health for all- primary health care- millennium development goals

Health For All , Primary Health Care and Millennium Development Goals Dr. Ahmed-Refat AG Refat

www.SlideShare.net/AhmedRefat

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HFA, PHC & MDG

Health For All,

Primary Health Care and

Millennium Development

Goals Dr. Ahmed-Refat AG Refat 07/12/20121



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Contents

Alma Ata Declaration- Health for All

Basic Principles of Primary Health care PHC

Components of Primary Health care

Comprehensive Vs. Selective PHC approaches

Selective PHC "GOBI & GOBI-FFF"

Millennium Development Goal -MDGs

The 8 MDG – Facts – Targets

Q & A



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Alma-Ata Declaration &

Primary Health Care



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Declaration of Alma-Ata International Conference on Primary Health Care,

Alma-Ata, USSR, 6–12 September 1978

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth

day of September in the year Nineteen hundred and seventy-eight, expressing 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, hereby makes

the following Declaration:



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I

The Conference strongly reaffirms that 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.

II

The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.



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III

Economic and social development, based on a New International

Economic Order, is of basic importance to the fullest attainment of health

for all and to the reduction of the gap between the health status of the

developing and developed countries. The promotion and protection of the

health of the people is essential to sustained economic and social

development and contributes to a better quality of life and to world peace.



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IV

The people have the right and duty to participate individually and

collectively in the planning and implementation of their health care.

V

Governments have a responsibility for the health of their people which

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

measures. A main social target of governments, international

organizations and the whole world community in the coming decades

should be the attainment by all peoples of the world by the year 2000 of a

level of health that will permit them to lead a socially and economically

productive life. Primary health care is the key to attaining this target as

part of development in the spirit of social justice.



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VI

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. It forms an integral part both

of the country’s 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

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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VII

Primary health care:

1. 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;

2. addresses the main health problems in the community, providing

promotive, preventive, curative and rehabilitative services accordingly;

3. includes at least: education concerning prevailing health problems and

the methods of preventing and controlling them; promotion of food



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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; prevention and

control of locally endemic diseases; appropriate treatment of common

diseases and injuries; and provision of essential drugs;

4. 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;



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5. 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;

6. 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;



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7. relies, at local and referral levels, on health workers, including

physicians, nurses, midwives, auxiliaries 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.

VIII

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.



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IX

All countries should cooperate in a spirit of partnership and service to

ensure primary health care for all people since the attainment of health by

people in any one country directly concerns and benefits every other

country. In this context the joint WHO/UNICEF report on primary health

care constitutes a solid basis for the further development and operation

of primary health care throughout the world.



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X

An acceptable level of health for all the people of the world by the year

2000 can be attained through a fuller and better use of the world’s

resources, a considerable part of which is now spent on armaments and

military conflicts. A genuine policy of independence, peace, détente and

disarmament could and should release additional resources that could

well be devoted to peaceful aims and in particular to the acceleration of

social and economic development of which primary health care, as an

essential part, should be allotted its proper share.



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The International Conference on Primary Health Care calls 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 urges governments, WHO and UNICEF,

and other international organizations, as well as multilateral and bilateral

agencies, nongovernmental 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 calls on all the aforementioned to collaborate in

introducing, developing and maintaining primary health care in

accordance with the spirit and content of this Declaration.



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PRIMARY HEALTH CARE (PHC)

Definition:

PHC is the essential care based on practical, scientifically sound and

socially acceptable method and technology made universally accessible to

individuals and families in the community through their full participation

and at a cost they and the country can afford to maintain in the spirit of self

reliance and self determination.



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BASIC PRINCIPLES OF PRIMARY HEALTH CARE

THE BASIC PRINCIPLES OF PRIMARY HEALTH CARE include:

1. Community participation

2. Intersectoral collaboration

3. Integration of health care programmes

4. Equity

5. Self-reliance.



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1- COMMUNITY PARTICIPATION

Is the wholemark of primary health care, without which it will not succeed.

Community participation is a process by which individuals and family

assume responsibility for their own health and those of the community and

develop the capacity to contribute to their/and the community development.

Participation can be in the area of identification of needs or during

implementation.



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The community needs to participate at village, ward, district or local

government level. Participation is easier at the ward or village level

because the issue of heterogeneity is eliminated.

ADVANTAGES

-It addresses the felt health needs of the people

-It ensures social responsibility among the community

-It ensures sustainability

-It ensures cost sharing

-It ensures enhancement of knowledge

-It encourages intersectoral collaboration



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2- INTER SECTORAL COLLBORATION

This is the coordination of health activities with other sectors; such sectors

include Education, Finance, Agriculture, Information etc. There should be a

working relationship these bodies and the health ministry.

ADVANTAGES

-Overall human development

-It ensures economic development

-It ensures affordability



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3- INTEGRATON OF HEALTH SERVICES

This is defined as coordination of various primary health care components

into a whole programme and made available at all times including referrals.

ADVANTAGES

-It ensures efficient use of all resources and removes areas of wastage.

-It ensures sustainability of programme

-It ensures bye pass phenomenon

-It reduces opportunity cost

-It grantees clients confidentiality



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4- EQUITY

The health care resources available in a given community should not be in

the handle of a few. And resources should be accessible and affordable to

all. It is divided in 3 components:

1. Decentralization of health of services into federal state-local

government-ward levels.

2. The essential drug services and the national drug formulae. making

drugs available at all levels and at low cost.

3. National health insurance scheme-where people contribute to the health

services of those who don’t have or cannot afford.



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5- SELF RELIANCE

This involves the use of technological methods and scientifically sound

and maintain by the community .It can be in terms of human resources,

money or materials.

.

ADVANTAGES OF SELF RELIANCE

-Affordability

-Sustainability

-Acceptability

-Authenticity



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COMPONENTS OF PRIMRY HEALTH CARE

There are 8 components (elements)of primary health care.

1. Immunization: An increasing number of infectious diseases can be

prevented by vaccinations example-measles, Meningitis, Pertusis,

tuberculosis, yellow fever etc

2. Maternal and child care: Pregnant women and women of child bearing

age (15-49 years) are the target group for special care. Children under

5yrs of age are also vulnerable to childhood killer disease. Maternal and

child health clinics are established in Nigeria to take care of these

groups.



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COMPONENTS OF PRIMRY HEALTH CARE- cont's 3. Essential drugs: The most vital drugs should be available and

affordable at all levels.

4. Food and Nutrition: The family’s food should be adequate, affordable

and balanced in nutrients.

5. Education: The community should be informed of health problem and

methods of prevention and control.

6. Illness and injury: Adequate provision of curative services for common

ailments and injuries should be made by the community.

7. Water and sanitation: A safe water supply and the clean disposal of

wastes are vital for health.

8. Vector and reservoirs: Endemic infection diseases can be regulated

through the control or eradication of vectors and animal reservoir.



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The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)

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.

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 patient’s care over

time be coordinated among providers.



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Comprehensive Vs Selective PHC

package

Comprehensive package of PHC included at least the

following:

1) Education on prevailing health problems and methods for

preventing and controlling them

2) Promotion of food supply and proper nutrition

3) An adequate supply of safe water and basic sanitation



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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 drugs.



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Selective Primary Health Care (1978 to Present)

A “selective” approach attacks the most severe public

health problems facing a locality in order to have the

greatest chance to improve health and medical care in less

developed countries.

Selective PHC, or the more frequently used term “vertical

approach”, refers to the implementation of a single disease



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programme that may have a significant impact on reducing

high morbidity and mortality within a short time frame.

Some examples are polio eradication, making pregnancy

safer, immunization programme, control of HIV/AIDS,

tuberculosis and malaria.



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Selective Primary Health Care (1978 to Present)

GOBI & GOBI-FFF

The Alma-Ata Declaration was criticized for being too

broad and idealistic, with an unrealistic timetable. A common

criticism was that saying Health for All by 2000 was not feasible.

The term " Selective PHC meant a package of low-cost, technical

interventions to tackle the main disease problems of poor countries.



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This interventions were known as GOBI, Meaning:

growth monitoring,

oral rehydration techniques,

breast feeding, and

immunizations.

These four interventions appeared easy to monitor and evaluate.

Moreover, they were measurable and had clear targets. Funding

appeared easier to obtain because indicators of success and

reporting could be produced more rapidly.



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GOBI-FFF

Later, some agencies added FFF to the

acronym GOBI, creating GOBI-FFF.

Food supplementation,

Female literacy,

Family Planning



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The Millennium

Development Goals

( MDGs )



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The Millennium Development Goals

(MDGs)

The Millennium Development Goals (MDGs) are eight international

development goals that were officially established following the

Millennium Summit of the United Nations in 2000, following the

adoption of the United Nations Millennium Declaration. All 193

United Nations member states and at least 23 international

organizations have agreed to achieve these goals by the year 2015.

The goals are:

http://en.wikipedia.org/wiki/International_development

http://en.wikipedia.org/wiki/International_development

http://en.wikipedia.org/wiki/Goal

http://en.wikipedia.org/wiki/Millennium_Summit

http://en.wikipedia.org/wiki/United_Nations

http://en.wikipedia.org/wiki/United_Nations_Millennium_Declaration

http://en.wikipedia.org/wiki/United_Nations_member_states

http://en.wikipedia.org/wiki/International_organizations

http://en.wikipedia.org/wiki/International_organizations



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The 8 MDG are:

1. Eradicating extreme poverty and hunger,

2. Achieving universal primary education,

3. Promoting gender equality and empowering women

4. Reducing child mortality rates,

5. Improving maternal health,

6. Combating HIV/AIDS, malaria, and other diseases,

7. Ensuring environmental sustainability, and

8. Developing a global partnership for development.

Each of the goals has specific stated targets and dates for achieving those

targets.

http://en.wikipedia.org/wiki/Extreme_poverty

http://en.wikipedia.org/wiki/Primary_education

http://en.wikipedia.org/wiki/Gender_equality

http://en.wikipedia.org/wiki/Empowerment

http://en.wikipedia.org/wiki/Child_mortality

http://en.wikipedia.org/wiki/Maternal_health

http://en.wikipedia.org/wiki/HIV/AIDS

http://en.wikipedia.org/wiki/Malaria

http://en.wikipedia.org/wiki/Sustainability



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Goal 1: Eradicate extreme poverty and hunger

Quick facts

The proportion of people living on less than $1.25 a day fell from 47

per cent in 1990 to 24 per cent in 2008.

Women are far more likely than men to be engaged in vulnerable

employment

The numbers of malnourished have stabilized since 1990

Progress in relieving food deprivation has slowed or stalled in many

regions

Countries in sub-Saharan Africa were the hardest hit by the food and

financial crises



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Goal 1: Eradicate extreme poverty and hunger-cont's

Nearly one in five children under age five in the developing world is

underweight

Differences in undernutrition found between rural and urban children

are largest in Latin America and the Caribbean

Poverty is a major determinant of undernutrution in children in all

regions

The number of refugees and of the displaced remains high, even with

an upturn in repatriation in 2011



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Targets of this goal:

Target 1A: Halve the proportion of people living on less than $1 a day

Proportion of population below $1 per day (PPP values)

Poverty gap ratio [incidence x depth of poverty]

Share of poorest quintile in national consumption

Target 1B: Achieve Decent Employment for Women, Men, and Young

People

GDP Growth per Employed Person

Employment Rate

Proportion of employed population below $1 per day (PPP values)

Proportion of family-based workers in employed population



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Target 1C: Halve the proportion of people who suffer from hunger

Prevalence of underweight children under five years of age

Proportion of population below minimum level of dietary energy

consumption[12]



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Goal 2: Achieve universal primary education

Quick Facts

Progress on primary school enrolment has slowed since 2004, even

as countries with the toughest challenges have made large strides.

More than half of all out-of-school children are in sub-Saharan Africa

Success at the primary level places increased demands on secondary

schools

Illiteracy still holds back more than 120 million young people



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Goal 2: Achieve universal primary education Targets of this goal:

Target 2A: By 2015, all children can complete a full course of primary

schooling, girls and boys

Enrollment in primary education

Completion of primary education

everyone will get into school





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Goal 3: Promote gender equality and empower women

Quick Facts

Parity is achieved in developing world primary schools, even though

some regions lag behind

Gender disparities emerge at different points through the education

system

Girls from the poorest households face the highest barriers to

education

Equal access to job opportunities remains a distant target for women

in some regions

Women, more often than men, turn to the informal economy



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Goal 3: Promote gender equality and empower women Targets of this goal:

Target 3A: Eliminate gender disparity in primary and secondary

education preferably by 2005, and at all levels by 2015

Ratios of girls to boys in primary, secondary and tertiary education

Share of women in wage employment in the non-agricultural

sector

Proportion of seats held by women in national parliament.



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Goal 3: Promote gender equality and empower women Targets of this goal:

For girls in some regions, education remains elusive. Poverty is a major barrier to education, especially among older

girls. Women are largely relegated to more vulnerable forms of

employment. Women are over-represented in informal employment, with its lack

of benefits and security. Top-level jobs still go to men — to an overwhelming degree. Women are slowly rising to political power, but mainly when

boosted by quotas and other special measures.



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Goal 4: Reduce child mortality rates

Quick Facts

Globally, deaths within the first month of life fell from 32 per 1,000 live

births in 1990 to 23 in 2010.

Since 1990, in the developing regions, the mortality rate of under-five

years old has declined by 35 percent, from 97 deaths per 1,000 births

to 63.

Sub- Saharan Africa has doubled its average rate of child mortality

reduction from 1.2 percent a year during 1990-2000, to 2.4 percent

during 2000-2010.



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Sub-Saharan Africa suffers though a higher neonatal mortality rate (35

deaths per 1,000 live births in 2010) than any other region, and has

recorded the least improvement over the last two decades.

Children in the developing regions as a whole, are twice as likely to

die before their fifth birthday as children in the richest 20 percent of

households.

Sub-Saharan Africa had a 85 percent drop in measles deaths

between 2000 and 2010.



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Goal 4: Reduce child mortality rates Targets of this goal:

Target 4A: Reduce by two-thirds, between 1990 and 2060, the under-

five mortality rate

Under-five mortality rate

Infant (under 1) mortality rate

Proportion of 1-year-old children immunized against measles[16]

http://en.wikipedia.org/wiki/Child_mortality

http://en.wikipedia.org/wiki/Infant_mortality

http://en.wikipedia.org/wiki/Measles

http://en.wikipedia.org/wiki/Measles



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Goal 5: Improve maternal health

Quick Facts

An estimated 287,000 maternal deaths occurred in 2010 worldwide, a

decline of 47 percent from 1990.

The regions with the highest maternal mortality, sub Saharan Africa

and Southern Asia, are also those with the lowest coverage of births

attended by skilled health personnel—less than half.

The rural-urban gap in skilled care during childbirth has narrowed.

The number of maternal deaths per 100,000 live births is down from

440 in 1990 to 240 in 2010, for the developing regions as a whole.



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hile Southern Africa reported almost universal coverage in 2010, in

West Africa about one-third of women did not receive antenatal care

visits.

The use of contraception is lowest among the poorest women and

those with no education.

More than half of all women aged 15 to 49 who were married or in a

union were using some form of contraception in 2010 in all regions

except sub-Saharan Africa and Oceania.

Fewer teens are having children in most regions, but progress has

slowed.

Maternal health coverage has progressively increased in developing

regions from 63 percent in 1990 to 71 percent in 2000, and then to 80

percent in 2010.



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Goal 5: Improve maternal health


Target 5A: Reduce by three quarters, between 1990 and 2015, the

maternal mortality ratio

Maternal mortality ratio

Proportion of births attended by skilled health personnel

Target 5B: Achieve, by 2015, universal access to reproductive health

Contraceptive prevalence rate

Adolescent birth rate

Antenatal care coverage

Unmet need for family planning.

http://en.wikipedia.org/wiki/Maternal_death

http://en.wikipedia.org/wiki/Reproductive_health

http://en.wikipedia.org/wiki/Family_planning

http://en.wikipedia.org/wiki/Family_planning



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Goal 6: Combat HIV/AIDS, malaria, and other diseases

Quick facts

In sub-Saharan Africa, annual new infections in 2011 reached 1.7

million people, including 300,000 children. This is 21 percent lower

than the 1997 peak and 15 percent lower than in 2001.

The number of people dying of AIDS- related causes fell to 1.7 million

in 2011, a decline of 24% since the peak in 2005.

At the end of 2011, an estimated 8 million people people were

receiving antiretroviral therapy for HIV or AIDS in low- and middle-



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income countries, up from 6.6 million people in 2010 and up from just

400 000 in 2003.

HIV incidence and prevalence is substantially lower in Asia than in

some other regions. But the absolute size of the Asia population

means it has the second largest number of people living with HIV.

57% of HIV-positive pregnant women received treatment to prevent

HIV transmission to their child in 2011.

The estimated incidence of malaria globally has decreased by 17

percent since 2000, and malaria-specific mortality rates by 25 percent.



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Goal 6: Combat HIV/AIDS, malaria, and other diseases Targets of this goal:

Target 6A: Have halted by 2015 and begun to reverse the spread of

HIV/AIDS

HIV prevalence among population aged 15–24 years

Condom use at last high-risk sex

Proportion of population aged 15–24 years with comprehensive

correct knowledge of HIV/AIDS

Target 6B: Achieve, by 2010, universal access to treatment for

HIV/AIDS for all those who need it

http://en.wikipedia.org/wiki/HIV

http://en.wikipedia.org/wiki/AIDS



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Proportion of population with advanced HIV infection with access

to antiretroviral drugs

Target 6C: Have halted by 2015 and begun to reverse the incidence

of malaria and other major diseases

Prevalence and death rates associated with malaria

Proportion of children under 5 sleeping under insecticide-treated

bednets

Proportion of children under 5 with fever who are treated with

appropriate anti-malarial drugs

Incidence, prevalence and death rates associated with

tuberculosis

Proportion of tuberculosis cases detected and cured under DOTS

(Directly Observed Treatment Short Course).

http://en.wikipedia.org/wiki/Malaria



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Goal 7: Ensure environmental sustainability

Quick Facts

The net loss worldwide of forests decreased over the last 20 years,

from -8.3 million hectares per year in the 1990s to -5.2 million

hectares per year in the last decade.

Overexploitation of global fisheries has stabilized, but steep

challenges remain to ensure their sustainability.

The number of people who do not use any facility and resort to open

defecation has decreased by 271 million since 1990. But there remain

1.1 billion people, or 15 percent of the global people with no sanitation

facilities at all.



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The number of people using improved drinking water sources reached

6.1 billion in 2010, up by over 2 billion since 1990.

In 2010, 89 percent of the world’s population was using improved

water sources, up from 76 percent in 1990.

The share of urban slum residents in the developing world declined

from 39 percent in 2000 to 33 percent in 2012.

More than 200 million people gained access to improved water

sources , improved sanitation facilities, or durable or less crowded

housing.

Slum prevalence remains high in sub-Saharan Africa and increase in

countries affected by conflict.



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Target 7A: Integrate the principles of sustainable

development into country policies and programs;

reverse loss of environmental resources


Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant

reduction in the rate of loss

Proportion of land area covered by forest

CO2 emissions, total, per capita and per $1 GDP (PPP)

Consumption of ozone-depleting substances

Proportion of fish stocks within safe biological limits

http://en.wikipedia.org/wiki/Sustainable_development

http://en.wikipedia.org/wiki/Sustainable_development

http://en.wikipedia.org/wiki/Biodiversity

http://en.wikipedia.org/wiki/CO2_emission

http://en.wikipedia.org/wiki/Ozone-depleting_substance



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Proportion of total water resources used

Proportion of terrestrial and marine areas protected

Proportion of species threatened with extinction

Target 7C: Halve, by 2015, the proportion of the population without

sustainable access to safe drinking water and basic sanitation (for

more information see the entry on water supply)

Proportion of population with sustainable access to an improved

water source, urban and rural

Proportion of urban population with access to improved sanitation

Target 7D: By 2020, to have achieved a significant improvement in

the lives of at least 100 million slum-dwellers

Proportion of urban population living in slums.

http://en.wikipedia.org/wiki/Threatened_species

http://en.wikipedia.org/wiki/Sanitation

http://en.wikipedia.org/wiki/Water_supply

http://en.wikipedia.org/wiki/Improved_water_source

http://en.wikipedia.org/wiki/Improved_water_source

http://en.wikipedia.org/wiki/Improved_sanitation

http://en.wikipedia.org/wiki/Slum

http://en.wikipedia.org/wiki/Slum



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Goal 8: Develop a global partnership for development

Quick facts

Official development assistance stands at 0.31 per cent of the

combined national income of developed countries, still far short of the

0.7 per cent UN target.

Aid to the African continent increased by 0.9 percent to 31.4 billion in

2011, but remains below expectations.



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Developing countries gain greater access to the markets of developed

countries.

In 2011, 75 percent of the worldwide mobile cellular subscriptions

were in the developing regions, up from 59 percent in 2006.

By the end of 2011, over 160 countries in the world had launched 3G

mobile broadband services and 45 percent of the population

worldwide was covered by a high-speed mobile broadband signal.

The developing world share of the world’s Internet users rose to 63

percent in 2011, when 35 percent of the world was online.

Only 1 in 6 people in the developing world has access to the Internet.



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Goal 8: Develop a global partnership for development Targets of this goal:

Target 8A: Develop further an open, rule-based, predictable, non-

discriminatory trading and financial system Includes a commitment to good governance, development, and

poverty reduction – both nationally and internationally Target 8B: Address the Special Needs of the Least Developed

Countries (LDC) Includes: tariff and quota free access for LDC exports; enhanced programme of debt relief for HIPC and cancellation of official bilateral debt; and more generous ODA (Official Development Assistance) for countries committed to poverty reduction

http://en.wikipedia.org/wiki/Good_governance

http://en.wikipedia.org/wiki/Poverty_reduction

http://en.wikipedia.org/wiki/Debt_relief



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Target 8C: developing countries through national and international

measures in order to make debt sustainable in the long term Target 8E: In co-operation with pharmaceutical companies, provide

access to affordable, essential drugs in developing countries

Proportion of population with access to affordable essential drugs on a sustainable basis

Target 8F: In co-operation with the private sector, make available the

benefits of new technologies, especially information and communications

Telephone lines and cellular subscribers per 100 population Personal computers in use per 100 population Internet users per 100 Population.

http://www.un.org/millenniumgoals/

http://www.undp.org/content/undp/en/home/mdgoverview/

http://www.un.org/millenniumgoals/

http://www.undp.org/content/undp/en/home/mdgoverview/



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Q & A

http://www.searo.who.int/LinkFiles/Primary_and_Community_Health_Care_SEA-HSD-338.pdf



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What is primary health care? How is it different from

primary care?



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Primary health care (PHC) is a broad and comprehensive

concept approach to health development.

It forms an integral part of both the country’s health

system

It is the first level of contact of individuals.

Primary care refers only to the first level of contact or

close-to-client health care.



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In rural areas, this contact is usually with the health

centre, health subcentre, health post or private practitioner

(doctor, nurse or midwife).

In urban areas, a majority of the middle- and upper-income

group visit a private practitioner, who may be a general

practitioner or a specialist, or go directly to a hospital.

In many countries, the so-called family doctor serves as the

first point of contact. Primary care is an integral component

of primary health care.



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Do developed countries also adopt PHC for health

development?



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Yes, they do.

In fact, PHC is a universal concept for health development,

as articulated in its definition.



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The last part of the PHC definition says that it is “a

continuing health-care process”. What does this

mean?



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A “continuing health-care process” implies that health care

does not stop at the primary level of care or at the first

point of contact. If more comprehensive or sophisticated

care is needed, the patient will be referred to a higher level

of care – either secondary or tertiary.



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How do we define equity in health?



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WHO has operationally defined “equity in health” as

“minimizing avoidable disparities in health and its

determinants – including but not limited to health care –

between groups of people who have different levels of

underlying social attributes”.

WHO’s definition of “equity in health” encompasses two

different aspects.



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means the attainment by

all citizens of the highest possible level of physical,

psychological and social well-being.

-care resources

are allocated according to need; health care is provided in

response to the legitimate expectations of the people;

health services are received according to need regardless of

the prevailing social attributes, and payment for health

services is made according to the ability to pay.



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How does PHC aim to address inequities in health?



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PHC addresses inequity in health by advocating the following

approaches:

i) universal coverage,

ii) intersectoral collaboration,

iii) community participation, and

iv) appropriate technology.



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How can we define “health system”?



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A health system consists of all organizations, people and

actions whose primary intent is to promote, restore or

maintain health. This includes efforts to influence the

determinants of health as well as more direct health-

improving activities.



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What is the difference between health system and health care

service?



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Health systems are much broader than health services.

Health services refer to medical and public health services

provided by both the government (the health sector) and the

private sector. They cover modern and traditional medicine

as well as services provided by the community.



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How can we define “Health for All”?



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Health for All (HFA) is a social goal. HFA aims at providing

the highest possible level of health to all people so that

they are able to live a socially and economically productive

life.

HFA can be defined as: a stage of health development

whereby everyone has access to quality health care or will

practise self-care protected by financial security so that no

individual or family experiences catastrophic expenditure

that may bring about impoverishment.1 HFA is a process



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leading to progressive improvement in the health of the

people. It translates into the following:

a. People will be enabled to use better approaches to

prevent disease and alleviate unavoidable disease and

disability through the life course.

b. Available resources for health will be evenly distributed

among the population.



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c. Essential health care will be accessible to all individuals

and families in an acceptable and affordable way, and with

their full involvement.

d. People will realize that they themselves have the power

to shape their lives and the lives of their families. They will

be free from the avoidable burden of disease, and aware

that ill-health is not inevitable.



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There are so many technical terms in the definition of health system using the

PHC approach. Compare comprehensive and selective

care?



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In 1978, the comprehensive package included at least the

following:

1) Education on prevailing health problems and methods for

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



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6) Prevention and control of locally endemic diseases

7) Appropriate treatment of common diseases and injuries

8) Provision of essential drugs.

A “selective” approach attacks the most severe public

health problems facing a locality in order to have the

greatest chance to improve health and medical care in less

developed countries.



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Selective PHC, or the more frequently used term “vertical

approach”, refers to the implementation of a single disease

programme that may have a significant impact on reducing

high morbidity and mortality within a short time frame.

Some examples are polio eradication, making pregnancy

safer, immunization programme, control of HIV/AIDS,

tuberculosis and malaria.

What is Equity ? is an ethical concept that eludes a

precise definition.



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Synonyms are social justice and fairness, which again, could

be taken to mean different things by people at different

times. Equity usually deals with a predetermined standard or

norm, which is considered “just” or “fair”.

There are three dimensions of equity:

Focus: Equity in health mainly focuses on the health of the

vulnerable population in absolute rather than relative terms.

A policy or programme aimed at improving the health of the

most vulnerable would be seen as being equitable.



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Inclusion: No one in the community should be left out. In

this view, a health policy that does not provide health care

to certain population groups, e.g. people living in thinly

settled, remote, mountainous, island or desert areas would

be inequitable.

Narrowing gaps: Equity measurement identifies the relative

and absolute gaps in health status. Thus, a policy that

improves the health of the best off more than anyone else

would not be considered equitable.



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Equality: Equality does not take into account whether the

existing disparity/gap/difference is “fair or just”. In

practice, the terms equity and equality are used

interchangeably.



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What is the difference between allocative inefficiency and

technical inefficiency?



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Allocative inefficiency occurs when more health funds are

allocated towards less cost-effective interventions. For

example, allocating an unnecessary amount of funds to

medical care as opposed to public health interventions would

qualify as allocative inefficiency. Overall, public health

interventions (disease prevention and health promotion) are

more cost-effective than medical care (treatment of cases

and rehabilitation of disabilities).



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Technical inefficiency is said to occur when we choose

sophisticated technologies that may be unnecessary instead

of available and appropriate technology.



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What is it the relationship

between PHC and the

Millennium Development

Goals?



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The Millennium Development Goals are a commitment made by the world's

nations to improve the health and well-being of people throughout the world,

including reducing poverty, infant and maternal mortality and the spread of

HIV by 2015. Within the framework of PHC as a strategy aimed at improving

the living conditions of communities, reducing the burden of disease, and

favoring equity in health, the principles the PHC need to be aligned,

harmonized, and adjusted along these goals. Due to its capacity for

strengthening health services, PHC can become a basic strategy for the

achievement of these internationally agreed-upon objectives.



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Cited References

1. World Health Organization Regional Office for South-East Asia. Strengthening health systems based on primary health care approach. New Delhi,

WHO SEARO, 2007. Pyongyang, Democratic People Republic of Korea, 18–20 April 2007. (SEA-HSD-298). Available at: http://203.90.70.117/PDS_DOCS/B0583.pdf

2. World Health Organization Regional Office for South-East Asia. The Regional six-point strategy for health systems strengthening based on primary health care approach. New Delhi, World Health Organization Regional Office for South-East Asia, 2007 (SEA-HSD-305). Available at: http://203.90.70.117/PDS_DOCS/B0684.pdf

3. World Health Organization Regional Office for South-East Asia. Revisiting community-based health workers and community health volunteers. New Delhi, WHO SEARO, 2008 (SEA-HSD-309). Chiang Mai, Thailand, 3–5 October 2007. Available at: http://www.searo.who.int/LinkFiles/Publications_HSD -



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4. World Health Organization Regional Office for South-East Asia. Strategic directions for strengthening community-based health workers and community health volunteers in the South-East Asia Region. New Delhi, World Health Organization Regional Office for South-East Asia, 2008 (SEA-HSD-311). Available at: http://www.searo.who.int/LinkFiles/Publications_HSD-311-Regional_Strategy_CBHWs_CHVs.pdf

5. World Health Organization Regional Office for South-East Asia. Accelerating progress towards achieving maternal and child health Millennium Development Goals (MDGs) 4 and 5 in South-East Asia. New Delhi, WHO SEARO, 2009 (SEA-CHD-7). Ahmedabad, India, 14–17 October 2008. Available at: http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdf

6. World Health Organization Regional Office for South-East Asia. Revitalizing primary health care. New Delhi, SEARO, 2008 (SEA-HSD316). Jakarta, Indonesia, 6–8 August 2008. Available at: http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-316.pdf

7. World Health Organization Regional Office for South-East Asia. Self-care in the context of primary health

care. New Delhi, SEARO, 2009 (SEA-HSD-320). Bangkok, Thailand, 7–9 January 2009. Available at: http://www.searo.who.int/LinkFiles/Health_System_Strengthening_SEA-HSD-320.pdf



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8. World Health Organization Regional Offices for South-East Asia and the Western Pacific. The application of

sociocultural approaches to accelerate the achievement of MDGs 4 and 5. New Delhi/Manila, WHO SEARO/WPRO, 2009 (SEA-MCH-256). Bali, Indonesia, 11–13 August 2009.

9. World Health Organization Regional Office for South-East Asia. Health care reform for the twenty-first century in the South-East Asia Region. New Delhi, WHO SEARO, 2009 (SEA-HSD-329). Bangkok, Thailand, 20–

22 October 2009. Available at: http://www.searo.who.int/LinkFiles/Reports_SEA-HSD-329.pdf

10. World Health Organization Regional Office for South-East Asia. The use of herbal medicines in primary health care. New Delhi, WHO SEARO, 2009 (SEA-HSD-322). Yangon, Myanmar, 10–12 March 2009. Available at: http://203.90.70.117/PDS_DOCS/B4260.pdf

11. World Health Organization Regional Office for South-East Asia. Teaching of public health in medical

schools. New Delhi, WHO SEARO, 2010 (SEA-NUR-465). Bangkok, Thailand, 8–10 December 2009. Available at: http://203.90.70.117/PDS_DOCS/B4507.pdf 12. World Health Organization Regional Office for South-East Asia. Decentralization of health care services. New Delhi, WHO SEARO, (in preparation). Bandung, Indonesia, 6–8 July 2010. –

http://www.undp.or.id/mdg/documents/MDG%20Indicators-UNDG.pdf

http://www.undp.or.id/mdg/documents/MDG%20Indicators-UNDG.pdf



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health for all- primary health care- millennium development goals

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