PRINCIPLES AND ELEMENTS OF PRIMARY HEALTH CARE & LEVELS OF HEALTH CARE

PRINCIPLES AND ELEMENTS OF PRIMARY HEALTH CARE AND LEVELS OF HEALTH CARE

Primary Health Care (PHC) is the foundational strategy for achieving health for all. It was first articulated internationally at the Alma Ata Conference in 1978. Ayurveda, the science of life, also emphasizes promotive and preventive aspects of health which resonate deeply with PHC principles.

चरक संहिता, सूत्रस्थान 30/26
"धर्मार्थकाममोक्षाणामारोगं मूलमुत्तमम्।"

Translation: "Health is the supreme foundation for the attainment of Dharma, Artha, Kama, and Moksha."

DEFINITION OF PRIMARY HEALTH CARE
Primary Health Care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford.

PRINCIPLES OF PRIMARY HEALTH CARE

• EQUITY IN HEALTH CARE
  Equal access to health services for all, especially the vulnerable and underprivileged groups.

• COMMUNITY PARTICIPATION
  Involvement of individuals, families, and communities in planning and implementation of health care programs.

  सुश्रुत संहिता, सूत्रस्थान 15/48
  "स्वस्थस्य स्वास्थ्य रक्षणं आतुरस्य विकार प्रशमनं च।"

  Translation: “Preservation of health in the healthy and treatment of disease in the diseased.”

• INTERSECTORAL COORDINATION
  Collaborative work across sectors like agriculture, education, water supply, sanitation, and housing to improve health outcomes.

• APPROPRIATE TECHNOLOGY
  Use of scientifically sound, socially acceptable, and affordable technology that can be maintained by the community.

• HEALTH PROMOTION AND DISEASE PREVENTION
  Focus on preventive and promotive aspects through education, nutrition, immunization, and hygiene.

ELEMENTS OF PRIMARY HEALTH CARE
(As outlined by WHO and Alma Ata Declaration, 1978)

• EDUCATION ABOUT HEALTH PROBLEMS AND THEIR PREVENTION
  Health awareness regarding personal hygiene, nutrition, family planning, etc.

  अष्टाङ्गहृदय, सूत्रस्थान 2/9
  "नित्यं हिताहितं च यं पश्येत् स कर्म कुर्वीत"

  Translation: “One should act only after knowing what is beneficial and harmful for health.”

• PROMOTION OF FOOD SUPPLY AND PROPER NUTRITION
  Emphasis on balanced diet and availability of safe food.

• ADEQUATE SUPPLY OF SAFE WATER AND BASIC SANITATION
  Clean drinking water and proper waste disposal to prevent communicable diseases.

• MATERNAL AND CHILD HEALTH CARE INCLUDING FAMILY PLANNING
  Antenatal, postnatal care, immunization, spacing of children, and nutritional support.

• IMMUNIZATION AGAINST MAJOR INFECTIOUS DISEASES
  Especially in children – includes vaccines for polio, measles, DPT, tuberculosis.

• PREVENTION AND CONTROL OF LOCALLY ENDEMIC DISEASES
  Addressing region-specific diseases like malaria, filariasis, etc.

• APPROPRIATE TREATMENT FOR COMMON DISEASES AND INJURIES
  Provision of first-level curative services with referral if necessary.

• PROVISION OF ESSENTIAL DRUGS
  Availability of a basic list of essential medicines at all PHC centers.

LEVELS OF HEALTH CARE

Health care is delivered at three main levels, forming a referral system:

• PRIMARY LEVEL

  • Focus: First contact, accessible and affordable care.

  • Institutions: Sub-centres, Primary Health Centres (PHC)

  • Staff: ASHA, ANM, MPW, Medical Officer

  • Services: Preventive, promotive, curative, family planning, minor surgeries.

• SECONDARY LEVEL

  • Focus: More complex health problems needing specialized care.

  • Institutions: Community Health Centres (CHC), District Hospitals

  • Staff: Specialists (Physician, Surgeon, Pediatrician, etc.)

  • Services: Emergency care, diagnostics, inpatient services.

• TERTIARY LEVEL

  • Focus: Highly specialized and advanced care.

  • Institutions: Medical Colleges, Super-specialty hospitals

  • Staff: Super specialists and highly trained medical personnel

  • Services: Organ transplant, cancer care, neurosurgery, cardiac surgery.

AYURVEDIC PERSPECTIVE ON PREVENTIVE HEALTH CARE

Ayurveda offers various preventive approaches that align with PHC:

• DINACHARYA (Daily Regimen)
  Maintains body functions and immunity.

• RITUCHARYA (Seasonal Regimen)
  Adaptation to seasonal variations to prevent disease.

• SADVRITTA (Code of Conduct)
  Ethical and behavioral rules promoting mental and social well-being.

• AHARA (Dietary Management)
  Emphasis on wholesome food and proper dietary habits.

• VYAYAMA (Exercise)
  To maintain physical fitness and prevent lifestyle disorders.

• RAKSHA KARMA (Protective Measures)
  Use of Rasayana, immuno-modulators like Chyawanprasha, and Swarna Prashana in children.

MODERN PUBLIC HEALTH INTEGRATION

Modern textbooks (like Park’s Textbook of Preventive and Social Medicine) emphasize:

• Health Indicators to measure PHC efficiency.

• National Health Programs targeting primary care needs (e.g., RMNCH+A, NACP, NLEP).

• Universal Health Coverage (UHC) to ensure access to quality health services.

• Social Determinants of Health including education, employment, and environment.