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(A)In Developed Countries

*diseases of modernisation.

*over eating &non blalanced diets

*Alcoholism

*Smoking

*overuse of hard drugs

*Worry & distress 5

(B) In Developing Countries

*Third did not have access to safe water

*Quarter suffered from malnutrition

*Diarrhoea

*High infant mortality rate 150-250per1000

*High maternal rate 3-15 per 1000

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Generally adverse situation due to:*In Both Developed and Developing Countries, there is low access to comprehensive services*In some countries one out of two see health worker once/year*Services were urban based*Services were curative oriented*Planning not related to needs*Absent statistics leading to maldistribution*No community participation*Lack of coordination*Economical deterioration

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Definition of Health

health is the state of complete physical, mental and social well being that will permit the person to become productive and not only the absence of disease or infirmity. 8

PHC as a Tool for HFA• Member of WHO & signatory of HFA declaration.

• PHC has become a national strategy development plan.

• 1980 A Ministerial decree was issued, consolidating dispensaries, health offices and MCH centers into PHC centers.

• Health coverage reached 99 % .

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Cardinal Features of PHC(WHO 1978)

PHC is essential health care based on practical, scientifically & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation and a cost that the country can afford to maintain self-reliance and self-determination. It forms an integral part of health system & the overall social & economic development of the community. First level of contact, close as possible to people & constitutes continuing care 10

CONCEPT OF COMMON ILLNESS

• OF THE HEALTH PROBLEMS SEEN IN PHC

• 400 DISEASES REPRESENT 95%

• 100 DISEASES REPRESENT 80%

• 50 DISEASES REPRESENT 60%

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PHC ELEMENTS(1)Health education(2)Promotion of nutrition(3)Environmental sanitation(4)Maternal and child care(5)Immunisation(6)Prevention , control&eradication(7)Treatment of common diseases(8)Essential drugs

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Strategies for PHC

1.Expansion and efficiency

2.Better relations with community

3.Comprehensive health care

4.Integration of preventive and curative

5.Promotion of health awareness

6.Coordination with secondary and tertiary care

7.Coordination with academic institutions

8.Multisectorial coordination

9.At risk approach14

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1. Available2. Accessible3. Affordable 4. Acceptable5. Adaptable6. Applicable7. Attainable 8. Appropriate9. Assessable

According to W. Fabb and J. Fry, good primary health care must include the following “As” It must be:

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Major PrinciplesTo Achieve HFA

• Each H.C. serves a specific catchment area.

• Every citizen is tied to a specific H.C.• Major H.Cs. for Certain No. eg 5-10

centers equipped with essential ancillary facilities.

• Free services.• Accessible services with easy reach of

a max. one hour travel.• Comprehensive & integrated services.

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Major Principles To Achieve HFA

”cont.” • Decentralization through

regional PHC Directorates.

• Consolidation & strengthening of national central programs. (e.g. malaria, bilharzia (,..

• Promoting health awareness.

• Adoption of high risk approach.

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Major Principles To Achieve HFA ”cont.”

• Training of PHC staff.

• Insurance of community involvement.

• Effective co-ordination with secondary health care services.

• Co-ordination with other governmental health related sectors.

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THE POLICY DEVELOPED FOR PHC REMAINS SOUNDLY BASED. THERE IS

CLEAR EVIDENCE OF ITS SUCCESS.

Indepth evaluation of PHC ,JOINT MOH AND WhO 1989.

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Ongoing Programs• Maternal Health .

• Acute Respiratory Infection .

• Quality Assurance .

• Br. Asthma .

• Mental Health .

• Mini-Clinics .

• Supportive Supervision.

• Elderly Health .

• Essential Drugs List .

• Integrated Management of Childhood Illnesses (IMCI)

• Computerized Information System .30

PHC& Hospitals in SA

64,114,758visits

3 visits / Person / Year

16.5% Hospitals

83.5% PHC Centers 31

PHC vs HOSPITAL• Availability

• Accessability

• Contact

• Triaging

• Dr/Pt relationship

• Continuity

• Preventive measure

• Cost effectiveness

• Community participation32

IMPACT OF MCH

Main PHC activity.• Percent of mothers who received ANC 96 %• % who received 5 or more ANC visits > 80 %• % of births by trained health personnel 96 %• Exclusive breast feeding (1st 4 months) 31.1 %• Newborns with weight <2500gm 5 %• Underweight among < 5 Yrs children 14.3 %• Mothers knowledge of birth spacing91.3 %

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Health systems have several major components:

• Public health activities

• Primary care

• Specialty care

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• Are primary care-oriented

• Have more equitable resource distributions

• Have government-provided health services or health insurance

• Have little or no private health insurance

• Have no or low co-payments for health services

Overall, countries that achieve better health levels

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Development of FM

1982 2008• 300HCs 2000HCs

• No. undergraduate All university

• No. postgraduate About 20 program

• No. commission SCFHS

• No. Family physicians 500 FPs

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Graduate SCFHS-FM2009

م 1/10/1995 البرنامج بداية 1

متدرب 13 االمتحان دخلت دفعة أولالكتابي النهائي

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353خريج تاريخه حتى الخريجين عدد 3

مركز 28 التدريبية المراكز عددبـها المعترف

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DIFFICULTIES AND Challenges

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DIFFICULTIES• Premises• Manpower Quantity Quality Breadth• Training Basic Advanced• Continuing professional development• Satisfaction Public Professionals• Motivation

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Bad outcome due to accumulation of risk factors

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Healthy

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PROMOTING THE HEALTHOF THE NATION

PROMOTING THE HEALTHOF THE NATION

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CONCLUSIONCONCLUSION

1. The implementation the 9 As of PHC need to be revisited.

2. Future plan to accelerate the process of QA in all aspects of PHC should be emphasized including patient safety.

3. Selective training, further leadership development of PHC staff should be priority.

4. Health system research within the PHC activities should be enhanced.

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RECOMMENDATIONS

1. Encourage CME & involvement of academic institutions.

2. Energize supportive supervision through QA.

3. Procure training needs. 4. Integration of hospital & HC services

(referral). Train more trainers as necessary. Revise & update manuals.Revision information system & unify registration and reporting through the

statistical department.Consider redistribution of manpower according to needs, ensuring fairness,

variability of experiences and avoiding boredom. Intensify communicating and field visits between central level and periphery.

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Vision for The New Era• To emphasize commitment & support for PHC.• To restructure the health care system.• Nationalization of health staff.• To computerize the HIS. In all H.C.• Revitalization of referral system.• To develop an appointment system.• To promote inter-sectoral collaboration.• Primary care doctors operate with smaller lists than

now and spend significantly increased time with each patient in each consultation.

• To Promote and implement the concept of patient safety in PHC. 45

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Thank you for your

kind attention

داعيا3 الله سبحانه لي ولكمبدوام الصحة والعافية والرضوان

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