Primary Health Care

 A new approach to health care came into existence in 1978, following an international conference at Alma-Ata (USSR). This is known as "primary health care". It has all the hallmarks of a primary health care delivery, first proposed by the Bhore Committee in 1946 and now espoused worldwide by international agencies and national governments.

      Before Alma-Ata, primary health care was regarded as synonymous with "basic health services", "fist contact care", "easily accessible care", "services provided by generalists", etc. The Alma-Ata international conference gave primary health care a wider meaning. The Alma-Ata Conference defined primary health care as follows:-

"Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford".

     The primary health care is equally valid for all countries from the most to the least developed, although it takes varying forms in each of them. The concept of primary health care has been accepted by all countries as the key to the attainment of Health for All by 2000 AD. It has also been accepted as an integral part of the country's health system.

Elements of primary health care

    Although specific services provided will vary in different countries and communities, the Alma-Ata Declaration has outlined 8 essential components of primary health care.

1. education concerning prevailing health problems and the methods of 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;
6. prevention and control of locally endemic diseases;
7. appropriate treatment of common diseases and injuries; and
8. provision of essential drugs.

Principles of primary health care 

1.Equitable distribution

    The first key principle in the primary health care strategy is equity or equitable distribution of health services, i.e., health services must be shared equally by all people irrespective of their ability to pay, and all (rich or poor, urban or rural) must have access to health services. At present, health services are mainly concentrated in the major towns and cities resulting in inequality of care to the people in rural areas. The worst hit are the needy and vulnerable groups of the population in rural areas and urban slums. This has been termed as social injustice. The failure to reach the majority of the people is usually due to inaccessibility. Primary health care aims to redress this imbalance by shifting the centre of gravity of the health care system from cities (where three-quarters of the health budget is spent) to the rural areas (where three-quarters of the people live), and bring these services as near people's homes as possible.

2. Community participation

        Notwithstanding the overall responsibility of the Central and State Governments, the involvement of individuals, families, and communities in promotion of their own health and welfare, is an essential  ingredient of primary health care. Countries are now conscious of the fact that universal coverage by primary health care cannot achieved without the involvement of the local community. There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, besides maximum reliance on local resources such as manpower, money and materials. In short, primary health care must be built on the principle of community participation (or involvement).

         One approach that has been tried successfully in India is the use of village health guides and trained ideas . They are selected by the local community and trained locally in the delivery  of primary health care to the community they belong, free of charge. By overcoming cultural and communication barriers, they provide primary health care in ways that are acceptable to the community. It is now considered that "health guides" and trained ideas are an essential feature of primary health care in India. These concepts are revolutionary. They have been greatly influenced by experience in China where community participation in the form of bare-foot doctors took place on an unprecedented scale.

3. Intersectoral coordination

   There is an increasing realization of the fact that the components of primary health care cannot be provided by the health sector alone. The Declaration of Alma-Ata states that "Primary health care 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, communication and others sectors". To achieve such cooperation, countries may have to review their administrative system, reallocate their resources and introduce suitable legislation to ensure that coordination can take place. This requires strong political will to translate values into action. An important element of intersectoral approach is planning-planning with other sectors to avod unnecessary duplication of activities.

4. Appropriate technology

    Appropriate technology has been defined as "technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self  reliance with the resources the community and country can afford". The term "appropriate " is emphasized because in some countries, large, luxurious hospital that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking any improvement in general health services. This also applies to using costly equipment, procedures and techniques when cheaper, scientifically valid and acceptable ones are available, viz, oral re-hydration fluid, standpipes which are socially acceptable, and financially more feasible than house-to-house connections, etc.

      Ii will be seen from the above discussion that primary care is qualitatively a different approach to deal with the health problems of a community. Unlike the previous approaches (e.g., basic health services, integrated health care, vertical health services) which depended upon taking health care, vertical health services to the doors of the people, primary health care approach starts  with  the people themselves. This approach signifies a new dynamism in health care and has been described as Health by the people , placing people's health care approach are the same as those of earlier approaches (i.e. attainment of an acceptable level of health by every individual), but the means adopted are different, that is, more intersectoral coordination and more community involvement in health related matters. In short, primary health care goes beyond the conventional health services. It forms part of the larger concept of Human Resources and Development.