2000 – 2015

In 2000, the UN met and reconstructed with PHC (primary health care) policy to the millennium development goal.

Millennium development goals

1. Eradication of extreme poverty & hunger
2. Achievement of universal primary education
3. Reducing of mortality
4. Improve maternal health.

The present

In 2015, the achievement of MDGO & UNGA develop the goals

1. To end poverty in all forms
2. To end hunger & achieve food security
3. To ensure healthy life etc.

Forms of health care services

It is divided into two (2) (a) formal (b) informal.

Formal health care service: this is orthodox health service net are well planned.

Informal health care services: the health care services are render by relatives of victims and trado medical centres.

Taboo

Taboo means forbidden things by a particular people or community.

Concept of health

1. Biological concept of disease (germ causes diseases)
2. Ecological concept (in balance health between envt.)
3. Physio social concept (health influenced by social cultural factors) etc.

What is primary health care?

It’s the essential health base on practical, scientifically sound and social acceptable method & technical universally accessible to the individual, families and community at large.

Concept of disease

Disease, illness, sickness, an ecologist, sociologist.

Theory of disease causation

Help us to know what causative disease, etc. and how it can be understood. Tradition African theory germ, magnetic etc.

Causes of disease

• Physical causes
• social, cultural causes
• biological causes etc.

Implications of cultural practices on the causes of disease

This is a various activities carried out by the community arising from their way of life.

Circle of poverty

Poverty is the extension of lack of need or want due to insufficient fund

Deprivation is when something is out of the reach of a person.

Circle: a continuation of a particular thing.

When a family is rich as well as the spouses, the children enjoy good education good life and health because parent can afford it. Due to good jobs acquired but when born by a parent, attend poor school, live in bed environment, they drop out pick a job with low salary pay raising up poor children in a poor emit support from relative and up marrying a poor girl.

Component of PHC

They have different activities that acceded to in making PHC. Eight (8) component where stated by WHO /UNICEF.

1. Health education on prevailing health problems & methods of controlling them
2. Environmental sanitation e.g. water supply
3. Adequate nutrition & food supply.

Primary health care organisation

Primary health care have been organized in such a way that it involve the 3 – tiers of government. Local,  state and federal govt.

Local government.: it is lowest among them all and it is the closet to the people. They have direct contact to the people. They involve community diagnosis, monitory and evaluation of the services, vaccination etc.

State government: they are middle men in between the local and federal in PHC activities. They store and collect vaccines. They monitors and evaluate activities of the local government area (LGA). They also train health workers, they collate data from LGA and report to the federal govt.

Federal government: he is the overall and the oversee the health care delivery in the country on PHC. They guide and support the state and level Govt. areas and also create PHC centre, they set policy and also train workers on PHC, they receive grant and distribute it. They support zonal centre.

Concept of PHC

1. Essential
2. Availability & accessible
3. Acceptable to the community
4. Affordable by the community country
5. Handles all the major problem of the community
6. Effective

It is the fundamental and basin of the people for whom it is intended to serve. It should close to the people to prevent any barriers.

The fingers of PHC are

1. Effectiveness
2. Accessibility
3. Affordability etc.

Health education

Health education in the context of PHC is defined as intervention aim at assisting people to participate activity in health issues to their interest on a sustain bases. It involves information on education and communication. It is a way in which communication ideals are pass to the people in an educative manner. Its general principle on health educative and comprehension involves from know to unknown, participation re- enforcement etc.

Environmental sanitation

Environmental sanitation may be defined as the control measures in keeping the environment clean from all forms of deleterious, hazardous and harmful substances may affects man is physical, social and mental well being. The various areas covered by environmental sanitation are:

1. Water supply: Wholesome and portable water supply in adequate quantity will prevent meter related disease like cholera, guinea worm, schistosomiasis etc. portable water should be made available for rural and urban dwellers.
2. Food: The consumption of healthy rich and hygiene food is essential for good health, in PHC and also prevent food born disease.
3. Housing: The provision of good housing is essential for good health and also prevent disease, common with poor housing.
4. Air pollutant: The environment free from poisonous gases emitted into the air also improve the PHC of the health of the people etc.
5. Vector control
6. Solid waste management: The solid waste should be properly managed so that it will not pollute the environment and the health of the people.

Adequate nutrition and food supply

Malnutrition is one of the major health problem affecting developing countries. It has brought about much death in Africa. During famine, war, drought, civil cases etc. it has lead to loss of lives of mothers, children, men. Etc. food should be provided in the adequate proportion and quality to the people to prevent disease or ill health e.g. kwashiorkor, obesity etc.

Factors affecting food supply are;

1. Production,
2. distribution,
3. preservation and processing,
4. ignorance,
5. lack of education,
6. infections and poverty.

Maternal & child health

In Nigeria, birth related diseases have killed mothers and children greatly.

Implementation

Useful steps for implementation on PHC:

1. Training & retraining of health workers e.g. volunteers
2. Identifying the major health problem of the community
3. Community mobilization and formation of committees.

Monitoring & evaluation of PHC programme

Monitoring is the systematic way of ascertaining the success of an activity. The entire system and process are monitored to ensure their effectiveness.