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Primary Health CareNursing 105

Donna Pierrynowski Gallant PhD, RN

October 1, 2008


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Objectives

Explain the terms primary health care and primarycare.

Describe the historical significance of the

Declaration of Alma Ata (1978) and the LalondeReport (1974)

List and describe the five principles and eightessentials of primary health care.

Describe the barriers to achieving primary healthcare.

Discuss the contribution of nurses toward primaryhealth care.


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Primary health care is the single most

important basis from which to renew the

health care system

Roy Romanow


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Alma Ata Conference

In 1978 at an International conference in Alma

Ata, formerly in USSR, representatives from 189

countries gathered and committed themselves

and their resources to the achievement of health

for all by the year 2000 through primary health

care.

(McMurray, pg. 30)


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Why?

Inadequate illness management systems were not creatinghealthier societies

Response on the part of the World Health Organization(WHO) to address the issues of unjust suffering and deaththat was/is occurring world wide, especially in the poorercountries.

(McMurray pg.30)

.


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Definition: Primary Health Care(PHC)

PHC is a philosophy and model for improvinghealth that focuses on promoting health/wellness and preventing illness. Attention is primarily on

aspects of peoples lives that make them sick (CNA, 2003). Addresses issues such as diet,lifestyle choices, income, housing, education,relationships, and environmental toxins.

Goal: Build community capacity to achievesustainable health and well-being (McMurray,pg.28).


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LaLonde Report (1974)

Health is not achievable from health care services

alone.. Must consider human biology, lifestyle,

environment, organization of health care

Lifestyle received the most attention

What is wrong with this focus?

(Potter & Perry, pg. 4).


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Primary health care approachconceptualizes health as a

Fundamental right

Individual and collective responsibility

An equal opportunity concept

Essential component of socio-economicdevelopment

(McMurray, pg.31; Besner, J. (2004), p. 352)


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Essentials of PHC

Health education

Safe food supply and adequate nutrition

Adequate supply of safe water and basic sanitation

Maternal and child care Immunization against basic infectious diseases

Prevention and control of locally endemic diseases

Appropriate treatment of common diseases and injuries

Essential drugs.

(World Health Organization)


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Primary Health Care Principles

Accessibility

Public Participation

Intersectoral collaboration

Appropriate Technology

Health Promotion and Illness Prevention


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Social Justice (Equitable access for all)

Deliberate consideration of the needs andagendas of all people.

Must supersede individual goals so that theleast advantaged people in a communityreceive equal care and service to thosewho are advantaged by virtue of finances

and knowledge. (McMurray, pg 34)


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Accessibility

Health for all people means equal access

to opportunity for all people whether they

differ by geography, race, age, gender,income, employment status, language,

functional capacity, to name a few.

(McMurray, pg.33)


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Barriers to Accessibility

Poverty/Socioeconomic Status:

Wealthy usually have better access to food

and a better lifestyle.Need to provide services that are

responsive to the poor and help them cope

and avoid the worst effects of poverty.


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Barriers

Cultural Minorities

Cultural bias can pose a barrier to

accessibility and have an impact on acommunitys health status and program

development.


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Barriers

Geography/ Rural

communities: People who

live in rural areas have

fewer resources thanthose in urban

environments.

Problems revolve around

limited resourcesinaccessible and

inappropriate services.


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Barriers

Stigma: Population groups with certain

health problems, AIDS, addictions,

hemophiliacs, homeless people In Canada people with HIV/AIDS have

described insensitivity, prejudice, and

avoidance from nurses and physicians,

other HP and friends(Health Canada)


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Barriers

Lack of education or information. Should

the informed person who demands certain

services from the health care system havean advantage over someone who is not

aware of what is available? Internet. (p.35,

McMurray).


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Nurses Role: Accessibility

Act as an entry point for access.

Identify and facilitate use of health

resources. Provide health information.

Care should be appropriate in content andamount to satisfy the essential needs ofthe people, and it has to be provided bymethods acceptable to them.


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Questions to ask yourself

How does the client get here? How much does parking costand does the client have sufficient money?

Are services and programs available in the neededlanguages?

Are the hours user friendly?

Is any print materials in literacy appropriate language?

How much do the drugs cost and can lower priced options besuggested?

Is the site wheel chair accessible?


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All persons are encouraged to participate

individually and collectively in the planning and

implementation of their health care.

Shift from professionally driven to people driven.

Example: Community health boards. (McMurray, pg 42; CNA, 2005)


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Empowerment

Based on the premise that if people are prepared for events or

circumstances with both information and community support

systems, they can become empowered and chart their own course

of action.

Empowered community members enjoy broad participation in

health policies, choosing priorities for health services and initiatives

and in developing appropriate conditions for living and working.

Empowerment helps build community capacity.

(McMurray, pg 16-17)


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Examples of Barriers to PublicParticipation

Clients isolation and vulnerability when

confronting bureaucratic organizations.

Tokenism of health boards.


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Nursing role: Public Participation

Promote the client as thecenter of care

Using community

development approaches.(Community development isthe process of empoweringcommunities to improve theirhealth and wellbeing).

Example Lillian Wald(Besner, 2004, pg. 353).


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How has the community been involved in

determining whether this program is

needed/performing as it should?

Is this program reflective of a need or problem

identified by the client or community, or is this a

professionally defined need?

Is the community working in partnership, or arethey just implementing what professionals tell

them to?


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Intersectoral & InterdisciplinaryCollaboration

Collaboration between all disciplines within the

community. (health, education, housing,

transportation and government). (McMurray p.41)

The basic determinants of health cross many

disciplines.

Do we need work in this area?

Are human resource issues affecting theimplementation of primary health care?


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Nurses Role: IntersectoralCollaboration

Collaborating with other sectors

Coordinating health services/referrals..

Ask the questions: What other professionalcolleagues should be involved in supporting thisperson? What community information, servicesand referrals does this person need? What

services are available in this community and howdoes the client access them?


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Appropriate Skills and Technology

A very broad definition

that encompasses

appropriate use of all

health care resourcessuch as funds,

personnel, facilities

and equipment.(CNA, 2005)


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Technology

Technology needs to be appropriate to thecommunitys social, economic and cultural development. Must be affordable by the

community.

Also means that individuals will receiveappropriate care from the appropriate HCP

within a time frame that is appropriate. (CNA, 2005)


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Technology

Recognizes the importance of developing

and testing innovative models of health

care and disseminating the results ofresearch related to health care.


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Technology

Should be subordinate to the goal of

improving peoples health.

A question: We have the technology tokeep very small birth weight babies alive,

yet should we do so at the expense of

others?

Do we need a MRI in every hospital?


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Nurses role: Appropriate Technology

Demonstrating cost effective, evidence

based (informed) care.

Being part of developing, implementing andevaluating technology.


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Questions

Is this the most cost effective way ofdealing with this issue?

Does the client know how to use theequipment safely?

Is the most appropriate professionalworking with the person?

Are professionals being used in the mostcost effective ways?


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Health Promotion & IllnessPrevention

Move away from the medical model to one

of prevention and health promotion.

Process of enabling people to increasecontrol over and to improve their own

health (WHO, 1986).

Range from local initiatives to interactingwith the global community.


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Barriers

Canadians value

expensive technology

and quick fix cures.

(CNA, 2002)


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Nurses role

Initiate health education and other

activities that assist, promote, support

clients as they strive to achieve thehighest possible level of health.

(CNA, 2002)


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What community resources are available toclients you deal with?

How are clients involved in the preparation and

implementation of your healtheducation/promotion programs?

Do the health education and health promotionprograms include a focus on the determinants of

health? Is there a focus on enabling people to increase

control over and improve their health?


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Ottawa Charter

Throughout the past two decades healthpromotion advocates have used the OttawaCharter for Health Promotion as a framework toencapsulate the goals of Primary Health

Care..(Build healthy public policy, create supportive environments, strengthen communityaction, develop personal skills, and reorient healthservices)

(McMurray, pg. 26).


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Primary health care vrs. Primarycare

Primary Care:

Primary management of a persons

condition. First level of contact an individualhas with an organized health system.


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PC vrs PHC

Primary care

individual focused

emphasis on cure

care provided by

health professionals

professional

dominance

PHC

community focused

emphasis on

promotion and

prevention

care provided by a

wide variety of people self reliance


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PHC and Nursing

If the millions of nurses in a thousand

different places articulate the same ideas

and convictions about primary health care,

and come together as one force, then they

could become a powerhouse for change.

(Mahler, 1985)


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PHC and Nursing

Nursing in a PHC system involves the

person, family and community. It starts

where the person is at and acknowledges

the many factors that affect that person's

health and illness.


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If we want to be sure that we have a health

system based on PHC principles, nurses need

to be sitting at the decision making tables.

What can you do to ensure that the changes

taking place will reflect a PHC model?


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Additional References Besner, J. (2004). Nurses role in advancing primary health care: a call to

action. Primary Health Care Research and Development, 5, 351-358.

Canadian Nurses Association (2005). Primary health care: Asummary of the issues. Retrieved on October 1, 2007 fromhttp://www.cnanurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdf

Canadian Nurses Association (2003). Primary health care: Thetime has come. Nursing Now, 16, 1-4.

Canadian Nurses Association (2002). A New Approach toPrimary Health Care. Retrieved on October 2, 2007 from

http://www.cnanurses.ca/CNA/documents/pdf/publications/PHC_presentation_Kirby_6602_e.pdf
http://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdfhttp://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdfhttp://www.cnanurses.ca/CNA/documents/pdf/publications/PHhttp://www.cnanurses.ca/CNA/documents/pdf/publications/PHhttp://www.cnanurses.ca/CNA/documents/pdf/publications/PHhttp://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdfhttp://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdfhttp://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdfhttp://www.cna-nurses.ca/CNA/documents/pdf/publications/BG7_Primary_Health_Care_e.pdf


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Case studies

Can you identify the components of primary

health care in this case study? RAKKU


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Summary

Primary health care and primary care.

Historical significance of the Declaration of Alma

Ata (1978) and the Lalonde Report (1974)

Five principles and eight essentials of primary

health care.

Barriers to achieving primary health care.

Contribution of nurses toward primary healthcare.

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