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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