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By the end of this session the learner should be able to: 1. Understand the PHC specialty e.g., its philosophy and features; its methods and its holistic approach to patient care. 2.List the principles and component of PHC and demonstrate an understanding of their role in patient care in Saudi Arabia 3.Understand the difference between PHC, PC and Family Medicine 4.Demonstrates awareness of the general structure of the health care system in Saudi Arabia

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Case 1 Jamila 55 years old Saudi female, seen in KKUH primary care clinic. She was referred from PHCC with diagnosis of IBS and referred upon patient request. She claimed that she has files in SFH, Military hospital and national guard hospital, she refused to give any further history and demands full unjustified range of investigations.

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Case 2 Nadia 24 years old Saudi female seen in KKUH primary care clinic. You were shocked by seeing skin and bone patient with referral from PHCC with query diagnosis of esophageal carcinoma. The referral was dated 18 months ago. She missed one appointment 7/12 ago because she gave birth to her first child. This appointment was the only available appointment at that time.

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Group task Divide into group of 5 and discuss the 2 cases in regards to these issues: Social equity Nation-wide coverage Self-reliance Inter-Sectoral coordination Peoples involvement in the planning and implementation of health programs

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History of Health Care Services 1926 PHC Taif and Makka 1928 health and emergency services directorate 1931 Ministry of interior (department of health) 1950 establishment of ministry of health (MOH) and hospitals

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What is Primary Health Care? How would you define Primary Health Care?

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Primary health care has been defined by the World Health Organization (WHO, 1978) as: Essential 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. Primary Health Care

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primary health care is It forms an integral part both of the countrys health system, of which it 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 the 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.

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In accordance with Alma-ata (1978) declaration Saudi Arabia decides to adopt PHC approach in 1980 Alm-ata declaration PHC, WORLD HEALTH ORGANIZATION, GENEVA; 1978 Primary health care

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Principles for PHC PHC based on the following principles : Social equity Nation-wide coverage Self-reliance Inter-sectoral coordination Peoples involvement in the planning and implementation of health programs

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Primary Health Care addresses the main health problems in the community, providing: Promotive, Preventive, Curative and Rehabilitative services accordingly.

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Components of Primary Health Care 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

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Components of Primary Health Care (cont) Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Basic laboratory services and provision of essential drugs Training of health guides, health workers and health assistants Referral services

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The Basic Requirements for Sound PHC (the 8 As and the 3 Cs) Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity

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Appropriateness Whether the service is needed at all in relation to essential human needs, priorities and policies. The service has to be properly selected and carried out by trained personnel in the proper way.

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Adequacy The service proportionate to requirement. Sufficient volume of care to meet the need and demand of a community

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Affordability The cost should be within the means and resources of the individual and the country.

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Accessibility Reachable, convenient services Geographic, economic, cultural accessibility

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Acceptability Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.

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Availability Availability of medical care means that care can be obtained whenever people need it.

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Assessability Assessebility means that medical care can be readily evaluated.

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Accountability Accountability implies the feasibility of regular review of financial records by certified public accountants.

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Completeness Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.

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Comprehensiveness Comprehensiveness of care means that care is provided for all types of health problems.

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Continuity Continuity of care requires that the management of a patients care over time be coordinated among providers.

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The current Status of PHC as per Saudi Ministry of Health Stat Book 2010: 33% of PHC centers are equipped with X rays. 72% of PHC centers are equipped with labs. Very basic labs: CBC, EP, VS. INR, Hba1C, Lipid. TSH. Average 27 patients/physician/day, Can reach 72 3155 GPs, 1729 with FM training. Board certified FM (