Primary Health Care: Good News for Global Maternal and Child Health
Thirty years ago, representatives of 134 WHO member states convened in Alma- Ata to discuss global health issues and the potential of primary health care to address huge needs. The Alma-Ata Declaration advocated the implementation of primary care health systems as a central strategy to achieve “Health for All by 2000” noting that an estimated 2 billion of the world’s people lacked access to health care at that time. This declaration met with significant resistance from various interest groups in 1978 but fortunately, its central strategy has gained momentum in recent years. The Lancet, in its September 13-16, 2008 issue, has revisited Alma-Ata with an editorial and extensive comments and articles.
The “Health for All” target has not yet been met but the news is not as bad as you might think. The effectiveness of multidisciplinary primary care models has been established in many settings. Total global child mortality has declined from 15 to 9.2 million, still an unacceptable number. As acute infections and malnutrition are being tackled, application of primary health care systems is extending to chronic conditions both communicable and non-communicable. Experience gained in low-income country settings suggests that primary health care works best if it is tailored to suit local circumstances and if its bureaucracy is minimized.
This local, low-bureaucracy focus is appealing provided mechanisms are in place to foster critical discussion, sharing of experiences and research between local programs. To assist in advancing the application and quality of primary health care models, at least those directed to children and mothers, this website has at least 2 important resources to contribute to the cause.
1.Communication capacity
Our website is easily accessed, free, interactive and flexible. As primary care initiatives develop in communities around the world, there is a need for workers and policy makers to share and compare experiences, to present their successes and learn from their failures. Given that most such programs are quite local, active steps should be taken to avoid a pattern in which a silo mentality prevails. As The Lancet shows so well, there will always be a place for publications but rapid, less formal interactions, comparable to corridor chats are needed..
2.Personnel
Health professionals in the west will be keen to participate, to learn from the experiences in low-income settings, and to share their own experiences. Since well before Alma-Ata, western pediatricians have worked in multidisciplinary primary care models usually directed to chronic diseases such as cystic fibrosis and inflammatory bowel disease.
I urge you to read the inspiring material in this recent issue of The Lancet 37(942) September 13-16, 2009
What do you think?
Can our network contribute to the development of effective primary health care initiatives around the world? If the answer is “yes” or even “maybe” how should we go about it?
- Richard Hamilton
- rhamilton's blog
- Login or register to post comments
Comments
development of effective primary health care initiatives
Dr. Hamilton: my quick reply will fail to do justice to the intriguing suggestion and the important historical parallel you draw attention to here. Nevertheless, I wanted to agree that this forum has the potential to do exactly what you suggest, although the specific structures best suited to delivering on its promise are not entirely clear to me.
1) Are you familiar with ARXIV.ORG (http://arxiv.org/), "the E-print archive for electronic preprints of scientific papers in the fields of physics and mathematics, hosted at the Los Alamos National Laboratory"? Would a pre-publication forum that allowed for more rapid dissemination of research along this lines be useful to this on-line community*.
2) The blog format adopted here is convenient, accessible and well-supported, but I sometimes find the very notion of a blog commentary somewhat intimidating. This may just be my preconceived notion as to what is involved, but I wonder if a shorter-format, interactive discussion (e.g. a listserv, along the lines of question and answer forum) might encourage more rapid or casual exchanges, like 'corridor consultations'.
3) Although I hesitate to suggest imposing a 'top-down' structure (convinced that the forum should grow organically from the needs of its users), is there a place for hosting invited reviews, as a starting point for multi-participant discussion or debate? Certainly, paper-copy journals have long relied on this format to educate readers, summarize emerging trends, and stimulate new inquiry. This may be particularly apt for multidisciplinary projects, such as primary health care.
4) Is there a role for polling your membership to develop consensus views on subjects of importance to the whole community, or in communicating those views once they have been developed through discussion and debate?
I would be curious what you or others thought of these these suggestions, which are prompted by your commentary but not yet particularly well developed on my part.
Atul Sharma
* Writing almost a decade ago in an article entitled "Some Comments on E-biosci" appearing in the HMS Beagle: The BioMedNet Magazine, Paul Ginsparg discussed the future of electronic publishing in the life sciences. His comments remain relevant, and may be found at http://people.ccmr.cornell.edu/~ginsparg/blurb/beagle99.html
"The crucial question underlying this debate is how our scientific research communications infrastructure should be reconfigured to take maximal advantage of newly evolving electronic resources. Rather than just "electronic publishing" which connotes a rather straightforward cloning of the paper methodology to electronic network, we'd prefer to see new methodologies leading to some form of global "knowledge network" of the future."