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EVOLUTION OF PRIMARY HEALTH CARE IN SEYCHELLES
BERNARD VALENTIN
ARCHITECTURE OF PRESENTATION
HISTORICAL PERSPECTIVES
FUNDAMENTALS OF PRIMARY HEALTH CARE
SUCCESS STORIES
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RECAPITULATION OF CONFERENCE OBJECTIVES
DETERMINANTS OF HEALTH
Biology and genetics.
Examples: sex and age
Individual behavior.
Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking
Social environment.
Examples: discrimination, income, and gender
Physical environment.
Examples: where a person lives and crowding conditions
Health services.
Examples: Access to quality health care and having or not having health insurance7/11/2019 3
DEFINITION OF PRIMARY HEALTH CARE
Essential health care
Universally accessible
Acceptable by the
communityAffordable
Based on practical,
sound science
and technology
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DEFINITION OF PRIMARY HEALTH CARE
Nucleus and main focus of health system
Integral part of economic
and social development
First point of contact with
health system
As close as possible to
where people are
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ELEMENTS OF PRIMARY HEALTH CARE
IMMUNIZATION
MATERNAL AND CHILD HEALTH
HEALTH EDUCATION
TREATMENT OF COMMON AILMENTS
SAFE WATER AND
SANITATION
PROPER NUTRITION
ESSENTIAL DRUGS
PREVENTION OF ENDEMIC
DISEASES
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PRIMARY HEALTH CARE AT INCEPTION
EMPOWERMENT INCLUSIVITY SOCIAL JUSTICE HUMAN RIGHTS EQUITY
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Primary Care and Primary Health Care
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PUBLICHEALTH
DIMENSION
PHC
FAMILY DOCTORSERVICES
PRIMARY CARE
Historical Perspectives
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EARLY 70s – SEYCHELLES OPENS UP
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MID 70S - BIRTH OF OUR NATION
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MASSIVE SOCIO ECONOMIC TRANSFORMATION
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1977 -19961996 - date
LITTERATURE REVIEW
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PUBLISHED 2011
ACCESS TO HEALTH PRIMARY CARE/PHC
AT INDEPENDENCE SINCE LATE 70s
NUMBER OF DISPENSARIES/HEALTH CENTRES
8 17
ACCESS TO HEALTH ABILITY TO PAY FREE FOR ALL
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SOCIO ECONOMIS STATUS
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HOUSING 70S
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HOUSING NOW
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EMPLOYMENT 70S
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EMPLOYMENT NOW
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HEALTH SPENDING
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AVERAGE LIFE EXPECTANCY AT BIRTH
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AVERAGE LIFE EXPECTANCY AT BIRTH
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INFANT MORTALITY
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The Immunization Programme
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Vaccine Success Stories
Seychelles is at “polio free” certification level since 2006
Country aiming towards measles elimination
No mortality from vaccine preventable illnesses
Close to 99% coverage rate for all childhood vaccination
Close to 100% of vaccination resources come from government.
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Success Factors
Follow up and tracing
Free access to health care (and vaccines)
High literacy rate and access to good information
Role of women
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Vaccine Preventable Childhood Illnesses
Diphtheria
1956
Pertussis (whooping cough)
1956
Tetanus
1956
Measles
67, 74, 1982 –1983 and 1997 –
1988, 2018
MumpsRubella
(German Measles)
Poliomyelitis
1960, 1966, 1970s
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Tuberculosis
Hepatitis B Infection
1992, 1995
Rotavirus Infection
2015
Pneumococcus
2017HPV
YELLOW FEVER
1995
AGE VACCINATION
Birth BCG
3 months DPT1,POLIO1
4 months DPT2,POLIO2
5 months DPT3,POLIO3
9 months MEASLES
18 months B.DPT,POLIO
11years RUBELLA
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VACCINATION SCHEDULE BEFORE 1989
AGE VACCINATION
Birth & 5years BCG
3 months DPT1,POLIO1
4 months DPT2,POLIO2
5 months DPT3,POLIO3
15 months MMR
18 months B.DPT,POLIO
15 years Tetanus, Polio
VACCINATION SCHEDULE AFTER 1989 UP TO 1995
AGE VACCINATION
Birth BCG
3 months DPT1,OPV1,HepB1
4 months DPT2, OPV2, HepB2
5months DPT3, OPV3
9months HepB3
12 months Yellow fever
15 months MMR
6 years BCG,DT,OPV5.MMR2
15 years OPV6, TT
Pregnant women>25 Years
TT Booster
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VACCINATION SCHEDULE FROM 1995 TO 2009
AGE VACCINATION INTRODUCTION YEAR
Birth BCG3mths DPT-Hib-HepB;
RotarixPCV13;bOPV
201020172018
4Mths DPT-Hib-HepB;RotarixPCV13IPV;bOPV
IPV-2015
5Mths DPT-Hib-HepB;PCV13;bOPV
12Mths Yellow Fever15Mths MMR1
6 years DT,OPV5.MMR2,Bopv5
10-11YRS HPV 201415 years bOPV6, TTPregnant women>25 Years
TT Booster
FROM 2010 TO 2018
Why do we vaccinate?
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Smallpox (Lavaryol)
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Smallpox (Lavaryol)
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1808 – First case
1861 – Law forcing immunization
1977 – Last known case
(Somalia)
1980 – Eradication
(WHO)
Mumps Measles Rubella (MMR)
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Malmouton Larouzol Larouzol Alman
Diphtheria Vaccine - 1956
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Difteri
Whooping Cough Vaccine (Lakoklis) - 1956
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NEONATAL TETANUS
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Tetanus Vaccine - 1956
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Poliomyelitis, BCG – 1956, Routine 1959
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Success factors of PHC in Seychelles
POLITICAL COMMITMENT
INVESTMENTS IN THE SOCIAL DETERMINANTS
OF HEALTH
PERSISTENT INVESTMENT IN HEALTH
SYSTEM STRENGTHENING
FREE ACCESS TO HEALTH SERVICES
COMPREHENSIVE HEALTH CARE PACKAGE
CLOSE TO WHERE PEOPLE, LIVE WORK
AND PLAY
PRIMARY CARE WAS VERY OUTCOME-
ORIENTED
COMMUNITY ENGAGEMENT
PARTNERSHIPS
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NATIONAL CHALLENGES/OPPORTUNITIES
NON COMMUNICABLE DISEASES
COMMUNICABLE
DISEASES
SOCIAL ILLS
(DRUGS, PTOSTITUTION, VIOLENCE, FAMILY DISINTEGRATION)
RESOURCE CONSTRAINTS
SOCIAL MEDIA PRIVATE PRACTICE
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GLOBAL ISSUES
Global Health Emergencies
Climate Change
Advances in Technologies
Globalization
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FAILURE OF PRIMARY HEALTH IN REST OF WORLD
Competing priorities
Lack of financial resources
Lack of political commitment
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Failure of Primary Health Care
Comprehensive PHC
(Horizontal Approach)
Selective PHC
(Vertical Approach)
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Why do we need this conference?
Seychelles’ Society has
changed, but has our PHC
Approach adjusted to the
change?
Is our approach to tackling NCD
prevention, right?
Are we harnessing the
energy and opportunities in the community
to the fullest
Are we focusing on quality?
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PURPOSE OF THE CONFERENCE
To reflect on the strengths and weaknesses ofprimary health care in Seychelles in the light of theevolving society with a view to respond to new andemerging challenges, safeguard the gains ofyesteryears and address the priority unmet needs.
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SPECIFIC OBJECTIVES
1. Agree on what the good primary health care practicesin Seychelles are and on how they can and should besustained
2. Agree on whether there are priority unmet health needs in primary health care and determine what they are.
3. Identify new strategies for governance, leadership, planning, monitoring and evaluation
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SPECIFIC OBJECTIVES
4. Identify more rationale approaches to the deployment of resources for greater efficiency and effectiveness
5. Identify new strategies for health promotion in primary health care
6. Agree on how to build partnership and increase engagement of non-health actors to strengthen primary health care
7. Identify strategies to strengthen primary health care in private practice and improve the interaction between public and private sectors
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