DR Congo + 2 more

Merlin Primary health care Factsheet March 2000

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At a glance
  • Primary health care provides basic health care to all community members
  • It includes prevention & treatment of poor health and promotion of good health practices
  • Merlin works in partnership with Ministry of Health staff & fellow aid agencies
  • We support existing health services through health education, vaccination, treatment and the provision of essential supplies
What is primary health care?

Primary health care is a broad term for basic health care at community level. It incorporates prevention of ill health as well as treatment of disease and health problems. The concept was formalised by the World Health Assembly in the A lma Ata Declaration of 1978. A typical primary health care programme might include health education; introduction of measures which reduce the risk of disease; vaccination against infectious diseases; maternal and child health care;
treatments for disease and malnutrition and provision of essential drugs.

Primary health care is based on activities which are acceptable and accessible to all members of a community, regardless of their age and status. It is marked by the principles of community participation and self-reliance. Health services must be appropriate and affordable for their users if they are to benefit their target communities. Access is the most important principle of primary health care, but it does not refer only to the distance between someone's home and
their nearest health centre. Access also involves whether, for example, people can afford treatment; whether women feel safe travelling alone to a clinic location and whether communities have been sufficiently informed about the health care available and its suitability for them to take advantage of it. The factors which make primary health care accessible are linked. Ensuring the services provided are appropriate for all can be achieved through full consultation with the community.

Primary health care can mean the first level of access to any country's health system, making the topic immensely wide-ranging. In the UK, this is via your GP. In several of the developing countries in which Merlin works, primary health
care in remote rural areas focuses on health centres which each serve a wide local community. The approach followed by health staff combines treatment of health problems, prevention of ill health and promotion of ways for people to stay healthy which fit into their way of life. However, the health of a population cannot be improved by health services alone. Many health problems are caused or increased by underlying poverty and lack of education or food. As a result, different services within a country need to work together to improve overall living conditions. For instance, cholera increases where people have poor access to clean water and hygienic living conditions. A safe water supply,
an efficient sanitation system and health education on the importance of hand-washing are required to reduce the risk from cholera.

In Merlin's primary health care programmes, we work in partnership with local authorities and other agencies to minimise many of the factors which contribute to poor health. Some programmes, such as our malaria control programme in East
Timor, take a selective approach i.e. integrating different ways to fight malaria into different services at primary health level. In other programmes, Merlin's approach is comprehensive and involves prevention and treatment of many
different health problems.

Primary health care in action

Primary health care is viewed as a concept which fits best with long-term development work because it encourages sustainable, low-tech, appropriate solutions to health problems faced by many people in a community. However, the principles of primary health care remain just as relevant in the emergency situations in which Merlin works. We adapt our work to the needs of the country, for example running temporary mobile clinics until we can revitalise existing health centres that have been damaged by conflict.

In each of Merlin's programmes in Liberia, Sierra Leone and the Democratic Republic of Congo (DRC), several elements of primary health care are undertaken, together forming programmes which combine prevention of ill health, treatment of problems and promotion of good health.

Spreading the word

Health education brings together all these components. In Nimba county, Liberia, Merlin is raising awareness of infectious diseases, including malaria, measles and diarrhoeal diseases, and how they are transmitted so that people learn how to prevent their spread. Promoting the use of bednets reduces malaria which is transmitted by mosquitoes. Explaining the importance of vaccination increases the number of people who wish to be protected from measles and other preventable childhood illnesses, while hygiene messages help limit cases of diarrhoea. Merlin's health education is carried out by a network of over 100 community health workers who make sure that their methods fit the local culture, thereby increasing acceptance of their message. In Nimba county, community health committees participate in decision-making. Tapping into existing local groups not only makes communities self-reliant, it also provides Liberia's Ministry of Health with a source of regular data about disease patterns for that area which improves their capacity to respond swiftly to outbreaks.

In addition to teaching communities, Merlin trains health staff in prevention, diagnosis and treatment of disease. Training staff who can then train their colleagues spreads medical expertise across a wide area and enables its benefit to last long into the future. Merlin is training Sierra Leonean health staff in measures which reduce the risk of malaria among people in Kenema district who have been made homeless by conflict. Insecticide-spraying the shelters which are their temporary homes demonstrates the need to be flexible when delivering primary health care in post-conflict situations.

Protecting communities

Merlin has responded to two outbreaks of yellow fever in Liberia in the last two years, vaccinating over 80,000 people against the disease and limiting its spread. But a regular programme of vaccination against childhood diseases such
as measles is equally important as a preventive tool. Such programmes are supported by training of health staff in management of the refrigerated equipment needed to store vaccines.

Pregnant and breastfeeding women and young children are two of the groups in any community that are most vulnerable to disease. Pregnant women in parts of eastern DRC attend antenatal clinics at health centres supported by Merlin. At
the clinics they have a check-up, are treated for anaemia and receive health education. Most babies are delivered by traditional birth attendants, not trained midwives. The need for a referral system so that women with serious childbirth problems can be referred to a hospital which can provide specialist care demonstrates that primary health care should not be the only level of health care available to a community. Merlin aims to encourage health centres to run family planning and reproductive health sessions at the same time as clinics for children under five years. This reduces unnecessary travelling and maintains the principle of wide access to primary health care for all who need it.

Treating and supplying

Providing one service can often lessen the burden on others. Severely malnourished children in Sierra Leone require intensive 24 hour treatment in a therapeutic feeding centre. If food supply in a community is sufficient, or if moderately malnourished children on a less intensive supplementary feeding programme do not deteriorate, there is less strain on primary health resources.

DRC has suffered from the effects of an internal conflict which has damaged basic health facilities and disrupted the services they can provide. As access to affected areas increases, so too can access to primary health care. In the east, Merlin is supplying 42 health centres with essential drugs to improve the prevention and treatment of the top five causes of disease and death in Maniema province. The cost of the drugs is being shared with each local community so that they remain affordable. Money raised is used on health centre maintenance which in turn keeps the health centres functioning.

Merlin is Medical Emergency Relief International
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