Definitions and the new Primary Health Care Sector
Primary Health care as Philosophy, as Strategy, as Set of Activities and as 1st Level of Care
NZ Primary Health Care Strategy Feb. 2001, and 2002 Review of progress to date.
Delivery of PHC Service through PHC Organisations
Implications for Primary Health Care Nursing.
Example of PHC Nursing Initiative. Nursing Innovation in To Tai Tokerau Northland.
References.
1. Allan, M. Carthew, M.Palmer, J. (2004).Nursing Innovation in Te Tai Tokerau Northland. Health Symposium presentation.Albany. Dec. 2004
2. King. A. The Honourable. Minister M.O.H. ( 2001). The Primary Health Care. Strategy.Wellington (and the Implementation Report 2002
3. MOH (2002 Dec). Public Health in Primary Health Care Setting.
4. Report to MOH (2002) from:
Expert Advisory Group on PHC nursing in NZ. Investing in Health: Whakatohutia te Oranga Tangeta. A Framework for activating PHC nursing in NZ.
5. Wass, A. (2000). Ch. 1. Health Promotion in context: Primary health Care and the new public health movement in:
Promoting Health. The PHC approach. 2nd Edition.
Harcourt health Sciences Co. Australia.
Topic 1.Reviewing PHC and definitions
??In groups of 3, do a 2 minute brainstorm about what you know about PHC.
??What is it?
??What are the key aspects of PHC?
Setting the context in New Zealand. Two Key MOH documents
??The New Zealand Health Strategy (2000).
Aim is to reduce inequalities in health and improve the overall health status of the population.
??The Primary Health Care Strategy (2001) sets out this will happen in a primary care setting.
Topic 2. Definitions. What is…
Public Health?
Population Health? Considers the health of groups, families and communities. Populations may be defined by locality, age and gender, socioeconomic status or cultural criteria. It integrates all activities of the health sector (public health, mental health, personal health, disability support).
(refer to the 13 Population Goals in Bk Readings Primary Health Strategy Document pg….How do they differ from the 7 Public Health Goals pg….?)
Primary Health Care (PHC).
Definition from The Ministry of Health (MOH) NZ PHC Strategy.
1.Quality PHC means essential health care based on practical, scientifically sound, culturally appropriate and socially acceptable methods that is::
2.universally accessible to people in their communities
3. involves community participation
4.integral to, and a central function of, NZ’s health system
5. the first level of contact with our health system
Study skills homework tonight: HOW DOES THIS RELATE TO THE ALMAATA DEFINITION?
Distinguish between Primary Care and Primary Health Care.
??Primary Care: when people require health care because of illness or injury, the FIRST line of care is primary.
??May include only one intervention or treatment over a period of time.
??Primary Health Care (PHC) includes primary or initial care to address a problem, BUT ALSO encompasses the broader activities of govt and other sectors of society . (It is philosophy, a strategy, a set of activities and a level of care).
??Goal of PHC is to help communities and the people in them to achieve lasting improvements in the quality of their lives. (Ferrinho, 1993, cited McMurray, 1999).
The New NZ Primary Health Care Sector
??Primary Health Care Strategy document. Note the lines of responsibility.
??NB primary health care practitioners will be free to decide whether or not they join a PHC Organisation.
Topic 3. PHC as Philosophy.
Emphasis on principles of:
Social justice, equity, community participation, socially acceptable and affordable technology.
The provision of services on the basis of needs of the population, health education and work to address the root causes of ill-health.
Emphasizes working WITHpeople to enable them to make decisions about their health.
PHC philosophy uses approaches that are affordable, appropriate to local needs and are therefore sustainable.
PHC as a strategy for organising care.
When the philosophy of PHC is implemented, the organisation of health care reflects a :
??Balanced system of illness treatment with
??Rehabilitation and
??Disease prevention and
??Health promotion
??How does the NZ PHC Strategy measure up?
PHC as a set of activities.
The Alma Ata (WHO 1978) highlights a minimum set of activities:
??Educationof prevailing health probs, prevention and control
??Promotion of food supply and proper nutrition
??Provision of adequate safe water supply and basic sanitation
??Provision of maternal and child health care including family planning
??Immunisation against themajor infectious diseases
??Prevention and control of locally endemic diseases
??Appropriate tratment of common diseases and injuries
??Provision of essential drugs
??How well are we doing inNew Zealand?
PHC as a LEVEL of care.
??Is often described as the first point of contact with the health system.
BUT
??Cannot be described as a PHC unless the service offered is comprehensive
??AND
??is underpinned by the Principles of PHC. including collaboration with other health and welfare workers to deal effectively with health issues in their local area.
Study Skills Break. Taking notes from Lectures
??Share your own lecture notes you have taken to enhance the power point slides with your neighbour.
??Outline your understanding of PHC as a Philosophy of Care in your own words to your neighbour
Topic 4. NZ PHC Strategy: Old and New PHC Strategies
Old
??Focus on individuals
??Provider focused
??Doctors principle providers
??Fee for service
??Service delivery monocultural
??Providers tend to work alone
New
??Population based
??Community/people focused
??Education and prevention important
??Teamwork-nursing too
??Needs based funding for population
??Cultural competence
??Connection to other health and non-health agencies
PHC Strategy in summary.
1.Aims of the Strategy.
??Better health for all
??Reduced health inequalities
??More emphasis on population health
??Better access to PHC services
??So-ordination, continuity, collaboration
??Community participation
??PHC fully involved in health system
2.How will the PHC Strategy be implemented?.
1.The MOH through health services and PHO’s will work with local communities and enrolled populations
2. Identify and remove health inequalities
3.Offer access to comprehensive services to improve, maintain and restore people’s health
4.Co-ordinate care across service areas
5.Develop the primary health care workforce (you will ask the visiting PHC nurses how this has impacted on them).
6.Continuously improve quality using good information.
3. What will guide the new Strategy directions?
??Principles
*Acknowledging the special relationship between Maori and the Crown under the Treaty of Waitangi and *Good health and wellbeing for all NZ’s throughout their lives.
??Population Health Objectives:13 (out of identified 61 Objectives). Reduce Smoking , Ensure access to appropriate child health care services including well child, family health care and immunisation. (NB note difference between Population Health Objectives and 7 Public Health Goals pg….. Bk readings)
??Priority Objectives to Reduce Inequalities.e.g. Ensure accessible and appropriate services for Maori.(more of this in Determinants of Health Lecture)
Topic 5. How will the new PHC Service be delivered?
The Process:
??NZ Public Health and Disability Act 2000
??21 District Health Boards (DHB’s) overall responsibility for assessing,managing and delivering services, both acute and primary health care
??Services will be devolved to Primary Health Care Organisations (PHO’s). E.g. Maori and P.I. And other PHC providers. IPA’s Practices and Health clinics.
??Refer back to diagram pg….. of Bk Readings: The NewPHC Sector.
Topic 6. Implications of PHC for Nursing.
What is the ICN’s position re nurses and PHC?
??The ICN believes that equity and access to primary health care services, particularly nursing services, are key to imporving the health and well being of all people.
What is the Current View of the NZ Government re PHC New Zealand Nurses?
??PHC Nursing is critical to implementing the PHC Strategy.
??The NZ Govt. realizes that nurses have a critical role in the development of health policy at all levels and has developed a:
??MEMORANDUMof UNDERSTANDING (MOU) (2001) between the MOH and NZ Nursing Organisations.
??Objectives include, leadership and nursing perspectives in health policies, andfacilitation of thedevelopment of nursing profession to improve health and well being of Nzer’s
What is needed to develop the PHC Nursing Workforce?
??Greater population focus and wider range of services, will increase need for well-trained PHC nurses
??Will have generalist knowledge and skills plus:
developing advanced skills in particular areas of practice (ask the visiting PHC what advanced skills they need in their practice).
??concept of PHC nurse needs greater clarification
??will happen at national level
??new Nurses Act and Nurse Prescribing Bill
Strategic Direction for Public Health will be delivered through PHC providers.
The Community Nurse’s Role in PHC delivery.
Key Community Nurses who Provide PHC include:
??Plunket and Public Health Nurses
??Rural and Practice Nurses
??School and community based clinics including marae.
??District and other nurses in peoples homes and communities in remote areas
??Their shared goal is to provide primary health care based on PHC philosophy.
??(the next few slides are example only).
Example of Primary Health Care Nursing in Action. Nursing Innovation in Te Tai Tokerau Northland
Vision.
??Primary health Care Nurses working in partnership for the health gain of Northlanders.
Background
??2001Appointment of director of Nursing Primary and community Health NHHB
??2001-2002 Establishment of the Regional Primary Health Care Nurse Leadership Group
??2003 MOH invite submissions for PHC Nursing Innovations Projects
??2003 appointment of 3 Nursing Integration Leaders for Northland.
Local Projects.
Kaipara Care Inc. Julie Palmer Nursing Integration leader.
??A collaborative approach to shared learning in Kaipara
??Establishment of immunization clinics in Plunket Rooms
Te Tai Tokerau PHO. Maureen Allan
??Implementing innovation in cardiac risk management with Maori Males.
??Growing sustainable Maori PHCN workforce in Northland
Manaia Health PHO Mary Cathew Nursing Integration leader
??Establishment of an integrated primary health care service in secondary schools.
??Implementing of specialist service within General Practice for the management of asthma and CORD.