The Role of PHC in Developing Countries

PHC

After having an interesting and interactive discussion during a Week 4 tutorial session with my group mates, I am spurred by my strong motivation and interest to share the content of discussion about PHC in our tutorial seesion.

First of all, What is PHC? What does this medical abbreviation mean?! Ok, I will let you know right here, right now. PHC stands for Primary Health Centre. It is in accordance with the Alma Ata Declaration, 1978 by the member nations of WHO; in which PHCs were established to provide accessible, affordable and available primary health care to people.

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care(PHC), Almaty (formerly Alma-Ata), currently in Kazakhstan, 6-12 September 1978.^[1]It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of "Health for All".

In South Asia, PHCs are the basic structural and functional unit of the public health services in developing countries. They are the cornerstone of rural healthcare where in these rural places, health services and healthcares are scarce. Therefore the establishment of PHCs and their sub-centres in rural areas are to meet the health care needs of rural population.

Objectives of PHC are organizing health efforts that are comprehensive, integrated, equitable, acceptable and affordable by the community, with active participation of the community and use the results of science and appropriate technology, a cost that can be carried by government and society. Health effort was organized by focusing on service to the wider community in order to achieve optimal health degree, without sacrificing quality of service to individuals. Lastly, they should provide preventive, promotive, and curative to rehabilitative either through the efforts of individual health (UKP) or public health efforts (SME).

Each primary health centre covers a population of 1,00,000 and spread over about 100 villages. Other sources, said that theoretically every 30,000 population gets one PHC. Each PHC has five or six sub-centres staffed by health workers for outreach services such as immunization, basic curative care services and maternal and child health services. PHCs generally consist of one or more doctors, a pharmacist, staff nurse and other paramedical support staff.

Below are the job scopes of a PHC:

• Medical care.
• Mother and child health care including family planning.
• Safe water supply and basic sanitation.
• Prevention and control of local diseases.
• Collecting statistical information.
• Health education.
• Training of health guides, health workers, dayees.
• Basic laboratory investigations.

In Indonesia, Puskesmas (Pusat Kesehatan Masyarakat) is the PHC that is located at the rural areas of the country. Puskesmas provides in-patient and out-patient services that were agreed by the health centres and health authorities concerned. In providing services in the community, puskesmas usually has a subunit of services such as health centres (puskesmas pembantu), mobile health clinic (puskesmas keliling), neighborhood health center (posyandu), rural health post (pos kesehatan desa) and village maternity posts (polindes).

In India, PHC's form a basic part of the health care system. The Medical Officer who provide services through the PHC's must be a MBBS degree holder. In addition to the provision of diagnostic and curative services, the Medical Officer also acts as the primary administrator for the PHC.

The primary field staff, who provide outreach services, are called "ASHA (Accredited Social Health Activist)" or village health nurse, depending upon the Indian state where the PHC is located. The village health nurse provides service at the point care, often in the patient's home. If additional diagnostic testing, or clinical interventions were required, the patient would be transported to the PHC to be evaluated by the Medical Officer.

Now under national rural health mission PHC are rapidly upgraded. Therefore, there are many health services that can be provided by puskesmas or PHC which includes an ECG (electrocardiogram), minor surgery, neonatal resuscitation, implants, nebulizers, maternal ward and some also have X-rays as well as a defibrillator.

Recently, a selective primary health care (PHC) approach referred to collectively under the acronym GOBI-FFF, these are strategies that are being adopted to improve maternal and child health as part of primary care. GOBI-FFF is a model of a PHC. Respectively they include:

• Growth monitoring
• Oral rehydration therapy
• Breast-feeding
• Immunization
• Family Spacing (planning)
• Female Education
• Food Supplementation

This was further reduced to GOBI only (selective PHC) on the priorities set by donors for poor countries.

References:

www.wikipedia.com (keyword: primary health centre, community health centre, Alma Ata Declaration, Puskesmas)

india.gov.in (keyword: primary health centre)