What Are the Primary Health Care Programs in the Community?

Primary Health Care (PHC) stands as the cornerstone of a robust healthcare system, aiming to bring essential health services closer to the people, right within their communities. The concept gained significant global momentum following the 30th World Health Assembly in May 1977, where the ambitious goal of “health for all” by the year 2000 was set. This vision was further solidified at the First International Conference on Primary Health Care in Alma Ata, Russia (USSR), in 1978, with the Alma Ata Declaration emphasizing PHC as the key to achieving this global health objective. In the Philippines, the commitment to PHC was formalized through Letter of Instruction (LOI) 949 in 1979, establishing it as the guiding approach for designing and implementing community-level health development programs.

The Foundation of Primary Health Care: Addressing Key Challenges

The adoption of Primary Health Care stems from a clear understanding of the multifaceted challenges within healthcare systems. Several compelling reasons underscore its importance:

• Magnitude of Health Problems: Communities face a wide array of health issues, from infectious diseases to chronic conditions, requiring comprehensive and accessible healthcare solutions.
• Inadequate and Unequal Distribution of Health Resources: Traditional healthcare models often concentrate resources in urban centers, leaving rural and underserved communities with limited access to essential services. PHC aims to bridge this gap by decentralizing healthcare delivery.
• Increasing Cost of Medical Care: Specialized and hospital-centric healthcare can be prohibitively expensive. PHC offers a cost-effective approach by focusing on preventive care and early intervention at the community level.
• Isolation of Health Care Activities: Health is interconnected with various aspects of life, including social and economic factors. PHC recognizes this interconnectedness and promotes integrated approaches that link health initiatives with broader community development activities.

Defining Primary Health Care: Essential, Accessible, and Participatory

At its core, Primary Health Care is defined as:

Essential health care made universally accessible to individuals and families in the community through means acceptable to them, with their full participation and at a cost that the community and country can afford at every stage of development.

This definition highlights several crucial aspects:

• Essential Care: PHC focuses on providing fundamental health services that address the most pressing health needs of the community.
• Universal Accessibility: PHC strives to make healthcare accessible to everyone, regardless of their location, socioeconomic status, or other barriers.
• Community Participation: PHC emphasizes the active involvement of community members in planning, implementing, and evaluating health programs, ensuring that services are relevant and culturally appropriate.
• Affordability: PHC aims to deliver healthcare services in a way that is financially sustainable for both the community and the healthcare system.

Ultimately, Primary Health Care is more than just a set of services; it is a practical and holistic approach to health development. It’s a strategy for continuously improving and maintaining the health status of populations by bringing healthcare closer to where people live and work.

The Goal of Primary Health Care: Health for All, By All

The overarching goal of Primary Health Care is ambitious yet profoundly important: HEALTH FOR ALL. This vision translates to achieving an improved state of health and enhanced quality of life for every individual. A key element in realizing this goal is SELF-RELIANCE, empowering communities to take ownership of their health and well-being. The aspirational target initially set was “HEALTH FOR ALL FILIPINOS by the year 2000” and further evolved to “HEALTH IN THE HANDS OF THE PEOPLE by the year 2020,” signifying a shift towards greater community empowerment and control over health decisions.

Partnership and Empowerment: The Core Strategy

To effectively achieve the goals of PHC, a central strategy stands out: Partnership with and Empowerment of the People. This principle permeates every aspect of PHC implementation, ensuring that essential health services are:

• Community-Based: Services are delivered within the community, making them easily accessible and relevant to local needs.
• Accessible: Geographical, financial, and cultural barriers to accessing care are minimized.
• Acceptable: Services are delivered in a manner that is respectful of community values and beliefs.
• Sustainable: Programs are designed to be long-lasting and integrated into the community fabric.
• Affordable: The cost of services is manageable for both individuals and the community as a whole.

Objectives of Primary Health Care: Concrete Steps Towards a Healthier Community

To translate the broad goals and strategies into action, PHC operates with a set of clear objectives:

• Improve the Level of Health Care: Elevate the overall health status of the community by addressing prevalent health issues and promoting well-being.
• Favorable Population Growth Structure: Contribute to healthy population dynamics through family planning and maternal and child health programs.
• Reduce Preventable Diseases: Decrease the incidence of preventable and communicable diseases through immunization, health education, and disease control programs.
• Reduce Morbidity and Mortality: Lower rates of illness and death, particularly among vulnerable populations like infants and children.
• Extend Essential Health Services to Underserved Sectors: Prioritize reaching marginalized and disadvantaged communities with necessary healthcare.
• Improve Basic Sanitation: Promote hygienic environments through sanitation programs and access to safe water.
• Develop Community Self-Reliance: Build the capacity of communities to manage their own health and participate actively in health initiatives.
• Maximize Intersectoral Collaboration: Foster cooperation between various sectors (e.g., education, agriculture, social welfare) to address the social determinants of health and promote holistic community development.

Mission of Primary Health Care: Strengthening the Health System from the Ground Up

The overarching mission of Primary Health Care is:

To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care.

This mission emphasizes building a health system that is not only effective in delivering services but also empowers individuals and communities to take control of their health journeys.

Primary Health Care Workers: The Frontline Force

The delivery of PHC services relies on a dedicated workforce operating at different levels:

1. Barangay Health Workers (BHWs): These are community health workers, often volunteers, who are the backbone of PHC at the grassroots level. They may include trained community members, health auxiliaries, traditional birth attendants, and healers. BHWs provide essential health information, basic services, and act as a crucial link between the community and the formal health system.
2. Intermediate Level Health Workers: This level includes professionals such as Public Health Nurses, Rural Sanitary Inspectors, and Midwives. They provide more specialized skills and supervision, supporting the BHWs and managing more complex health needs within the community.

Principles of Primary Health Care: Guiding the Approach

Several core principles guide the implementation of effective Primary Health Care programs:

1. The 4 A’s (Accessibility, Availability, Affordability, Acceptability, and Appropriateness): Health services must embody these five qualities to be truly effective.

   • Accessibility: Services must be geographically reachable and overcome barriers of distance and transportation.
   • Availability: The necessary services and resources must be consistently present and operational within the community.
   • Affordability: Costs of services should be within the financial reach of individuals and the community.
   • Acceptability: Services must be culturally sensitive and aligned with the values and beliefs of the community.
   • Appropriateness: Services should be relevant to the specific health needs and context of the community, prioritizing health promotion and disease prevention.

2. Community Participation: This is considered the “heart and soul” of PHC. Active community involvement is essential for ensuring that programs are relevant, effective, and sustainable. It means engaging community members in all stages, from needs assessment and planning to implementation and evaluation.

3. People-Centered Approach: PHC recognizes that individuals are not just recipients of care but are central to the development process. The success of any health initiative depends on people’s participation at all levels of decision-making, ensuring that programs are based on their needs and problems. This includes fostering partnerships between the community and various agencies, promoting social mobilization, and decentralizing health efforts. Health work should always start from understanding where people are and building upon their existing strengths and resources.

   • Barriers to Community Involvement: It’s important to acknowledge potential barriers to community participation, such as lack of motivation, negative attitudes, resistance to change, community dependence, and limited managerial skills within the community. Addressing these barriers is crucial for successful community engagement.

4. Self-Reliance: PHC aims to empower communities to become self-reliant in managing their health. This is achieved through community participation, fostering cohesive community organizations, and generating local support for healthcare through social mobilization, networking, and resource mobilization. Developing leadership and management skills within the community is also vital for long-term self-sufficiency. The presence of sustained, community-managed health facilities is a key indicator of progress towards self-reliance.

5. Partnership Between Community and Health Agencies: PHC necessitates strong partnerships between government health agencies, non-governmental organizations (NGOs), people’s organizations (POs), and the community itself. These linkages are crucial for effectively providing quality healthcare and support.

6. Recognition of Interrelationship Between Health and Development: PHC understands that health is not isolated but is deeply intertwined with broader development.

   • Health: Defined beyond just the absence of disease, health encompasses physical, mental, and social well-being. It is a social phenomenon influenced by political, socio-cultural, and economic factors. Good health is reflected in improved living conditions and quality of life within a community.
   • Development: Development is seen as the pursuit of an improved quality of life for all. It is multidimensional, encompassing political, social, cultural, institutional, and environmental aspects. It is measured by the ability of people to meet their basic needs and improve their overall well-being.

7. Social Mobilization: This involves enhancing people’s participation in governance and health initiatives. It requires building support systems from the government, fostering networking among stakeholders, and developing secondary leadership within communities to champion health.

8. Decentralization: Decentralization of healthcare administration empowers local political structures by giving them more responsibility for development initiatives. This also facilitates better allocation of budgetary resources at the local level, ensuring that resources are directed to where they are most needed within communities.

Elements of Primary Health Care: The Building Blocks of Community Health Programs

PHC is implemented through a set of essential elements that address key health needs within communities:

1. Education for Health: Health education is a powerful tool for disseminating information and promoting health. It fosters partnerships between families and health workers in promoting health and preventing illness.

2. Locally Endemic Disease Control: Programs focused on controlling locally endemic diseases aim to prevent their occurrence and reduce morbidity rates. Examples include malaria control and schistosomiasis control programs.

3. Expanded Program on Immunization (EPI): EPI programs are crucial for controlling preventable childhood illnesses. Immunizations against diseases like polio, measles, tetanus, diphtheria, and others are provided free of charge by governments and are ongoing programs of health departments.

4. Maternal and Child Health (MCH) and Family Planning: Mothers and children are recognized as particularly vulnerable populations. MCH programs focus on protecting their health and well-being, ensuring a healthy foundation for the community. Family planning services are integrated, promoting responsible parenthood and healthy birth spacing.

5. Environmental Sanitation and Promotion of Safe Water Supply: Environmental sanitation encompasses factors in the environment that can affect health. Safe water and sanitation are fundamental for health promotion and disease prevention. Access to safe water is a basic need for maintaining a healthy lifestyle.

6. Nutrition and Promotion of Adequate Food Supply: Adequate and proper nutrition is a basic family need. Promoting proper food preparation and knowledge about nutrition helps combat malnutrition, a significant health problem in many communities. Communities often have food resources that can be better utilized through education and planning.

7. Treatment of Communicable Diseases and Common Illnesses: Communicable diseases pose a significant public health risk. Programs focus on the prevention, control, and treatment of these illnesses. Tuberculosis, for example, remains a major communicable disease.

8. Supply of Essential Drugs: Ensuring access to essential medicines is a critical element of PHC. This includes information campaigns on the appropriate use and availability of essential drugs. Many countries have enacted generic drug laws to improve affordability and access to essential medications. Examples of essential drugs often include antibiotics like cotrimoxazole and amoxicillin, pain relievers like paracetamol, oral rehydration salts (ORS), and medications for specific conditions like tuberculosis and hypertension.

Major Strategies of Primary Health Care: Achieving National Health Goals

To achieve the broad goals of PHC and “Health for All,” several key strategies are employed at a national level:

1. Elevating Health to a Comprehensive and Sustained National Effort: Achieving “Health for All” requires broad participation in health and health-related programs, involving both service providers and beneficiaries. Empowering individuals, families, and communities to make informed decisions about their health is a desired outcome. Advocacy efforts are directed at national and local policymakers to secure support and commitment to major health concerns through legislation, budget allocations, and logistical considerations.

2. Promoting and Supporting Community Managed Health Care: Bringing “health in the hands of the people” means bringing government services closer to communities. This requires capacity building within communities and organizations to enable them to plan, implement, and evaluate health programs at their level.

3. Increasing Efficiencies in the Health Sector: Utilizing appropriate technology makes health services and resources more effective, affordable, accessible, and culturally acceptable. Human resource development must align with the actual health needs of the nation and PHC principles. Health ministries often support public and private institutions in faculty development, curriculum enhancement, and the development of standardized teaching materials.

4. Advancing Essential National Health Research (ENHR): ENHR is an integrated strategy for organizing and managing research using intersectoral, multidisciplinary, and scientific approaches to health programming and delivery. It ensures that health policies and programs are evidence-based and tailored to the specific needs of the population.

Four Cornerstones of Primary Health Care: The Foundational Pillars

In summary, Primary Health Care rests upon four fundamental cornerstones or pillars:

1. Active Community Participation: The indispensable involvement of communities in all aspects of PHC.
2. Intra and Inter-sectoral Linkages: Collaboration and coordination within the health sector and across other relevant sectors.
3. Use of Appropriate Technology: Employing technologies that are effective, affordable, and culturally suitable for the community context.
4. Support Mechanism Made Available: Ensuring that adequate resources, infrastructure, and support systems are in place to enable the successful implementation and sustainability of PHC programs.

By focusing on these programs and principles, Primary Health Care strives to create healthier, more resilient communities and move closer to the ideal of “Health for All.”