Principles of Primary Health Care

There are six fundamental principles that underpin the primary health care approach.

1. Equitable Distribution: Ensures that health services are available to all individuals regardless of their social, economic, cultural, or religious background. This principle aims to correct existing imbalances in healthcare access, ensuring that both affluent and underserved populations, whether urban or rural, have access to necessary health services. It emphasizes allocating healthcare resources to rural areas that may have been previously underserved compared to urban centers.

2. Manpower Development: Focuses on harnessing the human resources within a country to support healthcare delivery. This involves ensuring an adequate number of appropriately trained health personnel are available to develop and implement health plans and actions. Key strategies include the retraining and re-orientation of current health workers, the development of new categories of healthcare providers, and the provision of ongoing motivation and training to all personnel serving the community.

3. Community Participation: A process where individuals, families, and communities take an active role in promoting their own health and well-being. Encouraging community involvement in decision-making processes related to their health is vital for fostering community development and self-reliance. Collaboration between community members and healthcare providers is essential for finding solutions to the complex health issues facing communities.

4. Appropriate Technology: Refers to technology that is scientifically sound, adaptable to local needs, and acceptable to both those providing and receiving care. This includes technologies that the community can maintain using local resources, aligning with the principle of self-reliance. Appropriate technology also considers the cost and affordability of services within the context of available resources, including the number, type, and distribution of healthcare professionals and equipment. It emphasizes technology requiring low capital investment, conserving natural resources, managed by its users, and environmentally sustainable.

5. Multisectoral Approach: Recognizes that health outcomes are influenced by factors beyond the healthcare sector. It emphasizes the importance of collaboration and partnerships between various sectors, such as agriculture, education, housing, public works, and others, to address the broader determinants of health and promote community well-being. This intersectoral collaboration ensures coordinated goals and activities to maximize their contribution to community health and avoid duplication of effort.

6. Self-Reliance: This principle operates at the individual, family, and community levels, encouraging a shift from being passive recipients of aid to becoming active partners in managing their health, with or without external support from government or donors. PHC providers play a crucial role in empowering communities to achieve self-reliance in healthcare through active participation and involvement.

Pillars of Primary Health Care

1. Community Participation: Crucial for ensuring that PHC programs are socially acceptable and sustainable. It involves individuals and families taking responsibility for their health and the health of their community. This participation can manifest through the provision of resources such as funding, materials like bricks and sand, and local knowledge.

2. Intersectoral/Multi-sectoral Partnership: Recognizes the interconnectedness of various sectors and their impact on health outcomes. Collaboration between sectors such as agriculture, water and sanitation, and finance is essential for comprehensive health promotion.

3. Equity: Emphasizes that all individuals, regardless of their background or nationality, should have access to essential healthcare services.

4. Appropriate Technology: Refers to technology that is scientifically valid, adaptable to the local context, culturally acceptable, and financially sustainable for the community.

5. Political and Social Support: Requires commitment from political leaders in policy development, resource allocation, and mobilizing community support for PHC programs.

Positive Effects of Political Will:

• Facilitates effective policy making related to healthcare.

• Enables monitoring and evaluation of PHC activities.

• Ensures adequate budgetary allocation for healthcare initiatives.

• Supports mobilization efforts from national to local levels.

• Leads to the prioritization of plans reflecting PHC characteristics at various levels.

• Encourages active involvement and participation in health programs.

• Can lead to the establishment of designated days to promote and observe PHC.

Negative Effects of Lack of Political Will:

• Can result in the misappropriation of funds intended for healthcare.

• May contribute to social instability such as civil conflicts.

• Can lead to decisions and actions that prioritize individual gain over public health.

• May cause delays in the delivery of essential services due to inefficient top-down approaches.

• Can lead to conflicting priorities and approaches in healthcare implementation.

• May result in pressure to allocate disproportionately high salaries to political figures at the expense of service delivery.

Elements or Components of PHC

1. Education concerning prevailing health problems including the methods of preventing or controlling them (Health education): This involves comprehensive strategies tailored to local contexts. In Uganda, priority areas for health education include Sexually Transmitted Infections (STIs) including HIV/AIDS, Malaria, Tuberculosis, and management of epidemic outbreaks.

2. Promotion of safe food supply and proper nutrition: This encompasses efforts to improve all stages of the food system—production, processing, storage, marketing, preparation, and consumption—with the overarching goals of enhancing nutritional status and bolstering the community’s economic well-being. Education plays a critical role, particularly in addressing cultural beliefs and practices related to nutrition.

3. Provision of adequate safe water supply and proper sanitation: This element focuses on ensuring access to clean and safe water sources and promoting effective sanitation practices. Key considerations include:

   • The quality and accessibility of community water sources.

   • Enhancing sanitation infrastructure, with an emphasis on:

     • Increasing latrine coverage.

     • Implementing effective refuse disposal systems.

     • Establishing proper sewage management practices.

4. Provision of maternal child health and family planning: These essential health services are designed to improve the health and well-being of mothers and children. Services are delivered through antenatal, maternity, postnatal, and family planning clinics. Significant donor funding, often through conditional grants, supports these services to make them more affordable.

5. Provision of immunization against major infectious diseases: This component typically receives substantial donor funding. Organizations like WHO, UNICEF, and the Centers for Disease Control and Prevention (CDC) play a leading role in global immunization efforts. In Uganda, the routine immunization schedule under the Expanded Program on Immunization (EPI) covers eight diseases: poliomyelitis, tuberculosis, measles, diphtheria, pertussis (whooping cough), tetanus, Haemophilus influenzae type b, and hepatitis B. There are ongoing efforts to include additional vaccines like pneumococcal and rotavirus vaccines into the EPI, and the Human Papillomavirus (HPV) vaccine against cervical cancer is being introduced.

6. Prevention and control of locally endemic diseases: Specific programs are established to target and reduce the burden of diseases prevalent in particular regions. Examples include:

   • Malaria control programs.

   • Tuberculosis and Leprosy control programs.

   • Initiatives targeting Onchocerciasis (river blindness).

   • Programs to control Schistosomiasis (bilharzia).

   • Efforts to eradicate Guinea worm disease.

7. Appropriate treatment of common diseases and minor injuries: This involves:

   • Establishing primary health centers at levels II, III, and IV, staffed by qualified healthcare professionals.

   • Implementing home-based care programs through trained community health workers (CHWs) who are equipped to provide basic treatment and make referrals to higher levels of care when necessary.

8. Provision of essential drugs: The objective is to ensure that communities have access to the most necessary medications to meet their healthcare needs. The specific drugs provided depend on the level of the health facility and the scope of services offered.

NB: These initial eight elements were the foundational components identified in the Alma-Ata Declaration.

Additional components implemented in Uganda include:

1. Dental health and oral care: This involves:

   • Providing education on oral hygiene practices.

   • Implementing preventive measures against oral and dental diseases.

   • Offering treatment for various dental conditions.

2. Mental health (community mental health): Focuses on providing care and rehabilitation for individuals with mental illness within their communities and implementing strategies for the prevention of mental health disorders.

3. Rehabilitative health services (physically and mentally handicapped): These services are delivered through community-based rehabilitation programs aimed at helping persons with disabilities (PLWDs) to achieve independent living, engage in income-generating activities, and feel valued and included in their communities.

4. STI/HIV/AIDS prevention and care: Encompasses efforts focused on preventing the transmission of STIs and HIV, as well as providing treatment, care, and support for those infected and affected.

5. Eye care (primary comprehensive eye care): This includes:

   • Educating the community on preventing eye-related problems.

   • Providing treatment for common eye conditions.

   • Establishing referral pathways for patients with more complex eye issues.