Training Manual in Combatting Childhood Communicable Diseases Part I (Peace Corps, 1985, 579 pages): Module 2: Primary health care: Session 5: Primary health care: (introductory text...)

Training Manual in Combatting Childhood Communicable Diseases Part I (Peace Corps, 1985, 579 pages)

Module 2: Primary health care

Session 5: Primary health care

		*(introductory text...)*
		Handout 5A: Shattuck lecture - Health care in the developing world: Problems of scarcity and choice
		Handout 5B: Water supply and health in developing countries: Selective primary health care revisited
		Handout 5C: Selective primary health care

(introductory text...)

TOTAL TIME: 2 hours

OVERVIEW

A thorough understanding of Primary Health Care is important for Peace Corps Volunteers involved in health activities such as CCCD activities. In this session participants critically review the WHO/UNICEF concept of primary health care as originally defined at the World Health Conference at Alma Ata, Russia in 1978. They focus on the emphasis of an integrated/multisectoral approach and community involvement. In small groups they develop charts illustrating primary health care which show the place of health education and their assigned programs. Through readings they learn about and discuss different approaches to primary health care.

OBJECTIVES

· To explain why primary health care is an appropriate means of protecting and promoting the health of all the people of the world. (Step 1)
· To describe the eight components of primary health care and give examples of primary health care activities in Africa. (Steps 2, 3)
· To describe the integrated/multisectoral design of health and development that characterizes primary health care and CCCD activities. (Steps 1, 3, 4)
· To identify at least two approaches to implementing primary health care. (Steps 3-5)

RESOURCES

Health: A Time for Justice

Handouts:

- 5A Health Care in The Developing World: Problems of Scarcity and Choice
- 5B Water Supply and Health in Developing Countries: Selective Primary Health Care Revisited
- 5C Selective Primary Health Care

MATERIALS

Projector and screen if movie is shown, newsprint, markers, the Film, "That Our Children Will Not Die" (Ford Foundation).

PROCEDURE

Trainer Note

By way of an introduction to primary health care, you might consider having the participants read Health: A Time for Justice (available through ICE Reference No. HEO79), the day before this session is to be presented. Also before this session you should critically read all the handouts so that you are prepared to facilitate discussions on the provocative concept of PHC. Viewing and discussing the film "That Our Children Will Not Die" is a suggested alternative to reading and discussing the articles. You may consider lengthening this session so that the readings and film can both be included.

Step 1 (15 min)
Understanding The Primary Health Care Approach

Introduce this step by reading and writing the following definition of Primary Health Care as stated at the International Conference on PHC in Alma Ata in 1978.

"Primary Health Care is a practical approach to making essential health care universally accessible to individuals and facilities in the community in an acceptable and affordable way and with their full participation".

"Health cannot be attained by the health sector alone. In developing countries in particular, economic development, anti-poverty measures, food protection, water, sanitation, housing, environmental protection, and education all contribute to health and have the same goal of human development".

Ask participants to look at this definition carefully and then using their knowledge of health care in the U.S. discuss aspects of the Alma Ata definition of PHC, and why some countries may find it a difficult or revolutionary concept to implement.

Trainer Note

Possible questions to facilitate this discussion might include:

- What is meant by essential health care?
- What aspects of health care have been essential to you?
- Is health care universally accessible in the U.S.?
- Are there more physicians and other health personnel and facilities in urban areas as compared to rural areas?
- What is meant by secondary and tertiary health care? How do these levels of care relate to Primary Health Care?
- Do you think that the health care system in the U.S. is acceptable to everyone? If not, why not?
- Do most Americans fully participate in the decisions that affect the kind of health care that is delivered in their area? If not, why not?
- What about the cost of health care? Is it affordable?
- What do you think about viewing health as an integrated part of the political, economic, social and environmental aspects of a country?

Step 2 (15 min)
Defining the Eight Components of Primary Health Care

Present the list of the eight components that the delegates from 134 governments and representatives from 67 United Nations' organizations and other specialized agencies have determined to be essential services provided by primary health care and ask the participants to briefly discuss why they think these areas have been stressed.

Trainer Note

Write the following list of the eight components of Primary Health Care on newsprint and present to the participants:

- Education concerning prevailing health problems and the methods of preventing and controlling them;
- Promotion of food supply and proper nutrition;
- Adequate supply of safe water, and basic sanitation;
- Maternal and child care, including family planning;
- Immunization against the major infectious diseases ;
- Prevention and control of locally endemic diseases;
- Provision of essential drugs;
- Appropriate treatment of common diseases and injuries.

This discussion should focus on:

- How these eight areas can help persons to lead a socially and economically productive life.
- The interrelationship between these eight areas.
- How an integrated approach to health care can most effectively deliver these services.

Conclude this discussion by stating that although most persons agree that primary health care should include these eight essential components, the ways of approaching the implementation of the PHC programs vary from one country and community to another and the following articles they will read and discuss present some of the different approaches/strategies.

Step 3 (20 min)
Examining Different Approaches to Primary Health Care

Have the participants form three groups and assign one of the articles found in Handouts 5A (Health Care in The Developing World: Problems of Scarcity and Choice), 5B (Water Supply and Health in Developing Countries: Selective Primary Health Care Revisited), and SC (Selective Primary Health Care) for reading and brief discussion by each group.

Trainer Note

Ask the participants to keep the basic principals of Primary Health Care in mind when they read these articles and to select one person in each group to prepare a 3-5 minute summary of the article that they have read to present to the large group reconvened for discussion in the next step (Step 4).

The attached articles were selected because they present three different approaches/strategies for the implementation of primary health care.

Step 4 (25 min)
Discussion of PHC Approaches

Reconvene the large group and ask the selected persons from each group to present a summary, not longer than 3-5 minutes, of their articles. Based on their understanding of the different approaches to PHC as presented in the summaries of the articles, have the group discuss and list on newsprint the pros and cons of the different approaches, and decide which ones they feel will be most effective in attaining "Health For All By The Year 2000".

Trainer Note

This discussion should be most provocative given the different approaches to PHC that they have just reviewed and shared in their brief presentations. In this 25 minute discussion the participants should direct their discussion to various aspects or approaches to PHC, some of which include questions concerning:

- What are the different approaches presented in these articles and an what key issues do they differ?
- Is there coordination of the health and health related sectors? (e.g. agriculture, education, finance)
- What are the social and economic determinants of health and ways PHC approaches affect these determinants?
- How is or how should PHC be supported within the national health system?
- What should be the focus of PHC programs?
- What are the constraints on implementing a complete PHC program?
- How should these constraints be addressed? (For example, should they concentrate an two or three particular PHC activities and worry about integrating other activities later when more funds are available?)
- What is or should be the role of International agencies in PHC?
- How does "political will" affect or impact an the PHC approach of providing health for all?
- How does or can strong management capabilities affect PHC programs?

Step 5 (15 min)
Summarizing Primary Health Care

Lead a short discussion on summarizing PHC. Focus this discussion around the following questions:

- From what we have seen and discussed thus far concerning primary health care, how would you explain the meaning of this concept to someone?
- What generalizations can we make about primary health care and its effectiveness as a means of promoting positive health and development?
- We have seen that a key concept in the primary health care approach is integration. Where do you think problems might arise in trying to integrate the various components of primary health care services?
- How will what you have learned during this session help you in promoting primary health care in your primary job assignment? Through secondary activities?
- What are the controversial issues surrounding primary health care?

Step 6 (20 min)
The Role of the Peace Corps Volunteer in Primary Health Care

Based on their understanding of Primary Health Care and the discussions in Session 1 and from other parts of their training on their roles as health educators, ask the group to discuss and develop a diagram for Primary Health Care, identifying where they think they as health care generalists/educators fit in.

Trainer Note

An example of a diagram that may be developed and used for discussion is the following

Alternate Step 3 (30 min)
"That Our Children Will Not Die"
Show the film "That Our Children Will Not Die".

Trainer Note

Ask a participant to set up the projector and run the film. Introduce this activity while one of the participants is setting up the projector. Explain that the film they are going to watch discusses a primary health care approach in a particular part of Africa. Advise them to watch the film, keeping in mind the eight basic principles of PHC that they have just discussed, and to identify ways in which they have been incorporated.

Alternate Step 4 (30 min)
Discussion of the PHC Approaches

After viewing the film, have the group engage in a discussion on how practical the PHC approach is in achieving the health care needs of an individual, family and community, and what some of the difficulties are in implementing this strategy.

Trainer Note

In this 30 minute discussion, the participants should direct their discussion to various aspects or approaches to PHC some of which include questions concerning:

- From what you saw in the film, what were the major health problems and needs of the people in the area where primary health care was practiced? Do these problems differ from what you might find in the U.S.? How?
- How were these problems and needs identified? Handled? Specifically, how did this primary health care approach solve health problems/meet health needs? Were the people involved in helping themselves? How?
- Of the key elements of primary health care outlined before the film, which ones were incorporated into the health care approach in the film? Was the health care accessible, acceptable, affordable? Were the elements integrated?
- What would you say were the essential components of the primary health care approach in the film? Food and nutrition? Sanitation? Maternal and child health? Family planning? Immunization?
- Do you see any ways in which a PC Health Worker might fit into a process/approach like the one illustrated in the film?