Primary Health Care

"comprehensive" primary health care reflects deep differences in political interests and social policies. Primary health care is envisaged as a general solution for all types of communities and all people. It was repeatedly stated that primary health care approach should be the general answer to health needs of all people, regardless whether they live in better developed areas or in poor and underprivileged circumstances, in urban or in rural settings. However, very often primary health care is wrongly conceived as a special project for delivery of health services for poor rural population. Some of these population groups really need to have priority, but they should not be considered in isolation. Primary health care is not a second class service for the underprivileged.

T he concept of primary health care supervision may be compared to a roadworthy car whose owner constantly ensures that it transports people safely to the desired destination. Obviously the status of a car, particularly its safety and quality, must comply with prescribed standards. No part of the car can perform its intended function without interacting with the other parts. The parts, as well as their condition, are important and therefore need frequent monitoring and maintenance. Some parts can be checked only after the car has done a certain mileage. If the parts are not maintained as they should be, there is always a failure of some sort in the way the car functions. When car parts and fuel malfunction this could result in a fatal car accident, which would impact negatively on all the passengers and possibly on other road users.

Introduction The broad range of activities contained in the provision of Primary Health Care (PHC) places a burden on providers to make optimal use of limited resources to achieve maximal health benefit to the population served. 1 All too often, ‘ad hoc’ decisions and personal preferences guide PHC resource allocations, making accountability for results impossible. 2 An orderly collection of key information about health needs and service provision can transform PHC services to focus resources on the most effective activities, and therefore offer guidance to managers and providers, as well as provide clear evidence of impact. 3 Cost-effective decisions are guided by accurate and timely information, while supervisory oversight becomes objective and supportive to reach agreed targets.

Advantages and disadvantages of PHC models Participants described both advantages and disadvan- tages of the new PHC models. Overall they believed these models ultimately improved patient care, but for different reasons. For example, prevention was iden- tified as a main advantage: “I’m all for primary health care and preventive medicine, and I think that these models promote that.” Another participant noted the benefit of adding allied health professionals: “Everyone brings a different perspective to the table ... [they]

Management Consultant (Form AB - 5). Authorization for payment under the protocols expires 90 days after the collision unless the insurer approves use of the protocols beyond 90 days If, in the opinion of a primary health care practitioner, adjunct therapy is necessary for the treatment or rehabilitation of the injury and if the adjunct therapy is linked to the continued clinical improvement of the patient/claimant, the claimant may be referred to a massage therapist, acupuncturist, another primary health care practitioner, or perform the treatment themselves. Any treatment visit authorized by the primary health care practitioner will be deducted from the overall visits (10 or 21 as appropriate) and requires a signed copy of form AB-2a. The adjunct therapy provider can submit the form, with the signature of the patient/claimant, for reimbursement directly from the insurer.

• How many staff should be at the front-line: a multidisciplinary team of health workers or one multi-skilled health worker? • How will other sectors be engaged in joint promotion of health in this community? The case study illustrates the point that primary health care is about real health problems of individuals and families in a community. Their health problems usually will require the services of more than one primary health care programme. The choice you have to make is that you either integrate all the PHC programmes into one specific service package or you deliver the services as individual vertical programmes. In the case study cited it is not cost effective to mobilise a team of different health workers, each representing a different vertical programme, to descend on this household! The programmes are better integrated into one package that can be delivered at different service levels (household, clinic, health centre, hospital) using different categories of health workers with different skills.

It recognises the significant activity that already exists to prevent and manage diabetes, and creates a long-term vision to align existing activity and a con- text for new investment, based on evidence and best practice. This is a whole of society programme with ten action areas involving multiple agencies and is a plan for Counties Manukau not just the DHB. While it is branded for diabetes it is hoped the resultant work programme and interventions will deliver healthier lifestyles that will impact on global health significantly impacting on the incidence of obesity and its sequels, cancer and cardiovascular disease as well. Primary Care initiatives such as Diabetes Get Checked, CCM and the continued development of accessible retinal screening and monitoring via com- munity services (as a complication of diabetes) directly support the intent of LBD. The alignment and co dependency for success between LBD and primary care is further evident in that both plans recognise the importance of working in partnership the wider sector. LBD is also leading the way with regard to innovative models of care and finding new ways to design and deliver services to the popula- tion – a key focus of the primary health care Plan.

The future primary health care system will enable people to have continuity of care where it is important, but will not reduce their freedom to choose between different practitioners where this is valuable to them. In the process of enrolling with a Primary Health Organisation, people will also be asked to nominate a practitioner, practice, or provider for continuity of care. 4 There will be some national minimum requirements or protocols that will be fully explained to people at the time they make their choice. These might, for example, include ensuring that enrolled people have access to 24-hours-a-day, seven-days-a-week urgent services; that systems allow people to ask to see a particular practitioner; and that, unless people specifically request otherwise, their nominated provider will receive information about consultations or tests with other practitioners. These protocols will build on the work and advances already made by the Health Funding Authority in this area.

weakness, fear and suffering. Based on this, individuals will need care from a multidisciplinary team to inter- vene and ensure their quality of life and thus solving the problems presented by them [9]. Regarding the health team monitoring ratings related to their health, the majority of respondents rated the monitoring quality as good. Based on the health team monitoring ratings related to the elderly people’s health, it is noticeable that this causality can be explained by the fact of primary health care being understood as a space that shall address the most common problems of the community and provide health promotion, preventive, cura- tive and rehabilitative services able to raise health and the well-being of the population to its maximum, which implies an effective primary health care service and, therefore, monitoring the quality of population’s health.

Primary Health Care • October 19, 1979 - Letter of Instruction (LOI) 949, the legal basis of PHC was signed by then Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level.

The Douglas County Primary Health Care Network (PHCN) Clinic was established in July 1982, to provide outpatient medical care to low-income county residents who a[r]

Objective: To identify the scientific productions about the integrality attribute, in the care of the child, in Primary Health Care services, with the use of the Primary Care Assessment Tool. Method: This is an integrative review.The period of data collection was from June to August of 2018, and the studies were obtained from public domain access: Latin American and Caribbean Literature in Health Sciences, National Library of Medicine/National Institutes of Health, SciVerseScopuse Web Of Science. totaling sixteen productions. For the critical evaluation of the primary studies the classification of the level of evidence was used. Results: The results showed weaknesses related to the evaluation of integrality in primary health care, because it is inefficient due to the adequate application of the variety of services available and provided.Already as potentialities, the importance of an adequate evaluation of the real needs of the population stands out so as to offer an integral and humanized care that is determinant factor in the supply and support the necessary attention in the context of the health of the child. Conclusion: It is concluded that there is a need for improvement in the assistance practices related to the integrality attribute, in the child's health. It is suggested, more attention of the health services in the strengthening of the bond and dialogue between professionals and users to stimulate the promotion, protection and recovery of health.

activities should be monitored to facilitate budgeting and planning. In this chapter, a methodology for estimating and reporting the costs of waste management at primary health care facilities is outlined. Waste generation As seen in previous chapters, the most optimal solution for waste management varies between PHC centres, depending on the amount of waste generated and on the opportunities for transporting waste to a nearby treatment facility. The first step is therefore to define the amounts of waste generated in the facility. It is recommended to count the number of safety boxes and kilos of waste managed during a period of at least 1 month and if possible 3 months to ensure that any periodical variations are accounted for. The annual amount of waste managed should be estimated from the figures obtained during the monitoring phase.

PHEPA P rimary H ealth care E uropean P roject on A lcohol 1 The Primary Health Care European Project on Alcohol What’s the aim of the Phepa Project? The project aims to integrate health promotion interventions for hazardous and harmful alcohol consumption into primary health care professionals’ daily clinical work. It will achieve this by preparing: European recommendations and clinical guidelines on best practice for health care purchasers and providers; a training program for primary health care professionals; a comprehensive Internet site database on good practice, providing the evidence base in the domains of efficacy, economics, health outcomes and policy; and a series of country specific dissemination strategies. The aims support the European Community’s Public Health strategy and the European Charter on Alcohol and the European Alcohol Action Plan, of the World Health Organisation.

The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional inte- gration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. (J Am Board Fam Med 2012;25:S18 –26.)

Abstract Appropriate application of information technology in primary health care will extend traditional diagnosis and patient management beyond the doctor’s clinic into the everyday living environment. We describe a model of information management in primary health care, and place special emphasis on the emerging areas of clinical decision support, computerised clinical measurements, patient education and network connectivity. Briefly discussed is the design of innovative home monitoring techniques and a telemedicine based communications infrastructure that should improve access to high quality primary health care for all citizens, irrespective of their distance from major urban centres. A preliminary design for a telemedicine-assisted primary health care network is presented, based on this model of information management. The premise is that improvements in health care services and reductions in health care costs can be effected by establishing a continuum of patient care from the patient’s home, to the doctor’s surgery, to speciality services in hospitals and to other service providers in the health care sector. While, the proposal focuses on new opportunities arising from the imminent introduction of broad band interactive fibre optic networks throughout Australia, the technology and projected data transfers could easily be handled in the short-term using modem access to the standard telephone network. A simple connectivity scheme for system integration is also presented. © 1999 Elsevier Science Ireland Ltd. All rights reserved.

South Africa’s nutrition strategies in a Primary Health Care framework The extent of the problem of chronic malnutrition (including both under- and over-nutrition) in South Africa suggests that action is needed at all levels of causation as summarised in the conceptual framework (in Figure 2). From a PHC perspective, the situation requires a set of comprehensive actions, which span therapeutic intervention (i.e. treatment), rehabilitation, disease prevention and health promotion, with an emphasis on the social determinants of nutritional health. Documenting the impact of broader political and economic forces on the health and nutritional status of the population served, working cooperatively with other sectors and the communities involved, raising awareness of local and global issues impacting on food production and supply, and advocating for policy change in relation to these issues are essential aspects of comprehensive PHC. Examples of elements of a comprehensive PHC approach that would address the immediate, underlying and basic causes of malnutrition, to ensure adequate and health-promoting nutrition are provided in Table 3. Promotive strategies focus on addressing underlying and basic causes of malnutrition and often involve intersectoral actions and public health policies, including sectors such as trade and agriculture.

Don Harterre now has a flying pig gracing his desk at the offices of Primary Health Care Services of Peterborough. From the grassroots movement of eight dedicated doctors meeting every month for a few years, came the establishment of a larger community-wide steering group, headed jointly by Bill Casey and Don Harterre. They both volunteered their time and energy to find a solution to the ailing primary health care service in their region. By now, Dr. Harterre had fully retired from practice to become Chief of Staff at the Peterborough Regional Health Centre.

Comprehensive Primary Health Care Primary health care, which has become known as comprehensive PHC, is defined by the World Health Organisation as: “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.” 6 The philosophy behind PHC is based upon:

Although advancements in service delivery, standards and training have improved the quality and to some extent usage of interpreter services, the lack of agreement on the role of the interpreter continues to create an unstable foundation for further development of the profession. As such, interpreting is still very much at the preliminary stage of its professionalization. Standards development has been local in scope and lacking a national perspective, funding is sporadic, and overarching policy is non-existent. However, the SAPHC project has made great strides at initiating the ongoing work of reforming the primary health care sector through the many activities, outcomes, products and tools of the project. With further work in the interrelated areas of policy development, funding stability, role clarification, risk management and improved professional opportunities for