Title: THE ORGANIZATION OF THE PRIMARY HEALTH CARE FOR THE URBAN POPULATION
1THE ORGANIZATION OF THE PRIMARY HEALTH CARE
FOR THE URBAN POPULATION
- Elena A. Abumuslimova
- Ph.D., Assistant Professor
- Department of Public Health and Health Care,
- Northern-West State Medical University named
after I.I. Mechnikov, Saint-Petersburg
2Declaration of Alma-Ata
- In 1978 the WHO Declaration of Alma-Ata launched
primary health care as the route to health for
all. This was a deliberate effort to tackle huge,
and largely avoidable, differences in the health
status of populations. - It means that people should not be denied access
to life-saving and health-promoting interventions
for unfair reasons, including those with economic
or social causes.
3WHO The World Health Report, 2008
- Primary health care is a people-centered approach
to health that makes prevention as important as
cure. As part of this preventive approach, it
tackles the root causes of ill health, also in
non-health sectors, thus offering an upstream
attack on threats to health. - A primary health care approach is the most
efficient, fair, and cost-effective way to
organize a health system. It can prevent much of
the disease burden, and it can also prevent
people with minor complaints from flooding the
emergency wards of hospitals. primary health
care produces better outcomes, at lower costs,
and with higher user satisfaction.
4WHO the ultimate goal of primary health care is
better health for all.
5Five key elements to achieving that goal
- reducing exclusion and social disparities in
health (universal coverage reforms) - organizing health services around people's needs
and expectations (service delivery reforms) - integrating health into all sectors (public
policy reforms) - pursuing collaborative models of policy dialogue
(leadership reforms) - increasing stakeholder participation.
6Global Targets of PHC by WHO(1)
- All people in every country will have ready
access at least to essential health care to
first-level referral facilities - All people will be actively involved in carring
for themselves their families, as far as they
can, in community action for health - Communities throughout the world will share
governments responsibility for the health care
of their members - All governments will assume the overall
responsibility for the health of their people - Safe drinking water sanitation will be
available to all people
7Global Targets of PHC by WHO (2)
- All people will be adequately nourished
- All children will be immunizes against the major
diseases of childhood - Communicable diseases in the developing countries
will be of no greater public health significance
than they were in the developed countries - All possible ways will be applied to prevent
control non-communicable diseases promote mental
health through influencing the life styles
controlling the physical psychological
environment - Essential drugs will be available to all
8Obstacles to the Implementation of PHC Strategy
- Misinterpretation of the PHC Concept
- Misconception that PHC is a second rate health
care for poor - Selective PHC Strategies
- Resistance to Change
- Lack of political will
- Centralized Planning Management Infrastructure
9Reasons for slow progress towards Health For All
(1)
- Insufficient Political commitment to
implementation of HFA - Failure to achieve equity in access to all PHC
elements - The continuing low status of women
- Slow socioeconomic development
- Difficulty in achieving intersectoral action for
health - Unbalanced distribution of, and week support for,
human resources
10Reasons for slow progress towards Health For All
(2)
- Widespread inadequacy of health promotion
activities - Weak health information systems and no baseline
data - Pollution, poor food safety, and lack of safe
water supply and sanitation - Rapid demographic and epidemiological changes
- Inappropriate use of, and allocation of resources
for, high cost technology - Natural and man-made disasters
11New Trends that will influence Health in the 21st
century
- Widespread absolute and relative poverty
- Demographic changes aging and growth of cities
- Epidemiological changes continuing high
incidence of infections diseases increasing
incidence of non-communicable diseases, injuries
and violence - Global environmental threats to human survival
- New technologies information and telemedicine
services - Advances in biotechnology
- Globalization of trade, travel and spread of
values and ideas
12Primary Health Care in the 21th century
- Policy Objectives to Reinforce the PHC approach
by WHO - Make health central to development and enhance
prospects for intersectoral action - Combat poverty as a reflection of PHCs concern
for social justice - Promote equity in access to health care
- Build partnerships to include families,
communities and their organizations - Reorient health systems towards promotion of
health and prevention of disease
13Primary health care by WHO
- PHC is essential health care based on practical,
scientifically sound, and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation and at
a cost that the community and the country can
afford It forms an integral part of the
countrys health system, of which it is the
central function and the main focus, and of the
overall social and economic development of the
community
14Principles of PHC
- Health Prevention Promotion
- Equity
- Appropriate Technology
- Community Participation
- Intersectoral Coordination
- Decentralization
15Components of PHC
- Education concerning prevailing health problems
the methods of preventing controlling them - Promotion of food supply and proper nutrition
- An adequate supply of safe water and basic
sanitation - Maternal and Child Health (MCH) including Family
Planning (FP) - Immunization against major infectious diseases
- Prevention and control of locally endemic
diseases - Appropriate treatment of common diseases and
injuries - Provision of essential drugs
16The organization of primary public health
services in Russian Federation
17Establishments in PHC in Russia
- Polyclinic (render the territorial polyclinics
serving adult population) - Children's polyclinics
- Female consultations
protect the motherhood and the childhood
18A modern polyclinic is a large multyfield
treatment--prophylactic establishment, intended
to render medical aid at outpatient reception
hours at home, also to realize a complex of
preventive actions on improvement of the
population health and prevention of diseases.
19The main aspects of work of a municipal policlinic
- medical diagnostic work, including selection
for sanatorium-and-spa treatment, examination of
temporary disability, reference to medical- - social examination
- preventive work, sanitary antiepidemic work
- organizational methodical work (management,
planning, statistical account and reporting,
analysis of activity, improvement of professional
skills, etc) - organizational mass work (sanitary hygienic
education of the population, popularization of a
healthy way of life). Medical workers of a
polyclinic should know main risk factors of the
major diseases and for popularization of medical
knowledge use correctly main forms and methods of
educational work.
20The basic organizational - methodical principles
of work
- District principle - attaching to a medical post
of normative number of inhabitants - Dispanserisation method - regular active
supervision over a state of health of the certain
contingents - Accessibility of PHC
- Preventive orientation of PHC
21The basic scheduled - normative parameters
- The district specification (1700 patients on one
post of the local therapist) - Norm of local therapist loading (5 visits at one
hour on reception in a polyclinic and 2 visits -
at patient service at home) - The function of physician position (number of
visits per year for one post of doctor) - The regular specification of local therapists
(5,9 on 10 000 inhabitance more senior than 18
years old). - The head physician of a polyclinic has the right
- to change these parameters depending on local
- conditions. For example, he can increase or
- reduce number of a site and loading of doctors.
22Function of the district physician-therapist
- Rendering of the qualified medical aid in
speciality internal diseases during outpatient
reception hours and at home. - Provide preventive and sanitary antiepidemic
work, dispensarisation hygienic popularization. - Timely hospitalization of patients in accordance
with established order. - Organization of consultations of patients with
doctors of other specialties. - Realization of medical and rehabilitation
activities in out-patient establishment. - Realization of examination of temporary
disability and reference to medical-social
examination. - Analysis health status of the served population.
23- Reorganization of out-patient - polyclinic
service in Russia will pass in a direction of
creation of institute of family doctors/ general
practitioner (GP). - GP is the expert widely focused in the basic
medical specialities, and capable to render the
multyfield out-patient medical aid for the most
widespread diseases and urgent conditions (GP is
the highly skilled expert of a primary link at a
pre-hospital stage). - Number of a served contingent at the doctor of
the general/common/ practice - 1500 adult person,
at the family doctor (in view of the children's
population) - no more than 1200 person in all
age.
24Duties of the GP (1)
- GP should know the demographic and medico-social
characteristic of the attached contingent. - Promote healthy way of life
- Give recommendations for questions of feeding,
preparations of children for preschool
establishments - Advice about family planning
- Carrying out antiepidemic actions
- Revealing the primary and latent forms of
diseases and risk factors
25Duties of the GP (2)
- Organization of all complex of diagnostic,
medical - improving and rehabilitation actions - Diagnostics of pregnancy and supervision over
current of pregnancy, treatment extragenital
diseases, revealing of contra-indications to
pregnancy, a direction on interruption,
conducting the postnatal period - Organization help, together with establishments
of social security and services of mercy for
lonely, aged and disable people and chronic ill
patients, including placement of patient in
houses-boarding schools and so forth - Carrying out of medical-social examination
- The analysis of a state of health of the attached
contingent, conducting the registration -
accounting documentation.
26Preventive prophylaxis concept
- Preventive prophylaxis (preventive measures) is a
main component of medicine. - Creation of system of the prevention of diseases
and elimination of risk factors is the major
social, economic and medical tasks of the state. - There are individual and public forms of
preventive prophylaxis.
27Three kinds of preventive maintenance (1)
- Primary preventive maintenance
- Secondary preventive maintenance
- Tertiary preventive maintenance
28Three kinds of preventive maintenance (2)
- Primary preventive maintenance is a system of
measures of the prevention of illness occurrence
and influence of risk factors in diseases
development (vaccination, a rational way of work
and rest, a rational qualitative food, physical
activity, improvement of an environment, etc.)
29Three kinds of preventive maintenance (3)
- Secondary preventive maintenance is a complex of
actions eliminat the expressed risk factors,
which under certain conditions (immune status
decrease, the overstrain, adaptability failure)
can lead to occurrence, aggravation or relapse of
disease.
30Three kinds of preventive maintenance (4)
- Tertiary preventive maintenance is a complex of
rehabilitation actions of the patients who have
lost an opportunity of high-grade ability to
live. Tertiary preventive maintenance has four
directions of rehabilitations - - social (formation of confidence of own social
suitability), - - labour (an opportunity of restoration of labor
skills), - - psychological (restoration of behavioral
activity of the person), - - medical (restoration of functions of bodies
and systems).
31The major component of all preventive actions is
formation at the population medical -social
activity and installations on a healthy way of
life.
32Dispensarisation (profilactic medical
examination)
- Dispensarisation is a main method of
- secondary prophylactic using in PHC.
- Dispensary method is regular active supervision
over a state of health of the certain groups of
patients which include - active early revelation
- dynamic follow up
- complex sanitation.
33The evaluation of the organization of the
dispenserisation
- Quality of dispenserisation
- coverage by dispensary supervision of those who
were not observed within one year period, - coverage by various socialprophylactic and
medicalpreventive measures (sanatorium-and-spa
treatment, invalid food, rational employment,
etc.) - Efficiency of dispensarization
- dynamics of morbidity rate and disease rate
according to MRTD (morbidity rate with temporary
disability) for working persons - general disease rate due to the main and
accompanying pathology - hospitalized morbidity
- incapacity, including primary one
- lethality
- outcomes of dispensarisation according to annual
account recovery, improvement, without changes,
deterioration.
34Estimation of activity of municipal polyclinic
- The analysis of activity of out-patient
polyclinic establishments is carried out for - the improvement of organization of work of
municipal polyclinics, - current and forward planning of their activity
- evaluation of efficiency of various methods of
treatment - evaluation of efficiency of diagnostic, new
medical technologies and new forms of the
organization of work - evaluation of quality of rendering of the primary
medical-aid to urban population.
35Quantitative coefficients of activity of
municipal polyclinic
- Occupation of posts of doctors
- Ratio number of physician posts to number of
posts of the middle medical personnel - Dynamics of patient visits to the polyclinic
- Distribution of visits of a polyclinic by the
form of application (for treatment or for
preventive medical check up) - Loading for a medical post (for a year, month,
reception hours) - Completeness of coverage of the population served
by a polyclinic by preventive medical check ups
36Qualitative coefficients of activity of municipal
polyclinic
- A level of the general disease rate (due to
visits) - A level of disease rate with certain diseases
- Structure of the general disease rate
- Primary disablement
- Structure of primary disablement
- Structure of contingents of the disabled persons
- Death rate at home
- Relative number of incorrect diagnoses
- Number of the advanced cases of oncologic
diseases - Frequency of cases (days) of temporary
disablement. - Structure of disease rate with temporary
disablement etc.
37Thank you for your attention!