CHN 1

• Primary Health Care (PHC)

  Essential health care made universally accessible to individuals and acceptable to them, through full participation and at a cost the community and country can afford. It is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy.
• Primary Health Care (PHC)


  Health care that is available to all the people at the first level of health care.
• Primary Health Care (PHC)

  A whole of society approach to healthy well-being, focused on needs and priorities of individuals, families and communities.
• Primary Health Care (PHC)


  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 (PHC)


  Both a philosophy of health care and an approach to providing health services.
• Primary Health Care (PHC)

  Addresses the expansive determining factor of health and ensures whole person care for health demands during the course of the natural life.
• Primary Health Care (PHC)


  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.
• Primary health care is rooted in a commitment to social justice and equity and in the recognition of the fundamental right to the highest attainable standard of health, as echoed in Article 25 of the Universal Declaration on Human Rights
• Primary Health Care (PHC)

  • Addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing
  • Provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases
  • Ensures people receive comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care - as close as feasible to people's everyday environment
• WHO has developed a cohesive definition of Primary Health Care (PHC) based on three components
• WHO definition of Primary Health Care (PHC)

  1. Meeting people's health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course, strategically prioritizing key health care services aimed at individuals and families through primary care and the population through public health functions as the central elements of integrated health services

  2. Systematically addressing the broader determinants of health (including social, economic, environmental, as well as people's characteristics and behaviours) through evidence-informed public policies and actions across all sectors

  3. Empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and care-givers to others
• Alma-Ata conference where the concept of Primary Health Care (PHC) came into existence globally


  1978
• 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)
• Principles of Primary Health Care (PHC)

  • Equitable distribution of health care
  • Community participation
  • Multi-sectional approach
  • Use of appropriate technology
• Pillars of Primary Health Care (PHC)


  • Community participation
  • Inter-sectoral coordination
  • Appropriate technology
  • Support mechanism made available
• Essential elements of Primary Health Care (PHC)

  • Education concerning prevailing health problems and the methods of identifying, preventing, and controlling them
  • Locally endemic disease prevention and control
  • An expanded program of immunization against major infectious diseases
  • Maternal and child health care including family planning
  • Essential drugs arrangement
  • Nutritional food supplement, an adequate supply of safe and basic nutrition
  • Treatment of communicable and non-communicable diseases and the promotion of mental health
  • Safe water and sanitation
• Extended elements of Primary Health Care (PHC) in the 21st century


  • Expanded options of immunizations
  • Reproductive health needs
  • Provision of essential technologies for health
  • Health promotion
  • Prevention and control of non-communicable diseases
  • Food safety and the provision of selected food supplements
• Importance of Primary Health Care (PHC)

  • Stronger primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and universal health coverage
  • Primary health care is well-positioned to respond to rapid economic, technological, and demographic changes, all of which impact health and well-being
  • 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
  • Primary Health Care 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
• 2010 were due to factors outside the health sector (such as, water and sanitation, education, economic growth)
• Primary health care approach

  Draws in a wide range of stakeholders to examine and change policies to address the social, economic, environmental and commercial determinants of health and well-being
• Treating people and communities


  As key actors in the production of their own health and well-being is critical for understanding and responding to the complexities of our changing world
• Primary Health Care


  • Focuses more on quality health service and cost-effectiveness
  • Focuses on "Health for all"
  • Integrates preventive, promotive, curative, rehabilitative and palliative health care services
  • Encourages new connection and community participation
  • Includes services that are readily accessible and available to the community
  • Can be easily accessible by all as it includes services that are simple and efficient with respect to cost, techniques and organization
  • Promotes equity and equality
  • Improves safety, performance, and accountability
  • Advocates on health promotion and focuses on prevention, screening and early intervention of health disparities
  • Is also perceived as an integral part of country's socio-economic development
• 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
• Mitigating 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
• Integrated Management of Childhood Illness (IMCI)
• Communicable Diseases


  • MALARIA
  • FILARIASIS
  • TYPHOID FEVER
  • DYSENTERY
  • CHOLERA
  • MEASLES
  • MUMPS
  • RUBELLA OR GERMAN MEASLES
  • CHICKEN POX
  • POLIOMYELITIS
  • ASCARIASIS
  • ENTEROBIASIS
  • ANCYLOSTOSOMIASIS
  • SCHISTOMIASIS
• MALARIA


  • Causative Agent: Plasmodium falciparum, vivax, ovale, malariae (Protozoa)
  • Signs and Symptoms: Recurrent fever preceded by chills and profuse sweating, malaise, anemia
  • Mode of Transmission: Vector (female Anopheles mosquito)
  • Incubation Period: 7 days or longer
• MALARIA Laboratory/Diagnostic Examination


  • History of having been in a malaria endemic area: Palawan and Mindoro
  • Blood smear
• MALARIA Treatment


  • Chloroquine phosphate 250 mg--all species except P. malariae
  • Sulfadoxine 50 mg-For resistant P. falciparum
  • Primaquine-For relapse P. vivax and P. ovale
  • Pyrimethamine 25 mg/tab
  • Quinine sulfate 300 mg/tab
  • Tetracycline HCl 250 mg/cap
  • Quinidine sulfate 200 mg/durules
• MALARIA Prevention and Control

  • Mosquito control
  • Chemical methods-use of insecticides
  • Biological methods-stream seeding
  • Zooprophylaxis-larvae-eating fish, farm animals should be kept near the house
  • Environmental methods-cleaning irrigating canals
  • Protective screening of windows and doors of houses
  • Educational methods
  • Mechanical methods-use of fly swats or traps
  • Universal precaution
  • Screening of blood donors
• FILARIASIS


  • Causative Agent: Wuchereria bancrofti, Brugia malayi
  • Mode of Transmission: Bite of mosquito
  • Incubation Period: 8 to 16 months
  • Vector: Aedes poecilus, Culex quinquefasciatus
  • Signs and Symptoms: chills, fever, myalgia, lymphangitis with gradual thickening of the skin (commonly affecting limbs, scrotum) resulting in elephantiasis and hydrocele
  • Laboratory/Diagnostic Examination: Circulating filarial antigen (CFA)-finger prick
  • Treatment: Diethylcarbamazine citrate (Hetrazan)
  • Prevention and Control: Eradication of vectors
• TYPHOID FEVER


  • Causative Agent: Salmonella typhosa
  • Mode of Transmission: ingestion of contaminated food or water with feces or urine of infected individuals
  • Incubation Period: 7 to 14 days
  • Signs and Symptoms: Prodromal: headache, fever, ancrexia, lethargy, diarrhea, vomiting, abdominal pain; Fastigial: ladder-like curve of temperature, rose spots on trunks, spleenomegaly; Defervescence: fever gradually subsides, onset of complications such as hemorrhage, peritonitis
  • Laboratory/Diagnostic Examination: Typhidot test
  • Treatment: Chloramphenicol
  • Prevention and Control: sanitary disposal of feces, practice hand washing, avoid feces, fomites, flies, food, fluids (5 Fs) that carry the infection, immunization with Typhoid vaccine 0.5 ml per IM single dose at any age from 2 years old up
• DYSENTERY


  • Causative Agent: Shigella dysenteriae
  • Mode of Transmission: ingestion of contaminated food or water
  • Signs and Symptoms: High grade fever, colicky abdominal pain with tenderness, diarrhea with straining, bloody mucoid stool
  • Incubation Period: 3-4 days
  • Laboratory/ Diagnostic Examination: Stool examination
  • Treatment: Co-trimoxazole, Chloramphenicol
  • Prevention and Control: Safe water supply, Handwashing
• CHOLERA


  • Causative Agent: Vibrio cholerae (El Tor)
  • Mode of Transmission: ingestion of contaminated food, water, or milk
  • Incubation Period: 1 to 3 days
  • Signs and Symptoms: rapid explosive watery stool and vomiting
  • Laboratory/Diagnostic Examination: Stool Exam
  • Treatment: Tetracycline, Furazolidone
  • Prevention and Control: Boiling and chlorination of water, sanitary disposal of human waste, administer vaccine per orem with a dosage of 1.5 ml at a minimum age of 12 months for 2 doses with 2 weeks interval
• MEASLES


  • Causative Agent: Morbili virus that belongs to the family paramyxoviridae
  • Mode of Transmission: Airborne
  • Incubation Period: 8 to 20 days, average of 10 days
  • Signs and Symptoms: acute onset of fever, rhinitis, conjuctivitis, bronchitis, excessive lacrimation, Koplik's spots (clustered white lesions) on the buccal mucosa, stomatitis, maculo papular rashes that begin on the face and become generalized; can progress into severe complications, including pneumonia, encephalitis and death
  • Laboratory/Diagnostic Examination: tissue culture of naso-pharyngeal secretions and serological testing
  • Treatment: supportive care, antibiotic if with complications like pneumonia
  • Prevention and Control: administer measles vaccine (MMR vaccine) at the age of 9 and 12 months
• MUMPS


  • Causative Agent: Mumps virus from paramyxovirus
  • Mode of Transmission: airborne or droplets, or direct contact with saliva or infected person
  • Incubation Period: 16 to 18 days, range of 14 to 25 days
  • Communicability Period: 2 days before to 4 days after onset of parotitis but range can be 7 days before to 15 days after onset
  • Signs and Symptoms: acute onset of fever, painful swelling of the salivary or parotid glands, headache; complications range from meningo-encephalitis to permanent hearing impairment and orchitis in post pubescent males, but rarely sterility
  • Laboratory/Diagnostic Examination: isolation of virus from oral and throat spray, urine and cerebrospinal fluid
  • Treatment: Supportive care
  • Prevention and Control: Mumps vaccine (MMR vaccine) given at 9 and 12 months
• RUBELLA OR GERMAN MEASLES


  • Causative Agent: Rubella togaviridae virus family
  • Mode of Transmission: Droplet and direct contact with nasopharyngeal secretions of infected person
  • Incubation Period: 10 to 21 days
  • Signs and Symptoms: fever, headache, malaise, maculopapular rash, enlarged post auricular occipital and posterior cervical lymphadenopathy, sore throat, rhinitis, conjunctivitis, bronchitis, forchheimer's spot (small red spots) on the soft palate
  • Laboratory/Diagnostic Examination: serological testing
  • Treatment: supportive care but for exposed pregnant woman in 1" trimester or 2nd trimester, serum immune globulin is administered to protect the fetus
  • Prevention and Control: Rubella vaccine (MMR vaccine) at the age of 9 and 12 months
• CHICKEN POX


  • Causative Agent: Varicella Zoster Virus
  • Mode of Transmission: Direct and indirect contact with droplets from respiratory passages or vesicle fluid
  • Signs and Symptoms: Body malaise, fever, itchy vesiculo-pustular lesions first appearing on the chest and trunk spreading to extremities
  • Incubation Period: 14 to 16 days, range 2 to 3 weeks
  • Treatment: Supportive care, anti-viral drugs
  • Prevention and Control: Immunization (Varivax) for 2 doses at 12 to 18 months
• POLIOMYELITIS


  • Causative Agent: Legio debilitans or polio virus
  • Mode of Transmission: Fecal-oral, droplet
  • Incubation Period: 7 to 21 days
  • Types and Signs and Symptoms: 1. Abortive-fever, sore throat, low-lumbar backache/cervical stiffness on anteflexion of spine; 2. Non-paralytic-recurrence of fever, poker spine, tightness and spasm of hamstring hypersensitiveness of the skin, deep reflexes are exaggerated; 3. Paralytic-with paralysis depending on part affected
  • Laboratory/Diagnostic Examination: Blood and throat culture, stool examination, lumbar tap
  • Treatment: Symptomatic and supportive
  • Prevention and Control: Proper disposal of fecal waste, hand washing, proper preparation of food, and iminunization of oral polio vaccine given for 3 doses starting at the age of 6 weeks with a dosage of 2 drops
• ASCARIASIS


  • Causative Agent: Ascaris lumbricoides (round worm)
  • Mode of Transmission: fecal-oral
  • Incubation Period: 8 weeks
  • Laboratory/Diagnostic Examination: Stool examination
  • Signs and Symptoms: abdominal pain, and passing out of worms
  • Treatment: Mebendazole or Albendazole
  • Prevention and Control: Proper disposal of feces, avoid using feces as fertilizer, handwashing, and proper washing of vegetables before consumption