Primary Health CARE - Lecture notes 9 PDF

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Mustapha Bello the student of Kebbi State University of Science and Technology, Aliero, Kebbi State, Nigeria....

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PRIMARY HEALTH CARE Definition It is Essential Health Care base on practical, scientifically sound and socially acceptable methods and technology made university accessible to individuals and Families in the community through their full participation and at a cost that the community can afford to maintain at every stage of their development in the spirit of their self-reliance and self-determination. It forms an integrity part of both the countries health system of which it is the control function and main focus and of the overall social and economic development of the community with the first level of contact of individuals, the family and the community with the National health system bringing Health care as close as possible to which people live and work. PHC constitute the first element of a continuing health care process. The principles of Primary Health Care are: 1) Community Participation 2) Inter-sectoral 3) Affordable appropriate technology 4) Equity and social justice Components of PHC 1)

Health education concerning prevailing health problems.

2)

Promotion of food supply and pauper nutrition.

3)

Adequate supply of safe water and basic sanitation.

4)

Maternal and child care including family planning.

5)

Immunization against major infection diseases.

6)

Prevention and control of locally endemic disease.

7)

Appropriate treatment for common ailments and injuries

8)

Supply of essential drugs.

9)

Oral Health

10) Mental Health 11) Eye Health WHO sponsored a follow up meeting at Rigu in 1998 to review the progress on primary health care declaration globally participants were satisfied with the progress made so far and concluded that PHC concepts had made strong positive contribution to the health and well-being of people in all nations and felt that the remaining problems should be tackled through increased political community and making parents principles in the spirit of health for all. History Primary Health Care - In its 5 years’ development plan Nigeria in 1976 come off with BHSS. - The second attempt was 1986-1992 with 52 LGAs chosen as model LGA. - 1993-2001 ward Health system. - Accelerated LGA focused PHC implementation 1986-1992. - Community Health workers training institute school of health technology and CHO training centres producing large number of community health practitioners leading to the attending of universal child immunization (UCL) target 80% the high rating of the country by WHO review team and creation of NPHDA 1992. Restructuring of department and units at all levels of health Federal Directorate of PHC and 4 Zonal Offices, State Directorate of PHC SPHCDA, LGAs Directorate of PHC ward Health System, PHC Centres, PHC Clinics, Mobile Clinics Village Health Workers TBA others.

STRENGTHENING PRIMARY HEALTH CARE SYSTEMS AT LGA LEVEL Re-orientation of existing health and health-related staff The re-orientation of the existing health and health related staff is necessary in the light of the role these members of the health team play in implementing integrated Primary Health Care Services. The Orientation Programmes focus on the development of knowledge, attitude and skills requires to perform expected responsibilities. Process of orientation:  Identify all health and health-related workers;  Identify all policy makers and inter-sectoral collaborators in the LGA;  Schedule these health and health-related workers for a 2-3 day re-orientation workshop on what PHC is all about;  Obtain funds for the workshop;  Identify facilitators and resource persons for the orientation workshop;  Fix dates and venues for the workshop; and  Invite all participants accordingly. Training Programmes Steps/topics to be taken/presented during the training sessions include: Finding out what the participations already knew (Pretest) Topics to be presented include:  Philosophy, concept principles, and strategies of PHC  Roles of individual’s families, government and non-government organizations, and communities in PHC

 Roles of health and health-related workers at various levels of care in the LGA  Health team approach  Provision of integrated health services  Use of standing orders in treating minor ailments  Essential Drugs and Drug Revolving Fund  PHC Health Management Information System  Monitoring and Evaluation system  The 2-way Referral system Evaluate the training (Post-Test) Conduct Baseline Survey Steps in Conducting Baseline Survey: Plan Baseline Survey as follows:  Contact the State PHC Coordinator;  Explain the purpose, procedure and request for assistance;  Solicit cooperation of the community members;  Train interviewers. Carry out baseline survey using forms designed by the NPHCDA to collect:  Epidemiological information;  Socio-demographic information; and  Health and health-related information. Collate information from the community; Discuss result with the community; and Write a report, using the NPHCDA Guidelines. Plan the situation analysis as follows:

 Contact the LGA  Obtain the instruments to be employed from the NPHCDA  Train the interviewers. Conduct Situation Analysis by collecting information on the:  LGA population by wards and villages;  LGA Health Budget;  Health Facility by type, location and ownership;  Health personnel by type and location;  School population by type and location;  Socio-economic status;  Public utilities and services;  LGA PHC activities;  LGA logistics and information supports; Collate data from the field; Write a report using the NPHCDA LGA maps; i)

Obtain a map of the LGA or draw such a map if one is not available.

ii)

Locate the following on the map:  All settlements with their populations  Existing health facilities, including health posts, dispensaries, clinics, maternity centres, Health centres, Hospitals etc.  Roads-tarred and seasonal,  Schools-primary, secondary and post-secondary,  Topography-streams, rivers, hills mountains, etc.  Barracks-police, military, prisons, and others

This map will facilitate the selection of appropriate strategies for service delivery, and will facilitate community mobilization efforts.

Project Formulation Plan Project Formulation Workshops, which include:  Drawing up time table;  Assigning lectures to resource persons/facilitators;  Arranging venue for workshops;  Arranging logistic support for the workshop (transportation/secretarial support).  Funds for: - Accommodation of facilitator/resource persons and participants; - Vehicle maintenance and fueling; - Refreshments; - Field trips; and - Transportation for resource persons and participants. Invite Participants to Workshops, which include:  LGA Chairman;  Supervisory Councilor for Health;  LGA PHC Coordinator and Ass. PHC Coordinator M&E;  Target Ward Councilor;  CHO Training Institutions/Schools of Health Technology  State PHC Coordinator/Director of PHC  Facilitators and resource persons. Conduct the workshop using the report from the baseline survey/situation analysis and other relevant information from the LGA. Produce a 4-years PCH health plan for the LGA using the 10 steps project formulation model. - Assessment of the health situation

- Prioritize health problems and desired change - Choose the most appropriate interventions - Select strategies to overcome obstacles - Plan the programme to implement each strategy - Plan the support system - Plan for programme monitoring and evaluation of coverage - Budget for each programme/activity Implementation of primary health care plan within the local government area Objectives for dividing LGA into Autonomous Clans/Communities  To have clearly defined target area for PHC activities.  To assign a health team to take responsibility of all health activities in each district/ward. Steps in dividing LGA into Wards, or Autonomous Clans/Communities The following are necessary steps to be taken for this activity:  Conduct a quick geographical assessment of LGA physically to know where village, wards, schools, hospitals rivers/streams, etc. are located.  Divide the LGA into PHC ward (target area) for PHC services with each district/wards containing only a reasonable population of between 20,00050,000 (depending on the density of the population, level of communication/transportation, and the size of the health team).  Identify a health facility as the operational base and first referral facility in the ward. Assignment of Health Team Steps in assigning health team to a ward:

The current trust is to develop a health system around a ward population.  Form the health team by ensuring category mix;  Designate the most senior workers as team leader or Ward Supervisor;  Assign the health team to the identified referral facility in the wards;  Utilize wards referral facility for training of health teams and as base for supervision of Community Health Extension Workers; and  Assign health team to other facilities in the ward where applicable. Numbering of houses with special PHC numbers PHC House Numbering: The numbering of houses is an important activity that will facilitate referral and follow-up of patients. It will also make possible channeling of services to the homes of potential recipients. Steps  Identify all Wards on the map and number them;  Contact Community Development Communities;  Explain purpose and procedure of house numbering;  Solicit for their moral and material support e.g. paint, brush etc.;  Request community to select volunteers, for house numbering;  Use students from School of Health Technology, CHO Training Institutions, Medical Schools, Schools of Nursing and Midwifery, Teachers, Pupils and Colleges of Education as volunteers;  Train the volunteers to carry out appropriate system of house numbering;  Fix a date for commencement of house numbering; Purpose of House Numbering

Number houses using the following PHC System Numbering System Code. PHC

PHC

District/wards No. (with 2 digits) 01 – 99

Settlement/Ward/Village House No. (with 3 digits) Neighbourhood No. (with 3 digits) 001 – 999 001 – 999

Placement of Home-Based Records The home-based record is the passport to Primary Health Care System and its services. There are two types of home-based records, one for children (any below the age of five years), which consists of health charts and treatment card in polythene bag. The other is for adults and children five years and above, and it includes personal treatment cards kept in polythene bag. The home-based records for children contain such information as Growth Monitoring Chart, ORT and Immunization Schedule, child and family names. The adult card contains essential information on age, sex, number of children, marital status, treatment, history and for women of child-bearing age: pregnancy history and contraceptive usage. Objectives of using Home-Base Records are to:  Reduce waiting time at health facilities (the time patients wait while clerk searches for their records);  Enhance community participation by placing the responsibility for Recordkeeping directly on the patients themselves; - Facilitate referral; - Facilitate information system; and - Enhance continuity of care. Steps in Placement of Home-Based Records

 Estimate the number of home-based records required for children and adults in the area;  Order home-based records and clinic master cards;  Mobilize (preferably), appropriate volunteers and health team to carry out house-numbering e.g. students from schools of Health Technology and Nursing, CHO Training Institutions, Medical Schools and Teachers’ Training Colleges,  Content of Training should include;  Definition of household as a group of people living together and eating from the into household’  Respect for local beliefs and customs.  Probe adequately information on age which include;  Requesting for birth certificate or child health card or immunization card;  Requesting for Imam/Church Birth records;  Requesting for TBA/VHW records;  Utilizing Lunar and Muslim calendar;  Utilizing calendar of National and Local events;  Reconciling age of child with obvious discrepancies;  Observing birth days on body tattoo;  Examining household walls for child’s age’  Recording age based on your findings; and  Assigning PHC code number to family member as follows: House Number 001 – 999

01

-

Husband

Household or Family Number 01 – 99

Persons Number 01 – 99

02

-

Other head of the household (e.g. divorced, single-parent)

03

-

19 Wives

20

-

59 Children

60

-

69 Grannies

70

-

79 Dependent

80

-

99 House helps

90

-

99 Others

In this numbering system, it will be possible to cross-match child to mother, e.g. wife No.1 will be 3 and child No.1 will be 20, Wife No.3 will be 05, but if she has first child in the household, the child will be No. 05/20. Male Children will be given odd number and female children will be given even numbers.  Cards will be issued to children and adults who reside in a particular place while those who live elsewhere will be registered in places where they live. Cards will not be given to people who are not physically present;  Children who are in residential institutions should be registered at home and their cards taken to their respective institutions.  When home-based records are issued, the clinic master cards will be completed at the same time for the individuals in the appropriate households.  Educate Households on the use of the Home-Based Records. This education will include: - Reasons for use of home-based records; - Responsibility of households and family members in the use of homebased records; and - Safekeeping of home-based records.

Completion of Clinic Master Card For each household, where home-based records have been placed, a clinic master card is completed. This card contains essentially the same information as on the individual home-based records. At any contact with health services, information is recorded on the home-based record as well as the family clinic card. The significance of this master card is that it gives a picture of the health status of individuals and the families. For example, one can scan through the clinic master cards for a village and discover which children in what homes have not received any immunization, or Growth Monitoring Services for a given period of time. The service can then be channeled to such children directly. Minimum Ward Health Care Package This is a package aimed at providing the wards with a minimum set of interventions needed to meet the basic health requirements of households within the wards towards achieving the global target of “Health For All”. This package comprises of components known to promote healthy growth and development with an impact for reducing mortality and morbidity rates. The components of the Minimum Ward Health Care Package are:  Control of Communicable diseases (Malaria STI/HIV/AIDS, TB)  Child survival (Including IMC) and Basic Immunization  Safe Motherhood  Nutrition  Health Education and Community Mobilization The Ward Development Committee has the overall responsibility of ensuring the implementation of the Ward Minimum Health Care Package at ward level. The

funding shall be a joint responsibility of the ward and the three tiers of government (Federal, State and LGA) and non-governmental organization. CHAPTER THREE COMMUNITY AND SOCIAL MOBILIZATION FOR PRIMARY HEALTH CARE SERVICES AT THE LGA LEVEL Community mobilization is defined as a means of encouraging, influencing and arousing interest of people to make them actively involved in finding solutions to some of their own problems. Community mobilization and eventual participation requires time, patience, and understanding on the part of the health workers in order to achieve success. This is not a one-time activity, but rather, a continuous exercise, which should constitute an integral aspect of efforts, aimed at initiating health action by the people themselves. Steps to be taken in mobilization activities  Know the community  Plan for Mobilization Activities  Identify Community entry points during the first visit During the first contact, time should be taken to explain in some details: - What the PHC programme is all about; - What the government is doing in this regard; - What the community contribution could be; and - How community participation would make a difference to the programme.  Attend the second meeting - Adopt a Participatory Approach  Attend subsequent (follow-up) Meetings

Follow up visits will need to be made: - Meet the different wards or village heads; - Obtain a formal reaction from the community; - Explain points that were unclear to the community previous meetings; and - Clarify all questions. Set up Community Development Committee thus:  Discuss the plan with Community Elders and opinion leaders  Discuss the felt needs of the Community  Identify available resources (human and material)  State the composition of the committee in terms of numbers and membership  State what activities (role) the committee will be expected to play when formed  Identify different age groups, associations and religious affiliations that would be represented in the committee  Apply PLA tools and ensure that through election true representatives of the people emerged as reassures of the committee  Identify community members with specific skills, interest and orientation whose experiences would benefit the Committee  Identify who is to call the first meeting, where and when this will be held  Prepare an agenda for the next meeting. CHAPTER FOUR PRIMARY HEALTH CARE MANAGERIAL PROCESS AND THE WARD HEALTH SYSTEM

Primary Health Care emphasizes the importance of full involvement by all communities to ensure success in accordance with the Alma Ata Declaration of 1978. The managerial process refers to the organization and management infrastructures that have to exist at various levels (villages, wards, LGAs etc) for primary health care implementation. To some extent, some of these infrastructures are already in existence in one form or the other; nevertheless, there will be need to adapt some fo them to meet the current realities and ensure sustainability. In order to make this managerial process effective, the bottom up concept of planning should be applied. The PHC managerial process for each operational level are described below. Objectives: To establish a functioning and effective development committee at all levels of PHC in all LGAs. Strategies for formation of development committees: The committee members will be selected by the people in the communities. The Village/Community/Level Village/Ward/Community Development Committee (A) Composition The Village/Ward Head/Community shall be appointed as the patron  A respectable person elected by the committee members as Chairman.  An elected literate member of Village/Community shall serve as Secretary.  Representative of religious groups.  Representative of women’s groups/associations.

 Representative of occupational/professional groups.  Representative of NGOs.  Representative of VHVs/TBAs.  Representative of the disabled.  Representative of Youths.  Representative of Traditional Healers.  Representative of patent medicine stores owners. (B) Roles and responsibilities of the VDC/WDC The committee shall:  Identify health and health related needs in the village/community  Plan for the health and welfare of the community;  Identify available resources (human and material) within the community and allocate as appropriate to PHC programmes  Supervise the implementation of PHC work plan  Monitor and evaluate the progre...