Primary Health Care

Reference

Nies, M., McEwen, M. (2020). Primary Health Care. In Community and Public Health Nursing (2nd Philippine ed., pp. 191-204). C&E Publishing, Inc.

Primary care is the provision of interventions to cure specific conditions of individuals at the level of the community. It is the first level of healthcare delivery in which a generalist like a physician or a nurse renders medical and nursing services for individuals and population groups. It is often the first point of contact of patients in the healthcare system. Primary Health Care, in contrast, is an over-all approach to providing people access to basic healthcare and ultimately improve health of communities. It operates on three dimensions: a goal, a strategy, and a philosophy.

1. Goal: all people are provided access to basic health services, based on the declaration of health as a human right.
2. Strategy: it promotes collaboration among all sectors in society, valuing partnerships between public and private organizations.
3. Philosophy: it guides public health practitioners to rally communities to assume responsibility for the health.

PHC operates on the traditional cornerstones or pillars of active community participation, inter- and intra-sectoral linkages, the use of appropriate technology, and available support systems. They follow the core values of social justice, equity, respect for human dignity and rights, solidarity, and self-reliance in providing essential health services:

1. Health education, the primary role of public health nursing
2. Immunization
3. Essential Medicines/Drugs
4. Mother and Child Health Services (MNCHN)
5. Endemic Disease Control and Management
6. Nutrition
7. Treatment of Simple Conditions
8. Sanitation and Access to Safe Water Supply

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Elements of Primary Health Care

We’ve listed the three dimensions, four cornerstones, five core values, and eight health services from PHC. These are all considered in the three elements of PHC:

1. Primary Care and Essential Public Health Functions as the core of integrated services
2. Multisectoral Policy and Action: public health is a multidisciplinary science that revolves around prevention disease, prolonging life, and promoting health and efficiency of populations through collective efforts of all stakeholders.
3. Empowered People and Communities: this envisions health in the hands of the people, putting emphasis on health as a responsibility besides as a right. Health education and literacy can give people a sense of initiative, instilling a self-reliance in health.

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Determinants of Success

Four critical factors to “Health for all, by all” as outlined by The Astana Declaration (WHO, 2018a) include:

1. Knowledge and Capacity Building: information is an essential element of self-sufficiency. Active participation in planning and developing health programs and services aid in building capacity, fostering a people-centered healthcare system. Community organizing (e.g. COPAR) can also identify potential leaders as active partners of health agencies and professionals in promoting health and preventing disease.
2. Human Resources for Health: various skills and disciplines are required in community health. Manpower is the most important resource in healthcare delivery. This includes nurses, midwives, physicians, among other health professionals.

Manpower	Population Served
RHU/HC Physician	20,000
Public Health Nurse	10,000
Public Health Midwife	5,000
Public Health Dentist	50,000
RHU	20,000
BHS	5,000

3. Financing: access to essential health services ultimately advance the well-being of the population, but it entails cost and thus requires funding. In 2018, the DOH reported that more than half of all health expenditures remain funded out-of-pocket (OOP); directly from the person receiving care. Sin taxes (R.A. 10351, R.A. 10963) are partially used for healthcare funding.
4. Technology: the provision of the highest possible level of wellness requires the access to available services and technology. Health professionals must employ and equip their practice with technologies to contribute to the goals of PHC. The WHO defines appropriate health technology as effective, safe, affordable, sustainable, and acceptable.

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Health Services

Essential Drugs/Medicine

As mentioned earlier, the provision of essential drugs/medicine is part of PHC. These are used to treat endemic diseases, to reduce preventable deaths, and to improve health outcomes. Drugs are considered essential when they are life-saving but can also be used for all population groups. Examples of these include paracetamol and amoxicillin in primary care facilities for common problems like fever, headache, and infections

Traditional and Alternative Care

Republic Act 8423, titled the Traditional and Alternative Medicine Act (TAMA) institutes the Philippine Institute of Traditional and Alternative Health Care (PITAHC) under the DOH to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care. Today, these methods are called T&CM, Traditional and Complementary Medicine.

Herbal Medicines

The use of plants or derivatives from plants for the treatment of specific conditions. In the Philippines, it is one of the most popular modalities of complementary medicine. Currently, the DOH recommends ten such medicines:

1. Lagundi:
   • Use: Cold, cough, fever, asthma, dysentery, pain, skin diseases, wounds
   • Preparation: Decoction, Wash affected site with decoction
2. Yerba Buena:
   • Use: Headache, stomachache, cough and colds, rheumatism and arthritis
   • Preparation: Decoction, Infusion, Massage Sap
3. Sambong:
   • Use: Antiedema, antiurolithiasis
   • Preparation: Decoction
4. Tsaang Gubat:
   • Use: Diarrhea, Stomachache
   • Preparation: Decoction
5. Niyog-niyogan:
   • Use: Anthelminthic
   • Preparation: Seeds are used
6. Bayabas:
   • Use: Washing wounds, diarrhea, gargle, toothache
   • Preparation: Decoction
7. Akapulko:
   • Use: Antifungal
   • Preparation: Poultice
8. Ulasimang Bato; Pansit-pansitan:
   • Use: Lowers blood uric acid, rheumatism and gout
   • Preparation: Decoction, eaten raw
9. Bawang:
   • Use: Hypertension, lowers blood cholesterol, toothache
   • Preparation: Eaten raw or fried, applied on part (for toothache)
10. Ampalaya:
    • Use: Diabetes Mellitus Type 2, increases insulin sensitivity
    • Preparation: Decoction or Steamed Baby Leaves

Preparation	Procedure
Decoction	The recommended part of the plant material is boiled in water. The recommended boiling time is 20 minutes.
Infusion	The plant material is soaked in hot water, much like making tea. The recommended soaking time is 10 to 15 minutes.
Poultice	Directly apply the recommended plant material on the part affected, usually used on bruises, wounds, or rashes.
Tincture	Mix the plant material in alcohol.

Other Traditional Alternative Healthcare

Terminology	Definition
Acupressure	A method of healing and health promotion that uses the application of pressure on acupunture points.
Acupuncture	A method of healing using special needles to puncture and stimulate specific anatomical points on the body.
Aromatherapy	The art and science of the sense of smell whereby essential aromatic oils are combined and then applied to the body in some form of treatment.
Chiropracty	A discipline of the healing arts concerned with the pathogenesis, diagnosis, therapy, and prophylaxis of functional disturbances, pathomechanical states, pain syndromes, and neurophysiological effects related to the static and dynamics of the locomotor system, especially of the spine and pelvis.
Phytomedicine/Herbal Medicine	Finished, labeled, medicinal products that contain as active ingredients aerial or underground parts of the plant or other materials or combination thereof, either in the crude state or as plant preparations.
Massage	A method wherein the superficial soft parts of the body are rubbed, stroked, kneaded, or tapped for remedial, aesthetic, hygienic, or limited therapeutic purposes.
Nutritional Therpay	The use of food as medicine and to improve healthy by enhancing the nutritional value of food components that reduces the risk of a disease. It is synonymous with nutritional healing.
Pranic Healing	A holistic approach of healing that follows the principle of balancing energy; the Yin-Yang balance was mentioned here by the lecturer.
Reflexology	The application of therapeutic pressure on the body’s reflex points to enhance the body’s natural healing mechanisms and balance body functions. It is based on the principle that internal glands and organs can be influenced by properly applying pressure to the corresponding reflex area on the body.