ASSIGNMENT

PRIMARY HEALTH CARE AND ITS

COMPONENTS IN DETAIL IN THE LIGHT
OF ALMATA DECLARATION

BY

DR. __________________________________
Roll No. ________________________________________
Course _________________________________________________

FACILITATOR

MR. __________________________________
(NAME OF
INSTITUTE)________________________________

Date ________________________________
INTRODUCTION

The Declaration of Alma-Ata was adopted at the International Conference on Primary

Health Care (PHC), Almaty (formerly Alma-Ata), currently in Kazakhstan, 6-12

September 1978. It expressed the need for urgent action by all governments, all health

and development workers, and the world community to protect and promote the

health of all the people of the world. It was the first international declaration

underlining the importance of primary health care. The primary health care approach

has since then been accepted by member countries of WHO as the key to achieving

the goal of "Health for All". The Conference called for urgent and effective national

and international action to develop and implement primary health care throughout the

world and particularly in developing countries in a spirit of technical cooperation and

in keeping with a New International Economic Order. It urged governments, WHO

and UNICEF, and other international organizations, as well as multilateral and

bilateral agencies, non-governmental organizations, funding agencies, all health

workers and the whole world community to support national and international

commitment to primary health care and to channel increased technical and financial

support to it, particularly in developing countries. The Conference called on all the

aforementioned to collaborate in introducing, developing and maintaining primary

health care in accordance with the spirit and content of the Declaration. The

Declaration has 10 points and is non-binding on member states.

Primary health care and components: This section defined primary health care and

urged signatories to incorporate the concept of primary health care in their health

systems. Primary health care has since been adopted by many member nations. More

recently, Margaret Chan, the Director-General of the WHO has reaffirmed the

primary health care approach as the most efficient and cost-effective way to organize
a health system. She also pointed out that international evidence overwhelmingly

demonstrates that health systems oriented towards primary health care produce better

outcomes, at lower costs, and with higher user satisfaction. The seventh section lists

the components of primary health care.

PRIMARY HEALTH CARE

Health, which is a state of complete physical, mental and social wellbeing, and not

merely the absence of disease or infirmity, is a fundamental human right and that the

attainment of the highest possible level of health is a most important world-wide

social goal whose realization requires the action of many other social and economic

sectors in addition to the health sector. The people have the right and duty to

participate individually and collectively in the planning and implementation of their

health care. Governments have a responsibility for the health of their people which

can be fulfilled only by the provision of adequate health and social measures.

As per Alma Ata declaration Primary health care 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 country can afford to maintain at

every stage of their development in the spirit of self-reliance and self-determination.

If forms an integral part of both the country's health system, of which is the central

function and main focus, and of the overall social and economic development of the

community. It is the first level of contact of individuals, the family and community

with the national health system bringing health care as close as possible to where

people live and work, and constitutes the first element of a continuing health care

process.
Primary health care: reflects and evolves from the economic conditions and socio-

cultural and political characteristics of the country and its communities and is based

on the application of the relevant results of social, biomedical and health services

research and public health experience;

• addresses the main health problems in the community, providing promotive,

preventive, curative and rehabilitative services accordingly;

• includes at least: education concerning prevailing health problems and the

methods of preventing and controlling them; promotion of food supply and

proper nutrition; an adequate supply of safe water and basic sanitation;

maternal and child health care, including family planning; immunization

against the major infectious diseases;

• revention and control of locally endemic diseases; appropriate treatment of

common diseases and injuries; and provision of essential drugs;

• involves, in addition to the health sector, all related sectors and aspects of

national and community development, in particular agriculture, animal

husbandry, food, industry, education, housing, public works, communications

and other sectors; and demands the coordinated efforts of all those sectors;

• requires and promotes maximum community and individual self-reliance and

participation in the planning, organization, operation and control of primary

health care, making fullest use of local, national and other available resources;

and to this end develops through appropriate education the ability of

communities to participate;

• should be sustained by integrated, functional and mutually supportive referral

systems, leading to the progressive improvement of comprehensive health care

for all, and giving priority to those most in need;

 • relies, at local and referral levels, on health workers, including doctors, nurses,

midwives, allied health and community workers as applicable, as well as

traditional practitioners as needed, suitably trained socially and technically to

work as a health team and to respond to the expressed health needs of the

community.

All governments should formulate national policies, strategies and plans of action to

launch and sustain primary health care as part of a comprehensive national health

system and in coordination with other sectors. To this end, it will be necessary to

exercise political will, to mobilize the country's resources and to use available

external resources rationally.

ESSENTIAL COMPONENTS OF PHC

The Declaration of Alma Ata outlined the 8 essential components of primary health

care.

1. Education concerning prevailing health problems and the methods of

preventing and controlling them.

2. Promotion of food supply and proper nutrition.

3. An adequate supply of safe water and basic sanitation.

4. Maternal and child health care, including family planning.

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 medicines.

HEALTH EDUCATION
Health education is a process whereby knowledge, attitude, and practice of people are

changed to improve individual, family, and community health. Basic health service

and every member of the health team shares responsibility in providing health

education. Health education is a means of improving the health of the people by

employing various methods of scientific procedures to show the most healthful ways

of living. It consists of techniques that stimulate, arouse, and guide people to live

healthfully. It is the sum of activities in which health agencies engage to influence the

thinking, motivation, judgment, and action of the people in the community. Sequential

steps in health education are:

• Creating awareness

• Motivation

• Decision making action

PROMOTION OF FOOD SUPPLY AND PROPER NUTRITION

It is evident that malnutrition and its sinister effects on health are common in

developing countries, and result mainly from international and national policies which

prejudice food production and distribution. The international community can

contribute in many ways-with resources, with advice, and not least by refraining from

encouraging or requiring Third World countries to absorb food surpluses (the grain

and butter mountains) or to adopt agricultural and economic policies which contribute

to their poverty. However, the causes of food insecurity and the resultant ill health are

determined largely by national policies. The chief requirements are (a) to ensure an

adequate food supply through policies which promote domestic production (by

shifting resources from industry to agriculture, from large to small farms, from capital

intensive to labour-intensive activities) and (b) to give people at risk of food

insecurity the opportunity to earn an adequate income. The problem of food

deficiency is determined essentially by poverty. There should be programs that link

nutrition with health promotion in culturally appropriate way. It involves promotion

of good nutrition to all members of the community and promotion of good food

supplies through stores and locally available foods such as bush tucker and local

gardens. It also involves supplementation and meals for high risk groups.

AN ADEQUATE SUPPLY OF SAFE WATER AND BASIC SANITATION

1.1 billion people lack access to safe drinking water. 2.6 billion people lack adequate

sanitation. 1.8 million people die every year from diarrhoeal diseases, including 90 %

of children under 5. This situation is no longer bearable. Safe drinking water and basic

sanitation is of crucial importance to the preservation of human health, especially

among children. Water-related diseases are the most common cause of illness and

death among the poor of developing countries. According to the World Health

Organization, 1.6 million deaths of children per year can be attributed to unsafe water,

poor sanitation, and lack of hygiene. Provision of safe drinking water, adequate

sanitation and personal hygiene are vital for the sustainable environmental conditions

and reducing the incidence of diarrhoea, malaria, trachoma, hepatitis A & B and

morbidity levels. Not having access to water and sanitation is a courteous expression

for a form of deprivation that threatens life, destroys opportunity and undermines

human dignity. Thus, investing in the provision of safe water supply and adequate

sanitation is not only a development oriented strategy in itself, it can also yield other

socio-economic benefits in terms of improved health status, quality of labour force

and reduced burden-of-disease.

MATERNAL AND CHILD HEALTH CARE, INCLUDING FAMILY

PLANNING
The Maternal and Child Health (MCH) should includes a broad array of programs in

order to improve the availability of and access to high quality preventive and primary

health care for all children and to reproductive health care for all women and their

partners regardless of their ability to pay. It is MCH's goal that every child should

have the opportunity to grow up healthy. MCH aims to deliver to women and children

prenatal care, child health, family planning and home visiting services. MCH staff

develops program guidelines based on best practices and monitor the performance and

quality of services delivered. MCH also administers several other programs for

children and families.

IMMUNISATION AGAINST MAJOR INFECTIOUS DISEASES

Immunization is a proven tool for controlling and even eradicating disease. An

immunization campaign carried out by the World Health Organization (WHO) from

1967 to 1977 eradicated the natural occurrence of smallpox. When the programme

began, the disease still threatened 60% of the world's population and killed every

fourth victim. Eradication of poliomyelitis is within reach. Since the launch by WHO

and its partners of the Global Polio Eradication Initiative in 1988, infections have

fallen by 99%, and some five million people have escaped paralysis. Between 1999

and 2003, measles deaths dropped worldwide by almost 40%, and some regions have

set a target of eliminating the disease. Maternal and neonatal tetanus will soon be

eliminated in 14 of 57 high-risk countries.

New vaccines also have been introduced with significant results, including the first

vaccine to help prevent liver cancer, hepatitis B vaccine, which is now routinely given

to infants in 77% of WHO's Member States. Rapid progress in the development of

new vaccines means protection will be available in the near future against a wider

range of serious infectious diseases.

Immunization is considered among the most cost-effective of health investments.

There is a well-defined target group; contact with the health system is only needed at

the time of delivery; and vaccination does not require any major change of lifestyle.

Routine vaccination is now provided in all developing countries against measles,

polio, diphtheria, tetanus, pertussis, and tuberculosis. To this basic package of

vaccines, which served as the standard for years, have come new additions.

Immunization against hepatitis B is now recommended by WHO for all nations, and

currently is offered to infants in 147 of 192 WHO Member States. Immunization

against Haemophilus influenzae type b (Hib) is recommended where resources permit

its use and the burden of disease is established; it is provided in 89 countries (only in

selected parts of two of those countries). Yellow fever vaccine is offered in about

two-thirds of the nations at risk for yellow fever outbreaks. Routine immunization

against rubella is provided in 111 countries.

In industrialized countries a wider span of protection is typically provided than in

developing countries, often including vaccines against influenza, predominant strains

of pneumococcal disease, and mumps (usually in combination with measles and

rubella vaccine). Immunization programmes may be aimed at adolescents or adults —

depending on the disease concerned — as well as at infants and children.

PREVENTION AND CONTROL OF LOCALLY ENDEMIC DISAESES

In epidemiology, an infection is said to be endemic in a population when that

infection is maintained in the population without the need for external inputs. For

example, chickenpox is endemic (steady state) in the UK, but malaria is not. Every

year, there are a few cases of malaria acquired in the UK, but these do not lead to

sustained transmission in the population due to the lack of a suitable vector.

To promote the health of people and to control infectious diseases prevalent in the

country, the endemic diseases investigation and provision of proper diagnoses /

possible methods of prevention and control must be adopted. The major activities

involve: survey the present status of endemic infectious diseases, provide specific

diagnoses of infectious diseases, research various aspects of infectious diseases,

including clinical problems and preventive measures and educate the community on

the prevention of infectious diseases.

APPROPRIATE TREATMENT OF COMMON DISEASES AND INJURIES

Under Alma ata declaration one of the services is the appropriate treatment of

common diseases and injuries as a measure of dealing with the high morbidity and

mortality in the community. Since 1978, health leaders in the more developed

countries have enlarged the meaning of "appropriate treatment of common diseases"

to include specifically the identification and treatment of mental illness, simple

rehabilitation of the physically discied, and elementary dental care.

Beyond these specific health services, the Declaration of Alma Ata recognized that

effective implementation of the braid concept of primary health care required a

fundamentally new interpretation of national health system strategies. Although these

had to be adjusted to the economic realities of each country. every-where they

demanded "political commitment." The expression of this commitment was

formulated in a series of general principles that would apply in every country.

PROVISION OF ESSENTIAL MEDICINES

Essential medicines are the medicines that address the priority health care

requirements of a given population. These medicines are selected through an

evidence-based process with due regard to public health relevance, quality, safety,

efficacy and comparative cost-effectiveness. A fundamental criterion for essential

medicines is that they must be available within the context of functioning health

systems, and always in suitable amounts and dosage forms. The selection of essential

medicines is a cornerstone of national medicine policies and supports the smooth

functioning of the entire pharmaceutical system.

In 1978, the World Health Assembly passed Resolution WHA 31.32, urging Member

States to establish national lists of essential medicines and adequate procurement

systems. In that same year, the Declaration of Alma-Ata was adopted at the

International Conference on Primary Health Care, Alma-Ata, Kazakhstan. The

Declaration expressed the need for urgent action by all governments, all health and

development workers, and the world community to protect and promote the health of

all the people of the world. It was the first international declaration underlining the

importance of primary health care and to include the provision of essential medicines

and vaccines as a major component of primary health care.