PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE

SERVICES

WHO defines PHC as essential health care made universally accessible to individuals &
families in the community by means acceptable to them through their full participation and at a
cost that the community and country can afford at every stage of development.

Primary Health Care was declared during the First International Conference on Primary
Health Care held in Alma Ata, USSR on September 6-12, 1987 by WHO. The goal was “Health
for All by the year 2000”. This was adopted in the Philippines through Letter of Instruction 949
signed by President Marcos on October 19, 1979 and has an underlying theme of “Health in the
Hands of the People by 2020.”

The concept of PHC is characterized by partnership and empowerment of the people that
shall permeate as the core strategy in the effective provision of essential health services that are
community based, accessible, acceptable and sustainable at a cost which the community and the
government can afford.

It is strategy, which focuses responsibility for health on the individual, his family and the
community. It includes the full participation and active involvement of the community towards
the development of self-reliant people, capable of achieving an acceptable level of health and
well being. It also recognizes the interrelationship between health and the overall political, socio-
cultural and economic development of society.

ELEMENTS/COMPONENTS OF PRIMARY
HEALTH CARE

1. Environmental Sanitation (adequate supply

of safe water and good waste disposal)
2. Control of Communicable Diseases
3. Immunization
4. Health Education
5. Maternal and Child Health and Family
Planning
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency
Treatment
8. Treatment of Locally Endemic Diseases
9. Provision of Essential Drugs

STRATEGIES
1. Reorientation and reorganization of the national health care system w/the
establishment of functional support mechanism in support of the mandate of
devolution under the Local Government code of 1991.
2. Effective preparation & enabling process for health action at all levels.
 3. Mobilization of the people to their communities & identifying heir basic health
needs w/the end in view of providing appropriate solutions (including legal
measures) leading to self-reliance & self determination.
4. Development & utilization of appropriate technology focusing on local
indigenous resources available in & acceptable to the community.
5. Organization of communities arising from their expressed needs which they have
decided to address & that this is continually evolving in pursuit of their own
development.
6. Increase opportunities for community participation in local level planning,
management monitoring & evaluation w/in the context of regional & national
objectives.
7. Development of intra-sectoral linkages w/other government & private agencies so
that programs of the health sector is closely linked w/ those of other socio-
economic sectors at the national, intermediate & community levels.
8. Emphasizing partnership so that the health workers & the community
leaders/members view each other as partners rather than merely providers &
receiver of health care respectively.

4 CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE

1. Active community participation
2. Intra & inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

TYPES OF PRIMARY HEALTH CARE WORKERS

Various categories of health workers make up the primary health care team. The types vary in
different communities depending upon:
 Available health manpower resources
 Local health needs & problems
 Political & financial feasibility

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS HAVE BEEN IDENTIFIED

1. Village or Barangay Health Workers (V/BHWs)- This refers to trained community
health workers or health auxiliary volunteer or a traditional birth attendant or healer.
2. Intermediate level health care workers- General medical practitioners or their
assistants. Public Health Nurse, Rural Sanitary Inspectors and Midwives may
compose these groups.

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

1. Primary Level of Care
-Primary care is devolved to the cities and the municipalities. It is health care
provided by center physicians, public health nurses, rural health midwives, barangay
health workers, traditional workers, traditional healers and others at the barangay
health stations and rural health units. The primary health facility is usually the first
contact between the community members and the other levels of health facility.
 2. Secondary Level of Care
-Secondary care is given by physicians w/basic health training. This is usually given
in health facilities either privately owned or government operated such as infirmaries,
municipal & district hospitals & out-patient departments of provincial hospitals. This
serves as a referral center for the primary health facilities. Secondary facilities are
capable of performing minor surgeries & perform some simple laboratory
examinations.

3. Tertiary level of Care

-Tertiary care is rendered by specialists in health facilities including medical centers
as well as regional & provincial hospitals, & specialized hospitals such as the
Philippine Heart Center. The tertiary health facility is the referral center for the
secondary care facilities. Complicated cases & intensive care requires tertiary care &
all these can be provided by the tertiary care facility.

LEVELS OF HEALTH CARE SERVICES

Health problems that are beyond the capability of PHC units & beyond the competence of
PHC workers are referred to an intermediate health facility, usually a Rural Health Unit (RHU)
located in a town or poblacion. The RHU team generally consists of the physician, dentist public
health nurse, midwife, sanitarian & other health workers. The District Community Hospital
attends to cases needing hospitalization. Higher echelons of health services at the provincial,
regional and national levels, provide secondary or tertiary care to complete the health care given
at district & peripheral levels.

The higher the level, the more qualified the health personnel & the more sophisticated the
health equipment. Under this structure, health care is provided by the suitable health facility on
the basis of health need. There is better utilization of scare health resources.

More than ever, primary health care puts the concept of teamwork to the fore. Team
planning by health personnel in the same level & the various health levels will be essential for
the effectiveness & efficiency of health services. For example, as a nurse you will plan family
health care with the midwife and community health workers. Together , you will set common
objective, delineate task, allocate resources and evaluate family services. You may need to
consult the hospital nurse for referral of seriously ill patients or coordinate with the sanitary may
need to plan with the Chief Nurse of a public health agency regarding a home care program.
Likewise, the Medical Health Officer plans priority community health programs with the others
members of the health team.

Teamwork in primary health care entails joint planning, implementation, and evaluation of
community’ activities by the team members with- the community health needs/problems as bases
of action. Joint efforts in the implementation of health programs is demonstrated by the health
team in the expanded immunization program where the nurse as team leader works with the
midwife and other community health workers.
Levels of Health Care & Referral System

National
Health Services
Medical Centers
Teaching &
Training Hospitals

Regional Health Services

Regional Medical Centers
& Training Hospitals

Provincial/ City Health Services

Provincial / City Hospitals
Emergency/ District Hospitals

Rural Health Unit

Community Hospitals & Health Centers
Private Practitioners/ Puericulture Centers

Barangay Health Stations