By the end of this session the learner should be able to: • Understand the PHC specialty e.g., its philosophy and features; its methods and its holistic approach to patient care. • List the principles and componentof PHC and demonstrate an understanding of their role in patient care in Saudi Arabia • Understand the difference between PHC, PC and Family Medicine • Demonstrates awareness of the general structure of the health care system in Saudi Arabia
Case 1 • Jamila 55 years old Saudi female, seen in KKUH primary care clinic. She was referred from PHCC with diagnosis of IBS and referred upon patient request. She claimed that she has files in SFH, Military hospital and national guard hospital, she refused to give any further history and demands full unjustified range of investigations.
Case 2 • Nadia 24 years old Saudi female seen in KKUH primary care clinic. You were shocked by seeing skin and bone patient with referral from PHCC with query diagnosis of esophageal carcinoma. The referral was dated 18 months ago. She missed one appointment 7/12 ago because she gave birth to her first child. This appointment was the only available appointment at that time.
Group task • Divide into group of 5 and discuss the 2 cases in regards to these issues: • Social equity • Nation-wide coverage • Self-reliance • Inter-Sectoralcoordination • People’s involvement in the planning and implementation of health programs
History of Health Care Services • 1926 PHC Taif and Makka • 1928 health and emergency services directorate • 1931 Ministry of interior (department of health) • 1950 establishment of ministry of health (MOH) and hospitals
Primary Health Care • Primary health care has been defined by the World Health Organization (WHO, 1978) as: • Essential care based on practical, scientifically sound and socially acceptablemethods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination.
primary health care is • It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. • It is the first level of contact of individuals, the family, and the community with the national health system, bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
الرعاية الصحية الأولية(منظمة الصحة العالمية) • هي إتاحة الرعاية الصحية الأساسية للجميع • بتكلفة يستطيع البلد والمجتمع تحملها • باستخدام وسائل عملية سليمة من الناحية العلمية ومقبولة من وجهة النظر الاجتماعية • لكل فرد من أفراد المجتمع • وينبغي إشراك المجتمع • وإشراك القطاعات الأخرى ذات العلاقة
Primary health care In accordance with Alma-ata (1978) declaration Saudi Arabia decides to adopt PHC approach in 1980 Alm-ata declaration PHC, WORLD HEALTH ORGANIZATION, GENEVA; 1978
Principles for PHC • PHC based on the following principles : • Social equity • Nation-wide coverage • Self-reliance • Inter-sectoral coordination • People’s involvement in the planning and implementation of health programs
Primary Health Care addresses the main health problems in the community, providing: • Promotive, • Preventive, • Curative and • Rehabilitative services accordingly.
Components of Primary Health Care • Education concerning prevailing health problems and the methods of preventing and controlling them • Promotion of food supply and proper nutrition • An adequate supply of safe water and basic sanitation • Maternal and child health care, including family planning • Immunization against the major infectious diseases
Components of Primary Health Care (cont) • Prevention and control of locally endemic diseases • Appropriate treatment of common diseases and injuries • Basic laboratory services and provision of essential drugs • Training of health guides, health workers and health assistants • Referral services
Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
Appropriateness • Whether the service is needed at all in relation to essential human needs, priorities and policies. • The service has to be properly selected and carried out by trained personnel in the proper way.
Adequacy • The service proportionate to requirement. • Sufficient volume of care to meet the need and demand of a community
Affordability • The cost should be within the means and resources of the individual and the country.
Accessibility • Reachable, convenient services • Geographic, economic, cultural accessibility
Acceptability • Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.
Availability • Availability of medical care means that care can be obtained whenever people need it.
Assessability • Assessebility means that medical care can be readily evaluated.
Accountability • Accountability implies the feasibility of regular review of financial records by certified public accountants.
Completeness • Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.
Comprehensiveness • Comprehensiveness of care means that care is provided for all types of health problems.
Continuity • Continuity of care requires that the management of a patient’s care over time be coordinated among providers.
The current Status of PHC as per Saudi Ministry of Health Stat Book 2010: 33% of PHC centers are equipped with X rays. 72% of PHC centers are equipped with labs. Very basic labs: CBC, EP, VS. INR, Hba1C, Lipid. TSH. Average 27 patients/physician/day, Can reach 72 3155 GPs, 1729 with FM training. Board certified FM (<1%).
Think, Pair & Share
Primary care? Primary health care? Family medicine?
Primary Care: is “that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care provided elsewhere by others.” L.K. Muldoon, W.E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol.97, No.5, 409-11
Primary health care refers to an approach to health and a spectrum of services beyond the traditional health care system. It includes all services that play a part in health, such as income, housing, education, and environment. Primary care is the element within primary health care that focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury. L.K. Muldoon, W.E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol.97, No.5, 409-11
Family medicine is just one of the primary care specialties, the others being general internal medicine, general pediatrics and, in some cases, ob-gyn (obstetrics/gynecology). Family medicine training, however, is the only primary care specialty to offer care for the whole family, irrespective of age or gender. Family medicine also includes broader training in areas such as obstetrics, gynecology, orthopedics, surgery and psychiatry, which is not included in most of the other primary care specialties.
Differences between comprehensive and selective PHC Reference: Rogers W, Veale B. (2000). Primary Health Care: a scoping report. Adelaide: National Information Service, Dept of General Practice, Flinders University. p18
Organizational Structure of MOH
Health Indicators for the Year of 1432 H. http://www.moh.gov.sa/en/Ministry/Statistics/Indicator/Pages/Indicator-2013-06-19-001.aspx
Kingdom of Saudia Arabia National e-Health Strategy: The New PHC Systems The Ministry of Health (MOH) aims to improve health care in the Kingdom of Saudi Arabia by improving its equability, standards, availability and quality all over the Kingdom. To realize this vision, the MOH has developed a business strategy and 5 year plan, and has positioned e-Health as a primary transformation agent and enabler. MOH worked with national and international advisors and IBM, and has developed an e-Health Strategy and 5 years Roadmap to enable the vision. http://www.moh.gov.sa/en/Ministry/nehs/Pages/default.aspx
The e-Health strategy supports the primary MOH business goals: • To Care For Patients. • To Connect Providers at all levels of care. • To Measure the Performance of healthcare delivery. • To Transform Healthcare Delivery to a consistent, world-class standard. http://www.moh.gov.sa/en/Ministry/nehs/Pages/default.aspx
The New PHC Systems • The great majority of MOH PHC’s today are totally manual. • During the life of the Roadmap over 2,900 individual PHC’ will receive new automated, standardized systems. • All of these systems will be able share patient information between themselves, hospitals, labs and speciality clinics.
Think, Pair & Share
Home Health care (HHC) • Definition: • It is an important service to help aging patients get their medical treatment at home without the hassles of traveling to hospitals or clinics. • Prior to 2010, there were five well-established government-sponsored HHC programs at: • King Faisal Specialist Hospital in Alqassim, • King Fahad National Guard Hospital in Riyadh, • Military hospital in Riyadh, and • King Khalid National Guards Hospital in Jeddah.
Home Health care the number of patients on the Home Healthcare Program (HHP) has exceeded 20,000 since its introduction in April 2010 Riyadh region accounts for most beneficiaries, 12 per cent in total, followed by Asir (11 per cent), Madinah (10 per cent), and Makkah (9 per cent). 25 percent of these patients suffer from chronic ailments such as diabetes, cardiac and renal diseases, while 23 percent suffer from paralytic stroke and neural diseases. Some 18 percent of the patients are affected with psychiatric diseases, while another eight percent suffer from various age-related diseases such as Alzheimer’s.” Only two percent suffer from malignant diseases News and views "Saudi Arabia - Home care program benefits over 15,000 patients", International Journal of Health Care Quality Assurance, (2012) Vol. 25 Iss: 7,
Home Health care The Ministry of Health mobilized a new fleet of 189 vehicles for this program There are more than 700 health officials who are divided into 246 teams working in the field in all parts of the Kingdom,” they are linked to 169 hospitals to attend to the health needs of patients confined to their homes Each medical team comprises a doctor, a nurse, technicians, physiotherapists and social workers to offer counseling to patients and their relatives News and views "Saudi Arabia - Home care program benefits over 15,000 patients", International Journal of Health Care Quality Assurance, (2012) Vol. 25 Iss: 7,