Implementation, Effectiveness and Political Context of Comprehensive Primary Health Care: Preliminary Findings of a Global Literature Review

Abstract

Primary health care (PHC) is again high on the international agenda. It was the theme of The World Health Report in 2008, thirty years after the Alma-Ata Declaration, and has been the topic of a series of significant conferences around the world throughout 2008. What have we learnt about its impact in improving population health and health equity? What more do we still need to know? These two questions frame a four-year international research/capacity-building project, 'Revitalizing Health for All' (RHFA), funded by the Canadian Global Health Research Initiative (http://www.idrc.ca/en/ev-108118-201-1-DO_TOPIC.html). The RHFA project is organised under the umbrella of the People?s Health Movement (http://www.phmovement.org/en) and the International People?s Health University (http://phmovement.org/iphu/), and involves researchers from over a dozen countries. Our project team?s understanding of PHC is of a comprehensive approach aimed at reducing health inequities that is based on meaningful community participation, multidisciplinary teams and action across sectors.

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service

“…First, identifying Kotter's (1995) principles for successful, sustainable organisational change, together with a logic framework that links an improved structure to improvements in process and outcomes (Watson et al 2009), support our conclusion that the changes described in this case study are sustainable and will improve health outcomes. Second, the new service addressed all of the key sustainability requirements identified in the literature (Labonté et al 2008;Wakerman and Humphreys 2011). The Partnership also used the strategies recommended by The Steering Committee for Indigenous Health Equality (Chapman 2010), adding to the sustainability of change and likelihood of improved health inequity in the long term.…”

Comprehensive Primary Health Care in South America: contexts, achievements and policy implications

“…The Alma-Ata Declaration on Primary Health Care emphasized that systems should: reflect local needs; integrate social, biomedical and public health activities, including the provision of safe water, food security, local endemic disease control and access to essential drugs; encourage health-related actions across other sectors; work to foster strong community participation. For a number of reasons beyond the scope of this article, other variations on this concept of primary health care quickly arose with emphasis on more selective and basic care approaches 1,2 . Basic care refers to the gate-keeper model that stresses the importance of general practice or family medicine providers as the point of entry into the health system.…”

Reflections on the ethics of recruiting foreign-trained human resources for health

“…This view also supports a renewed interest in the training of community health workers in southern African countries [35,36]. But another rationale sometimes offered for such training - that it makes such workers less attractive for migration to developed countries - was considered unacceptable: "It's saying basically, take people that are less skilled, don't train them as well so we don't steal them."…”