Essential health care 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 the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
Essential Components of Primary Health Care
There are eight essential components of Primary Health Care (PHC) approach. These are given below:
- Education concerning prevailing health problems and the methods of preventing and controlling them.
- Promotion of safe food supply and proper nutrition.
- An adequate supply of safe water and basic sanitation.
- Maternal and child health care, including Family Planning.
- Immunization against major infectious diseases.
- Prevention and control of locally endemic diseases.
- Appropriate treatment of common diseases and injuries.
- Provision of essential drugs.
Secondary Health Care is an intermediate level of health care, that is concerned with the provision of specific technical, therapeutic or diagnostic services. Specialist consultation procedures and hospital admissions fall into this category of care. These services are episodic and usually focused on a particular health problem.
Continuity of care is less critical. The role of a district hospital in primary health care has been expanded beyond being dominantly curative and rehabilitative to include promotional,preventive and educational roles as part of a primary health care approach.
The Federal Medical Center (FMC), Yenagoa, Bayelsa State is that hospital which delivers secondary health care services in Bayelsa State. Federal Medical Centres (FMCs), were established nationwide in states that do not have Federal University Teaching Hospitals present. The exception to this rule is Lagos State, which has one such centre in addition to a Teaching Hospital. FMC, Yenagoa, Bayelsa State, provides promotive, preventive, curative, diagnostics, in patients, referral services and also specialist care. FMC, Yenagoa, Bayelsa State, provides basic and comprehensive Emergency Obstetric and New born Care (EmONC). FMC, Yenagoa, Bayelsa State, provides referral care to the patients including those referred by the Rural Health Centers, Basic Health Units, Lady Health Workers and other primary care facilities.
Tertiary health care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, some problems which fall in tertiary care are:
- Head and neck oncology
- Perinatology (high-risk pregnancies)
- Neonatology (high-risk newborn care)
- PET scans
- Organ transplantation
- Trauma surgery
- High-dose chemotherapy for cancer cases
- Growth and puberty disorders
- Neurology and neurosurgery
Preventive care refers to measures taken to prevent diseases, (or injuries) rather than curing them or treating their symptoms.
Prevention and management of STIs and RTIs
The stigma associated with sex and STIs/RTIs is a major hindrance to prevention efforts and early treatment, therefore to understand STIs, it is important to take into account social, economic, cultural and other factors that pave the way for the infected organism to enter the human body. Treatment of the infection would cure a single episode of STI, but simultaneously addressing other determinants of STIs empowers the community to lessen the chances of getting infected. STIs are predominantly linked to poverty. Currently, there is not enough information available on STIs and on their prevention. There is also a requirement for the provision of information and treatment of patients at all levels, according to WHO protocols of Syndromic Case Management.
Major Micronutrient Deficiencies
Current status shows that there is 9.9% and 3.0% deficiency of Vitamin A among mothers and children under five respectively. Iodine deficiency among mothers is 21%, and among school age children 6.6%, Iron deficiency among children below 5 years is 64% and mothers of under 5 years of age is 45%. Currently, there are programmes such as fortification of salt for Iodine, vegetable oils for Vitamins A & D, wheat for Iron and folic acid which can reduce these deficiencies at both national and provincial level. There is a requirement of developing and launching media campaigns that would bring awareness to the population at large.
Maternal and Child Health Services (Including Family Planning)
Maternal and peri-natal conditions account for about 12 percent of the total BOD. This large disease burden is due to several causes. First presently, in Yenagoa, only 44% of the antenatal care is being provided by a skilled birth attendant and only about 33% percent of women are assisted by an appropriately trained provider during delivery. Secondly, one-third of births occur less than two years apart, which doubles the mortality risk of newborns as compared to a more normal spacing. Third, about one-third of pregnant women are underweight, which is correlated with low birth weight –a risk factor for the newborn. Basic new born care should also be provided at all levels and comprehensive EMonC should be available at THQ and DHQ hospitals.
The above factors explaining poor reproductive health in Bayelsa State are in turn largely explained by poor consumer education. There is a massive information deficit concerning reproductive health, and the consequence has been the weak demand for family planning services for spacing (although this is changing) and for pre- and post-natal and delivery services by qualified personnel. The second explanation for poor reproductive health in many rural areas is prohibition placed on women seeking care from male providers, in a situation where qualified female providers are often not within reach.
The information deficit and restrictions on women justify government interventions in the reproductive health area. In this intervention, the government must also make reliable services available, especially in rural areas, where qualified private providers are generally not present. In addition to front-line services provided by community health workers and staff of first level care facilities, referral services for serious cases (e.g., obstetric emergencies) should be made available at all Tehsil and District Headquarters hospitals.
Immunization is carried out under Expanded Program on Immunization which is a WHO and UNICEF assisted programme. The objective of the expanded Programme on Immunization (EPI) is to immunize children against vaccine preventable childhood diseases and women against neonatal tetanus. Immunization is done at the health facilities, outreach sites and through mobile teams to provide immunization services for children against Measles, Diphtheria, Tetanus, Polio, Tuberculosis, Pertussis, and Hepatitis-B. In addition to this, mothers of child bearing age receive 5 doses of TT or 2 doses during pregnancy. The current overall coverage in Yenagoa as per EPI CES for children 12 to 23 months was 77.0% and for mothers against Tetanus, it was 63%.
Immunization coverage in Bayelsa State has improved in recent years but remains below the national targets. The programmatic aspects are fully decentralized to the District Governments for reaching the target population with a well-defined package of immunization services. A strategy to expand coverage through private health sector has not yet taken hold.
These services are defined as “The process of enabling people to increase control over their health and its determinants, and thereby improve their health”.
Health Education and Promotion
Many of health problems in Bayelsa State are the result of very poor consumer education. Health education is a classic example of a public good; the government must take responsibility for it and fund it. Some of the most important types of health education needed in Bayelsa State are as follows:
- Basic hygienic practices to prevent various types of communicable diseases (personal hygiene, proper cleaning of kitchen utensils, boiled water, proper disposal of human waste, etc).
- Education about HIV/AIDS and other sexually transmitted diseases and their prevention.
- Creation of greater awareness of, and demand for: (i) immunization of infants and tetanus toxoid vaccination for women of reproductive age; (ii) pre- and post-natal checkup and deliveries by trained health care providers; (iii) the health benefits of proper spacing of children through family planning; and (iv) good nutrition practices, not only for pregnant women and young children, but also for adults (so as to prevent cardiovascular disease).
- Anti-smoking campaigns, to lower the incidence of cardiovascular diseases and other diseases associated with smoking.
- Education of people as health consumers to enable them to develop a better understanding of service quality. Consumers should be educated as to what they should expect and demand from a health care provider, public or private. They should also be educated to be able to distinguish among various types of health care providers, and especially to create awareness about the dangers of seeking care from untrained providers. An important point to note is that there is a great deal of synergy between general education levels and specific health education efforts. The efficacy of health education is likely to rise as education levels rise. Nevertheless, health education efforts can have a significant effect even under present low levels of general education. For example, levels of immunization in Bayelsa State have risen in the past when information, education and communication activities related to the immunization programme were stepped up. Another example of a successful and recent (information, education and communications) campaign in Bayelsa State is the campaign of family planning.
Rehabilitative care services can help people with disabilities to get gainfully employed and do away with reliance on others. This includes meeting the physical, psychosocial, emotional and spiritual needs of patients and their families while incorporating the nursing and rehabilitative processes. Such services should be provided to all patients in both inpatient and outpatient settings at all levels of care.
The importance of Rehabilitative Care Services should not be underemphasized. These services are part and parcel of any type of treatment and most of the time are indistinguishable as separate entities. It should be kept in mind that patients are receiving some type of rehabilitation during treatment or interaction with health care providers, as for example while receiving treatment for typhoid fever he/she is also being rehabilitated psychologically/nutritionally. Putting this in another way, it goes without saying that health care providers must avail all opportunities to provide the right type of rehabilitative services according to prevailing circumstances and level of care.