A family is the basic unit of human relationship.
CHARACTERISTICS
(1) They share a bond through marriage.
(2) There is economic and cultural bond between the family.
FUNCTIONS OF THE FAMILY
(1) To provide sensual relationship.
(2) For procreation. i.e child bearing and child rearing.
(3) Economic roles.provide shelter,clothing , education, feeding.
(4) Education; The family is the first school for the child.
(5) Responsible for socialization; Relationship with parent and other siblings.
(6) For stabilization of child-adult relationship.Good citizenship start at home.
TYPES OF FAMILY
(1)Nuclear (2)Extended Family.
Families can be classified based on number of partners/parties;
(1) Polygamy (2) Monogamy (3)Polyandry(practiced in Asia,East-Africa.)
Classification based on the type of residence
(1)Patrilocal; They make their residence in the paternal home.
(2)Matrilocal; They make their residence in the maternal home.
(3)Neolocal
Classification according to line of inheritance
(1)Patrilinear; Inheritance along paternal line. As in Nigeria.
(2)Matrilinear;Inheritance along maternal line. As in Ghana.
Classification based on mode of choosing partners
(1)Endogamous;When you choose from your tribe/ethnics grp.
(2)Exogamous; When you choose from outside of your tribe.
COMPONENT OF FAMILY HEALTH
(1) Maternal health.
(2) Child health.
(3) Family planning.
MATERNAL/CHILD HEALTH (MCH)
This refers to the broad and currently accepted means of providing promotive, preventive, curative and rehabilitative health care to mothers and children.
SUBAREAS OF MCH
Maternal health, child health, Adolescent health, school health, handicap health. Heqalth care for children in special settings. E.g day care setting.
OBJECTIVES OF MCH
(1) To reduce maternal, perinatal, infant, childhood mortality and morbidity.
(2) Promotion of reproductive health.
(3) Promotion of physical and psychological development of the child and the adolescent within the family.
PROBLEM OF MCH
(1) In developing countries; Problem of malnutrition, communicable disease, spacing problem, alcoholism e.t.c.
(2) In developed countries; Perinatal, genetic, behavioural, congenital problem.
REASONS FOR PROVIDING HEALTH CARE SERVICES TO MOTHERS AND CHILDREN.
(1) They constitute the high risk group.
(2) Because there is need for prophylaxis and the opportunity to give prophylaxis
(3) They need early diagnosis and treatment.e.g ecclampsia, neonatal tetanus.
(4) Health of mother and children and their health problems are linked together. Health of next generation depend on the health of the children borne.
(5) For operational convenience and continuity of care.
(6) They are faced with high mortality rate especially in developing countries.
(7) Maternal health status is a major determinant of family health status.
(8) Growth and survival of the whole nation depends on successful child bearing and child rearing practices among its members.
(9) There is need for critical care during delivery.
CONCEPTS OF MCH
(1) Continuity.
(2) Comprehensiveness
(3) Well co-ordinated for ease of referral (PHC – LTH for cs – natal services)
(4) Integrated into existing programs.
(5) Made accessible to grassroot.
(6) Made acceptable to the people, culturally, religiously and ecstatically.
(7) Made affordable.
Concept of continuity states that throughout the lifespan of mothers and children there is always a special service provided.
MCH SERVICE CYCLE
DIAGRAM
Integration of family planning into MCH is very important; because acceptance of family planning is based on confidence in child survival which is best assured through a comprehensive MCH program.
PUBLIC HEALTH
Public health is the science and act of preventing disease, prolonging life, promoting health and efficiency through organized community effort, for the sanitation of the environment, control of communicable infection, education of the individual in personal hygiene, organization of medical and nursing services for early diagnosis and prevention of disease, and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing this benefit so as to enable every citizen to realize its birth right of health and longeivity.
Skills in public health includes; Planning, surveillance, evaluation and management.
There is need of skills in epidemiology, biostatistics and social sciences.
Public health service as an institution.
SYNONYMS;
(1) Preventive medicine
(2) Social medicine
(3) Community medicine; Practiced only by a Doctor and serves a defined geographical boundary.
These are similar but not equivalent.
Each is a component of Public health- can be practiced by anybody and it serves the whole world.
Preventive medicine; is the timely application of all means to promote the health of individuals and the community as a whole, including prophylaxis, health education and similar work done by a good Doctor in looking after individuals, families and community.
Specific prophylaxis; (1) Chemoprophylaxis (2) Chemo-suppression (3) Immuno-prophylaxis (Active and passive immunization (4) Chemotherapy
SCOPE OF PREVENTIVE MEDICINE
Historically, vaccination is used as a means of preventing disease.
Preventive medicine uses the knowledge of etiology of a disease and its prevention. Currently it includes;
Health promotion, health education, population control, environmental control, genetic counseling, specific protection, disability prevention, screening and prevention of chronic disease.
Community health; should not be used at all because it connotes environmental sanitation. The scope includes all personal health and environmental services in any human community irrespective of whether such services are public or private. Specialties-preventive cardiologist.
Social medicine; The study of man and total being in its total environment. It is concerned withal the factors affecting the distribution of health and illness in the population including the use of health services.
Community medicine;
The field concerns with the study of health and diseases in the population of a defined (Delimited) community or a group. Its goal is to identify the health problems and needs of a defined population (community diagnosis) and to plan, implement (community health actions)and evaluate the extent to which health measures effectively meet these needs.
It includes everything in public health but only done by Doctors on a delimited population.
Characteristics of a delimited community
(1) They know themselves. E.g in staff clinic and Ilie.
SCOPE
The term is used to describe the practice of medicine in a different community. Therefore some equate it with family medicine. E.g family physician.
History in Britain – first started in 1968 when the todd commission recommended that every medical school in England should have a department of community medicine. It was passed by
In 1972, the royal college of physicians establish facaulty of community medicine.
In 1974, abolish MOH and establish community physician.
In Nigeria; Dr Ladipo Oluwole (1897 -1953 ) is the father of public health in Nigeria. He was a medical officer of health in Lagos colony.
About 1920 -1924, there was an outbreak of plaque called black death.
In 1925, they made Dr Oluwole an assistant medical officer of health
- He started training of sanitary officers.
- He started health education in his clinic at massey street
- He started health work in school and began school of health services.
- He began the first infant welfare service.
- He started the training of home visitors.
- He collaborated with European authorities in the eradication of malaria, but he failed.
- He eradicated the incidence of plaque.
- He started the first old people (Geriatric) service in Nigeria.
HISTORY OF PUBLIC HEALTH IN NIGERIA
PH services originated in Nigeria from British army medical services in the precolonial era. With the integration of the army and colonial govt in the colonial era, govt offers to treat the local civil servants and thiier relative and eventually medical service extended to the local population.
As at this time health services provided to the local population was incidental rather than planned, thereafter various religious bodies and private agencies established hospitals, dispensaries and maternity centres in different parts oof the country.
The first attempt at planning for elaborate hhealth service in Nigeria was in 1946, as part of an exercise which produce the 10yrs plan for development and welfare (1946- 1956). This 10yrs plan included 24 major schemes formulated by expertrate. The major drawback of the scheme was that they were not properly co-ordinated and they did not relate to any overall economic target.
Since 1960, when the country became independent, healthpolicies have been formulated in various forms as part of national development plans or as govts decisions on specific health problems.
(1) Health component of the 2nd national devpt (1970- 1974).
(2) 3rd national devpt plan (1975- 1980). Which produced the basic health service schemes.
(3) Heath component of the 4th national devpt plan which produced the current national health policies which is been revised.
The basic health service scheme constitute the 3rd NDP, was the precursor of PHC in Nigeria. The basic plan of this scheme is to build in each LGA, one comprehensive health centre, 4 PHC, and 20 health clinics per LGA. This was designedfor a population of 150,000 people.
To provide the man power this scheme (BHSS), thereis establishment of schools of health technology and these produced the community health extension workers (CHEW), both senior and junior and some community health assistants and some environmental health officers.
The scheme was designed to provide the following services;
(1) Preventive and curative care for high risk populations e.g family health, health of handicap e.t.c.
(2) Family planning advice for couples
(3) Control of communicable diseases and environmental hygiene.
(4) Acute traumatic care.
(5) Referral to secondary tertiary levels of health care.
4th NDP (1980- 1985) produced the current national health policy which is been revised.
The national health policy identifies national PHC as the cornerstone of the national health system and recommended for main strategy for implementation.
(1) Promotion of community participation in planning for health care
(2) Involvement of health related sectors in health planning.
(3) Strengthening of functional integration at all levels of health care.
(4) Strengthening of managerial process for health devept, because poor management has been noted to be the
HISTORY OF PHC
In 1977, world health assembly (WHA), a movement was launched known as health for all by year 2000. the fundamental principle of health for all is equity i.e equal health status for all people in all countries ensured by the equitable distribution of health resources.
In 1978, a PHC conference held in Alma-ata USSR. In this conference , it was declared that provision of health care is a major social responsibility of all govt and it was stated that the best way of achieving HFA is PHC, especially to rural people and the urban poor.
At this time it was envisaged that by year 2000 essential healthcare will be made accessible to all individual and all families in an acceptable and affordable way with their full participation.
In 1981, a global strategy of health for all was evolved by WHO.
This strategy provided a global framework which could be applied to all member country and yet this framework was flexible. This was done in order to allow for national and regional variations.
DEFINITIONS, OBJECTIVES, COMPONENTS AND PRINCIPLES OF PHC
PHC is defined as essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost that the individual, community and family can afford.
PHC is essential HC based on practical, scientifically sound and socially acceptable methods 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 devpt in the spirit of self reliance and self determination.
COMPONENT OF PHC
(1) Curative service for common ailments and injury.
(2) Immunization.
(3) Provision of essential drugs.
(4) Maternal/ child care including family planning.
(5) Food and nutrition.
(6) Health education
(7) Control and eradication of vectors and animals reservoirs of diseases.
(8) Provision of portable water and environmental sanitation.
(9) Community mental health.
(10) Community dental health.
(11) Community geriatric health.
PRINCIPLES OF PHC
(1) It reflects the socioeconomic characteristics of the country.
(2) Provides promotive, preventive, curative, rehabilitative services.
(3) It includes health education, promotion of food supply and proper nutrition, provision of portable water e.t.c.
(4) It involves health related sector participation, like education, agriculture, information, housing and works.
(5) Requires community participation.
(6) Supported by integrated functional and mutually supportive system.
(7) It rely on community health workers.
OBJECTIVES OF PHC
The basic objective is the provision of heath for all.
IMPLIMENTATION MACHINERY FOR PHC
At the federal govt level, there is national PHC devpt agency (NPHCDA), established in 1993. Its function is to;
(1) Sustain the PHC.
(2) It maintain PHC link between SG and LG.
(3) It provide logistics and health service research for PHC.
Nigeria is divided into 4 zones ( A,B,C,D) with zonal co-ordinators.
SG- Thereis the state PHC co-ordinators.
LG level –PHC implementation steps are;
(1) Community diagnosis; The is a system of diagnosing the health problems of a community. In community diagnosis the things you do are;
(a) Community entry; First go to the oba of the community to gain his approval. He then informs his chiefs, e.t.c.
(b) After carrying out your research, you come out with the community diagnosis e.g in ilie, the health problems are schistosomiasis, malaria, gastroenteritis, hypertension, e.t.c.
(2) Situation analysis; Ask questions why this people come down with malaria, schistosomiasis, e.t.c, maybe because of poor water e.t.c, schistosomiasis because there is nearby river.
Take inventory of existing health facilities,e.g how many health centres, Doctors, beds, nurses, facilities for admission do they have.
(4) Map of the LG and the community.
Divide LG into districts and assign health team into each district.
(5) Placement of home based cards. There are two types; (a) Child health cards,< 18yrs. (b) Adult health cards > 18yrs. E.g in house 1, if there are 10 children, you place 10 child health cards and if there are 5 adult you place 5 adult health card in the house..
There are health facilities based cards and community based cards.
Community based card; The village health workers which is a member of the community who volunteered that he will treat anybody that falls sick in the community.
Characteristics of VHW
(a) He is a volunteer health worker.
(b) He must be 30yrs and above
(c) He must have received from the LG.
(d) He lives within the community and a member of the community.
(e) He is married and should have his own means of livelihood.
The community health log book is kept with the VHW who records every sickness within the community.
(6) Community mobilization;
District village Health facilities/centres
Committee vil devpt health facility dev committee
District committee
Health devpt
committee
Tell the committee their function.
Put important people in the committee, e.g oba, chiefs, pastors, oluwo. Their role is mobilization of the community members to go to the health facilities whenever they fall sick.
(7) Upgrade facilities at the health centres.
Resources at health centers; Beds, drugs, forms or cards, workers are adequate.
There are cadres of workers- Doctors, VHW, comm. Health officers (CHO), CHEW, TBA. VHW and TBA are part of the community. Train them and provide the facilities for them to operate.
STRATEGIES
(1) Community participation. Project comm. Partici comm. Mobilization comm. Organization
(2) Integration.
(3) Inter-sectoral collaboration.
(4) Referral system.
(5) Essential drug program.
(6) Good managerial capability.
Project with community participation has the following advantages;
(a) Less costly.
(b) Increase utilization.
(c) Increase sense of responsibility.
Integration; This means that different health services are going on in the same health facility/center at the same time, e.g performing immunization, ANC, family planning on the same day.
Intersectoral collaboration; e.g in case of diarrhea, get to the root of the problem,i.e due to poor sanitary facilities, bad water, bad personal hygiene or secondary to poor housing- this needs ministry of works and housing. All this ministry will have to come together and work so as to eradicate the cause of the diarrhea.
PHC is the first level of contact for the patient.
Secondary health center is the first level of referral.
Tertiary HC, e.g LTH
Essential drug program; When requesting for drugs for the LG, request drugs that is needed by the community. Essential drugs are drugs that address health problem of at least 90% of the community.
PROBLEM FACING THE IMPLEMENTATION OF PHC IN NIGERIA
(1) Poor management.
(2) Community participation- involves 8 steps.
(3) Poor utilization of health facilities secondary to poor community participation.
(4) Poor referral system.
(5) Poor linkage between the 3 tiers of govt.
(6) Riverine areas has problems, e.g difficulty in crossing the river.
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