Primary Health Care


Primary care is the level of a health services 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, regardless of where the care is delivered and who provides it. It is the means by which the two main goals of a health services system, optimization and equity of health status, are approached.
What is a Community Health Center?
Community health centers (CHCs) are private, nonprofit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically undeserved. Community health centers are authorized under Section 330 of the Public Health Service Act, 42 USC, 254b. Section 330 was revised in 1996 by the Consolidated Health Centers Act, which combined community health centers with migrant health centers, health care for the homeless, and public housing health care programs. Section 330 health centers receive grant funding from the federal government (about 26% of revenue) and reimbursement from Medicaid (35% of revenue). They are also supported by other federal grants, state and local grants or contracts, private grants, Medicare, private insurance, and patient fees.
Community health centers have a three-fold mission. First, CHCs aim to improve access to care for low income, underserved, and vulnerable populations. They are required to be located in medically underserved rural and urban areas; within those communities, they serve those with limited access to more mainstream health care. Second, CHCs provide a fully comprehensive range of primary care services, including “enabling” or support services. Third, true to their roots in the community activism of the 1960s, they involve the community in both the management and governance of the center.
In FY 1996, there were 685 federally funded CHCs, operating in 3,032 sites across the U.S. and serving over 8 million people. A large proportion of health center patients are children (42%) and women of childbearing ages (39%). CHCs also serve a high proportion of minorities: 33 percent of users are African American, 29 percent Hispanic, and 5 percent Asian or Pacific Islander.
A majority of health center patients are either uninsured (41%) or on Medicaid (33%). The rest are private paying (17%), on Medicare (8%), or have other forms of public insurance, such as state health insurance (8%). Fifty-nine percent of health care patients are below the poverty level, and another 20 percent are between 100-200 percent of poverty. Because of their lower socioeconomic status, many health center patients have pressing health care needs.
Community health centers are required by law to provide “primary health services,” and “additional health services as necessary” to the residents of the area served by the center (otherwise known as the “catchment area”). “Primary health services” are defined as 1) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology, 2) diagnostic laboratory and radiologic services, 3) preventive health services, 4) emergency medical services, and 5) pharmaceutical services. Additionally, health centers provide referrals to providers of substance abuse services, mental health services, patient case management services, enabling services such as transportation and language services, and patient education. When appropriate for the population, health centers also provide environmental health services and migrant/agricultural workers services.
†This definition describes community health centers that are supported by federal grants and financing. There are many other types of health centers operating in the U.S. health care system, which receive public or charity funding (e.g., “free clinics” or health centers affiliated with hospitals, etc.). With the growth in outpatient, community-based care, the number of health centers has grown. Unfortunately, we do not have systematic data on these other types of health centers.
Primary Health Care, menurut deklarasi Alma Alta 1978, adalah sebagai berikut:
“Primary Health Care is essential health care, based on practical, scientifically sound 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.”
“It forms and integral part both of the country’s health system, of which it is the central function and its 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 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”.

Primary Health Care ( PHC ) adalah : pelayanan kesehatan pokok yang berdasarkan kepada metode dan teknologi praktis, ilmiah dan sosial yang dapat diterima secara umum baik oleh individu maupun keluarga dalam masyarakat melalui partisipasi mereka sepenuhnya, serta dengan biaya yang dapat terjangkau oleh masyarakat dan negara untuk memelihara setiap tingkat perkembangan mereka dalam semangat untuk hidup mandiri dan menentukan nasib sendiri.

WHO. The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:
1. reducing exclusion and social disparities in health (universal coverage reforms);
2. organizing health services around people’s needs and expectations (service
delivery reforms);
3. integrating health into all sectors (public policy reforms);
4. pursuing collaborative models of policy dialogue (leadership reforms); and
5. increasing stakeholder participation


Filosofi Primary Health Care:

1. Menggambarkan keadaan sosial ekonomi, budaya (local wisdom) dan politik masyarakat dan berdasarkan penerapan hasil penelitian kesehatan-sosial-biomedis (eviden based medicine) dan pelayanan kesehatan masyarakat.
2. Ditujukan untuk mengatasi masalah utama kesehatan masyarakat dengan upaya preventif, promotif, kuratif dan rehabilitatif.
3. Minimal mencakup: penyuluhan tentang masalah kesehatan utama dan cara pencegahan dan pengendaliannya, penyediaan makanan dan peningkatan gizi, penyediaan sanitasi dasar dan air bersih, pembinaan kesehatan ibu dan anak termasuk keluarga berencana, imunisasi terhadap penyakit menular utama dan penyegahan penyakit endemik, pengobatan penyakit umum, cedera, penyediaan obat esensial, dan pengelolaan penyakit kronis.
4. Terlibat dan menjadi penggerak dalam peningkatan kerjasama lintas sektor dan aspek-aspek pembangunan nasional dan masyarakat.
5. Membutuhkan sekaligus meningkatkan kepercayaan diri serta masyarakat dalam perencanaan, pengorganisasian, pelaksanaan, dan pengendalian dalam upaya meningkatkan akses dan kualitas pelayanan kesehatan dengan penggunaan sumberdaya yang terbatas.
6. Ditunjang oleh system rujukan upaya kesehatan secara terpadu dengan memberikan pelayanan secara menyeluruh dan terintegrasi.
7. Didukung oleh tenaga kesehatan professional dan visioner, berperan sebagai social entrepreneurs, bersama dengan masyarakat yang memiliki keshalehan personal dan sosial untuk bekerja sebagai tim kesehatan yang mampu bekerja bersama mendorong peran serta masyarakat.

Dengan demikian, konsep pelayanan kesehatan primer (PHC) merupakan pelayanan kesehatan essensial yang dibuat dan bisa terjangkau secara universal oleh individu dan keluarga, dan masyarakat dalam rangka mendukung penuh tercapainya universal health coverage (UHC). Fokus dari pelayanan kesehatan primer luas jangkauannya dan merangkum berbagai aspek masyarakat dan kebutuhan kesehatan. PHC merupakan pola penyajian pelayanan kesehatan dimana konsumen pelayanan kesehatan menjadi mitra dengan profesi dan ikut serta mencapai tujuan umum kesehatan yang lebih baik.

(Klinik Insepar & KMC: Our clinics empower and inspire health profesional and public to embrace the challenges of today in order to create change for now, tomorrow, and on the next future for better primary care in Indonesia and the world

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