|Training Manual in Combatting Childhood Communicable Diseases Part I (Peace Corps, 1985, 579 pages)|
|Module 2: Primary health care|
|Session 5: Primary health care|
TOTAL TIME: 2 hours
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.
· 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)
Health: A Time for Justice
- 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
Projector and screen if movie is shown, newsprint, markers, the Film, "That Our Children Will Not Die" (Ford Foundation).
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
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.
Possible questions to facilitate this discussion might include:
- What is meant by essential health care?
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.
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;
This discussion should focus on:
- How these eight areas can help persons to lead a socially and economically productive life.
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
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.
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
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".
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?
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.
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".
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
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.
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?