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45-709: In Nigeria, primary healthcare is to be provided by Local Governments , secondary health care by State Governments and tertiary health care by the Federal Government . In operationalizing this policy, the Federal Government decided to establish at least one tertiary health institution in each State of the Nigerian Federation. Federal Medical Centres (FMCs), were established nationwide in states that do not have Federal University Teaching Hospitals present. The exception to this rule

90-565: A Save the Children paper, children from the poorest households in India are three times more likely to die before their fifth birthday than those from the richest households. A systematic study reports for all the low- and middle-income countries (not including China), the children among the poorest households are twice as likely to die before the age of 5 years old compare to those in the richest household. A large team of researchers published

135-486: A "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. There were many factors that inspired PHC; a prominent example is the Barefoot Doctors of China. The ultimate goal of primary healthcare

180-501: A cost that the community and the country can afford at every stage of their development in the spirit of self-reliance and self-determination . In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity -producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as

225-655: A disease or disorder, but can actively contribute to preventing such issues by understanding the individual as a whole. This ideal model of healthcare was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata , Kazakhstan in 1978 (known as the " Alma Ata Declaration "), and became a core concept of the World Health Organization 's goal of Health for all . The Alma-Ata Conference mobilized

270-575: A healthcare professional at the community level with community ties. Barefoot Doctors were a diverse array of village health workers who lived in rural areas and received basic healthcare training. They stressed rural rather than urban healthcare, and preventive rather than curative services. They also provided a combination of western and traditional medicines. The Barefoot Doctors had close community ties, were relatively low-cost, and perhaps most importantly they encouraged self-reliance through advocating prevention and hygiene practices. The program experienced

315-411: A high stage of DTM. From 2000 to 2010, child mortality has dropped from 9.6 million to 7.6 million. In order to reduce child mortality rates, there need to be better education, higher standards of healthcare and more caution in childbearing. Child mortality could be reduced by attendance of professionals at birth and by breastfeeding and through access to clean water, sanitation, and immunization. In 2016,

360-419: A hygienic birthing environment, drying and wrapping the baby immediately after birth, providing necessary warmth and promoting immediate and continued breastfeeding, immunization, and treatment of infections with antibiotics - could save the lives of 3 million newborns annually. Improved sanitation and access to clean drinking water can reduce childhood infections and diarrhea. As of 2017 , approximately 26% of

405-416: A least-cost method. The targets and effects of selective PHC are specific and measurable. The approach aims to prevent most health and nutrition problems before they begin: Given global demographic trends, with the numbers of people age 60 and over expected to double by 2025, PHC approaches have taken into account the need for countries to address the consequences of population ageing . In particular, in

450-520: A major study on the global distribution of child mortality in Nature in October 2019. It was the first global study that mapped child death on the level of subnational district (17,554 units). The study was described as an important step to make action possible that further reduces child mortality. The child survival rate of nations varies with factors such as fertility rate and income distribution ;

495-839: A massive expansion of rural medical services in China, with the number of Barefoot Doctors increasing dramatically between the early 1960s and the Cultural Revolution (1964-1976). Although many countries were keen on the idea of primary healthcare after the Alma Ata conference, the Declaration itself was criticized for being too “idealistic” and “having an unrealistic time table”. More specific approaches to prevent and control diseases - based on evidence of prevalence, morbidity, mortality and feasibility of control (cost-effectiveness) - were subsequently proposed. The best known model

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540-629: A more economically feasible approach to PHC by only targeting specific areas of health and choosing the most effective treatment plan in terms of cost and effectiveness. One of the foremost examples of SPHC is "GOBI" (growth monitoring, oral rehydration, breastfeeding, and immunization), focusing on combating the main diseases in developing nations. GOBI is a strategy of UNICEF consisting of (and an acronym for) four low-cost, high impact, knowledge mediated measures introduced as key to halving child mortality by James P. Grant at UNICEF in 1983. The measures are: Three additional measures were introduced to

585-468: A person’s health needs – from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. It is essential health care that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC initiatives allow for the full participation of community members in implementation and decision making. Services are provided at

630-608: A significant decline in preventable child deaths since 1990 with the global under-5 mortality rate declining by over half between 1990 and 2016. While in 1990, 12.6 million children under age five died and in 2016, that number fell to 5.6 million children and then in 2020, the global number fell again to 5 million. However, despite advances, there are still 15,000 under-five deaths per day from largely preventable causes. About 80 percent of these occur in sub-Saharan Africa and South Asia and just 6 countries account for half of all under-five deaths: China, India, Pakistan, Nigeria, Ethiopia and

675-609: A year will prevent blindness and death. Although vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24 per cent but only 70 per cent of targeted children were reached in 2015. Between 250,000 and 500,000 children become blind every year with 70 percent of them dying within 12 months. Oral rehydration therapy (ORT) is an effective treatment for lost liquids through diarrhea; yet only 4 in 10 (44 per cent) of children diagnosed with diarrhea are treated with ORT. Essential newborn care - including immunizing mothers against tetanus, ensuring clean delivery practices in

720-513: Is Lagos State , which has one such centre in addition to a Teaching Hospital. There are a total of 23 FMCs all over the country. As a general rule, most of the centres are situated in the State capital, especially in situations where the apex secondary health institution run by the state does not adequately meet the demands for specialist health care by the citizenry. Primary healthcare Primary health care enables health systems to support

765-460: Is a field of public health concerned with reducing child mortality. Child survival interventions are designed to address the most common causes of child deaths that occur, which include diarrhea , pneumonia , malaria , and neonatal conditions. Out of the number of children under the age of 5 alone, an estimated 5.6 million children die each year mostly from such preventable causes. The child survival strategies and interventions are in line with

810-748: Is not a short-lived intervention, but an ongoing process of improving people's lives and alleviating the underlying socioeconomic conditions that contribute to poor health. The principles link health, development, and advocating political interventions rather than passive acceptance of economic conditions. The primary health care approach has seen significant gains in health where applied even when adverse economic and political conditions prevail. The Alma-Ata declaration proposed PHC (Primary Health Care) goals but faced global criticism for being vague, costly, and unattainable. This led to diverse PHC approaches, including SPHC (Selective Primary Health Care), accommodating resource disparities and local health priorities After

855-482: Is not only caused by infection and disorder, it is also caused by premature birth, birth defect, new born infection, birth complication and diseases like malaria , sepsis, and diarrhea. In less developed countries, malnutrition is the main cause of child mortality. Pneumonia, diarrhea and malaria together are the cause of one out of every three deaths before the age of 5 while nearly half of under-five deaths globally are attributable to under-nutrition. Child survival

900-519: Is said to be affected after the introduction of structural adjustment programs by the World Bank. Child mortality Child mortality is the death of children under the age of five. The child mortality rate (also under-five mortality rate) refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births. It encompasses neonatal mortality and infant mortality (the probability of death in

945-602: Is the attainment of better health services for all. It is for this reason that the World Health Organization (WHO), has identified five key elements to achieving this goal: Behind these elements lies a series of basic principles identified in the Alma Ata Declaration that should be formulated in national policies in order to launch and sustain PHC as part of a comprehensive health system and in coordination with other sectors: In sum, PHC recognizes that healthcare

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990-659: Is variation of child mortality around the world. Countries that are in the second or third stage of the Demographic Transition Mode ( DTM ) have higher rates of child mortality than countries in the fourth or fifth stage. Chad infant mortality is about 96 per 1,000 live births compared to only 2.2 per 1,000 live births in Japan . In 2010, there was a global estimate of 7.6 million child deaths especially in less developed countries and among those, 4.7 million died from infection and disorder. Child mortality

1035-532: The Democratic Republic of the Congo , Ethiopia and China . India and Nigeria alone account for almost a third (32 per cent) of the global under-five deaths. Within low- and middle-income countries, there is also substantial variation in child mortality rates across administrative divisions . Likewise, there are disparities between wealthy and poor households in developing countries. According to

1080-679: The United States Agency for International Development . In the United States, most non-governmental child survival agencies belong to the CORE Group , a coalition working through collaborative action to save the lives of young children in the world's poorest countries. Substantial global progress has been made in reducing child deaths since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to approximately 5.5 million in 2020. Since 1990,

1125-475: The Democratic Republic of the Congo. 45% of these children died during the first 28 days of life. Death rates were highest among children under age 1, followed by children ages 15 to 19, 1 to 4 and 5 to 14. Child mortality refers to number of child deaths under the age of 5 per 1,000 live births. More specific terms include: The leading causes of death of children under five include: There

1170-480: The change in distribution shows a strong correlation between child survival and income distribution as well as fertility rate where increasing child survival allows the average income to increase as well as the average fertility rate to decrease. Child mortality unlike mortality throughout other ages actually dropped in 2020 when the Covid-19 pandemic hit the world. Children were among the lowest group of deaths in

1215-399: The children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines , antibiotics , micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices, and oral rehydration therapy . Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make

1260-466: The community level as well as disease management strategies within health care systems . Some jurisdictions apply PHC principles in planning and managing their healthcare services for the detection, diagnosis and treatment of common mental health conditions at local clinics, and organizing the referral of more complicated mental health problems to more appropriate levels of mental health care. The Ministerial Conference, which took place in Alma Ata, made

1305-415: The cornerstones of universal health systems. The World Health Organization, or WHO , elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services ." Based on these definitions, PHC cannot only help an individual after being diagnosed with

1350-681: The decision that measures should be taken to support mental health in regard to primary health care. However, there was no such documentation of this event in the Alma Ata Declaration. These discrepancies caused an inability for proper funding and although was worthy of being a part of the declaration, changing it would call for another conference. Individuals with severe mental health disorders are found to live much shorter lives than those without, anywhere from ten to twenty-five-year reduction in life expectancy when compared to those without. Cardiovascular diseases in particular are one of

1395-505: The first year of life). Reduction of child mortality is reflected in several of the United Nations ' Sustainable Development Goals . Target 3.2 states that "by 2030, the goal is to end preventable deaths of newborns and children under 5 years of age with all countries aiming to reduce under‑5 mortality to as low as 25 per 1,000 live births." Child mortality rates have decreased in the last 40 years. Rapid progress has resulted in

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1440-973: The fourth Millennium Development Goals (MDGs) which focused on reducing child mortality by 2/3 of children under five before the year 2015. In 2015, the MDGs were replaced with the Sustainable Development Goals (SDGs) which aim to end these deaths by 2030. In order to achieve SDG targets, progress must be accelerated in more than 1/4 of all countries (most of which are in sub-Saharan Africa) in order to achieve targets for under-5 mortality and in 60 countries (many in sub-Saharan Africa and South Asia) to achieve targets for neonatal mortality. Without accelerated progress, 60 million children under age five will die between 2017 and 2030, about half of which would be newborns. China achieved its target of reduction in under-5 mortality rates well ahead of schedule. Two-thirds of child deaths are preventable. Most of

1485-425: The framework of their primary health care systems, under the umbrella of universal health coverage. [1] A World Report on Hearing (WRH) was published in response to the resolution (WHA70.13), to provide guidance for Member States to integrate ear and hearing care into their national health plans. The "Barefoot Doctors" of China were an important inspiration for PHC because they illustrated the effectiveness of having

1530-444: The future the majority of older people will be living in developing countries that are often the least prepared to confront the challenges of rapidly ageing societies, including high risk of having at least one chronic non-communicable disease , such as diabetes and osteoporosis and conditions like hearing loss . According to WHO, dealing with this increasing burden requires health promotion and disease prevention intervention at

1575-775: The global under-5 mortality rate has dropped by 59%, from 93 deaths per 1000 live births in 1990 to 36 in 2020. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990 compared to 1 in 27 in 2019. The Sustainable Development Goals has set 2 new goals to reduce under-5 and newborn mortality. The goals set newborn mortality for 12 per 1,000 live births in every country and for under 5 mortality 25 per 1,000 livebirths in every country. In 2019, 122 countries met this and every 10 years, 20 more are expected to follow. World Health Organization (WHO) states they support health equity and universal health care so that all countries may have proper health care with no finances involved. Child mortality has been dropping as each country reaches

1620-415: The leading causes of death with individuals already suffering from severe mental health disorders. General health services such as PHC is one approach to integrating an improved access to such health services that could help treat already existing mental health disorders as well as prevent other disorders that could arise simultaneously as the pre-existing condition. Considering that 360 million people across

1665-581: The rate of mortality from these diseases by almost 50 per cent. Proven cost-effective interventions can save the lives of millions of children per year. The UN Vaccine division as of 2014 supported 36% of the world's children in order to best improve their survival chances, yet still, low-cost immunization interventions do not reach 30 million children despite success in reducing polio , tetanus , and measles . Measles and tetanus still kill more than 1 million children under 5 each year. Vitamin A supplementation costs only $ 0.02 for each capsule and given 2–3 times

1710-433: The region with the highest under-5 mortality rates in the world: All six countries with rates above 100 deaths per 1,000 live births are in sub-Saharan Africa, with Somalia having the highest under-5 mortality rates. Furthermore, approximately 80% of under-5 deaths occur in only two regions: sub-Saharan Africa and South Asia. 6 countries account for half of the global under-5 deaths, namely, India , Nigeria , Pakistan ,

1755-488: The strategy later (though food supplementation had been used by UNICEF since its inception in 1946), leading to the acronym GOBI-FFF. These strategies focus on severe population health problems in certain developing countries, where a few diseases are responsible for high rates of infant and child mortality. Health care planning is used to see which diseases require most attention and, subsequently, which intervention can be most effectively applied as part of primary care in

1800-429: The supply of critical services more available to the poor and increasing local accountability of health systems are policy interventions that have allowed health systems to improve equity and reduce mortality. In developing countries, child mortality rates related to respiratory and diarrheal diseases can be reduced by introducing simple behavioral changes such as handwashing with soap. This simple action can reduce

1845-403: The world average was 41 (4.1%), down from 93 (9.3%) in 1990. This is equivalent to 5.6 million children less than five years old dying in 2016. Huge disparities in under-5 mortality rates exist. Globally, the risk of a child dying in the country with the highest under-5 mortality rate is about 60 times higher than in the country with the lowest under-5 mortality rate. Sub-Saharan Africa remains

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1890-434: The world live with disabling hearing loss, including 32 million children and nearly 180 million older adults, and that chronic ear diseases, such as chronic suppurative otitis media, can lead to hearing loss and may cause life-threatening complications, the seventieth World Health Assembly on May 31, 2017 signed the resolution WHA70.13 (Agenda item 15.8) urging member states to integrate strategies for ear and hearing care within

1935-665: The world's population do not have access to basic sanitation and 785 million people use unsafe sources of drinking water. Agencies promoting and implementing child survival activities worldwide include UNICEF and non-governmental organizations ; major child survival donors worldwide include the World Bank , the British Government's Department for International Development , the Canadian International Development Agency and

1980-666: The year 1978 Alma Ata Conference, the Rockefeller Foundation held a conference in 1979 at its Bellagio conference center in Italy to address several concerns. Here, the idea of Selective Primary Health Care was introduced as a strategy to complement comprehensive PHC. It was based on a paper by Julia Walsh and Kenneth S. Warren entitled "Selective Primary Health Care, an Interim Strategy for Disease Control in Developing Countries". This new framework advocated

2025-693: Was the Selective PHC approach (described above). Selective PHC favoured short-term goals and targeted health investment, but it did not address the social causes of disease. As such, the SPHC approach has been criticized as not following Alma Ata's core principle of everyone's entitlement to healthcare and health system development. In Africa, the PHC system has been extended into isolated rural areas through construction of health posts and centers that offer basic maternal-child health, immunization, nutrition, first aid, and referral services. Implementation of PHC

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