Sustaining Primary Health Care

Analyzing the dimensions of the struggle for effective health care in the developing countries, this study demonstrates how current governmental and donor agency policies in such countries as Uganda, Ghana, Nepal, Pakistan and Vietnam have failed to develop efficient systems. The author argues against the current emphasis on decentralization and privatization, and outlines a framework for a long-term approach that should bring benefits and improvements in health care.

How did seven low- and middle-income countries, inspired by the landmark Alma-Ata Declaration, dramatically improve citizen health by focusing on primary health care? The Alma-Ata Declaration of 1978 marked a potential turning point in global health, signaling a commitment to primary health care that could have improved the safety of air, food, water, roads, homes, and workplaces in all 180 countries that signed it. Unfortunately, progress in many countries stalled in the 1980s. The declaration was, however, embraced by a number of countries, where its implementation led to substantial improvement in citizen health. Achieving Health for All reveals how, inspired by Alma-Ata, the governments of seven countries executed comprehensive primary health care systems, deploying new cadres of community-based health workers to bring relevant services to ordinary households. Drawing on a set of narrative case studies from Bangladesh, Indonesia, Ethiopia, Nepal, Ghana, Sri Lanka, and Vietnam,the book explains how a primary health care focus succeeded in improving population health. The book also conclusively demonstrates that comprehensive, multisector, community-controlled, and population-level primary health care is a viable strategy that, against the odds, has led to sustainable, scalable good health at lower cost. Bringing together a group of experts to analyze the forty-year legacy of the Alma-Ata Declaration, Achieving Health for All is a fascinating look at the work needed to transform nations from places that make people sick to places where they stay healthy. An inspiring array of lessons learned along the way shows how readers can make policies that support the health of all people. Contributors: Onaopemipo Abiodun, Vinya Ariyaratne, John Koku Awoonor-Williams, Kedar Prasad Baral, Ayaga A. Bawah, Pedro Más Bermejo, Fred N. Binka, David Bishai, Carolina Cardona, Dennis Carlson, Chala Tesfaye Chekagn, Hoang Khanh Chi, Svea Closser, Luc Barrière Constantin, Zufan Abera Damtew, Marlou de Rouw, Nadia Diamond-Smith, Philip Forth, Mignote Solomon Haile, Nguyen Thanh Huong, Taufique Joarder, Alice Kuan, Seblewengel Lemma, Sasmira Matta, Ahmed Moen, Rituu B. Nanda, Frank K. Nyonator, Ferdous Arfina Osman, Claudia Pereira, Henry B. Perry, James F. Phillips, Meike Schleiff, Melissa Sherry, Rita Thapa, Kebede Worku

Primary health care (PHC) began as a solution to problems in the developing world and is coming to be seen as a profound challenge to medical attitudes the world over. The book points to three issues at the root of PHC - universal availability of essential health care to individuals, families and population groups according to need, the involvement of communities in planning, delivering and evaluating such care and an organized active role for other sectors in health activities. It is pointed out although these principles may seem uncontroversial their introduction in developing countries has been far from smooth. When it comes to the north the principles of equity, participation and intersectoral collaboration have been resisted even more strongly by both planners and the medical establishment. By examining the lessons learnt from the developing countries, the author demonstrates the necessity to de-professionalize health. He writes at a time when resistance to PHC in the Third World is increasingly being based on dubious northern models for health care. This book demonstrates the way in which a strategy for survival in poor regions becomes a model for adequate and sustainable living everywhere.

Updated framework for health promotion practice including distinction between comprehensive and selective primary health care approaches, and the addition of the health promotion practice cycle Introduction to the values and principles of critical health promotion and their application within a comprehensive primary health care context Increased focus on indigenous perspectives, with current Australian and New Zealand examples Quizzes to check understanding of the content of each chapter

Health care is constantly undergoing change and refinement resulting from the adoption of new practices and technologies, the changing nature of societies and populations, and also shifts in the very places from which care is delivered. Primary Health Care: People, Practice, Place draws together significant contributions from established experts across a variety of disciplines to focus on such changes in primary health care, not only because it is the most basic and integral form of health service delivery, but also because it is an area to which geographers have made significant contributions and to which other scholars have engaged in 'thinking geographically' about its core concepts and issues. Including perspectives from both consumers and producers, it moves beyond geographical accounts of the context of health service provision through its explicit focus on the practice of primary health care. With arguments well-supported by empirical research, this book will appeal not only to scholars across a range of social and health sciences, but also to professionals involved in health services.

General practitioners and other primary care professionals have a leading role in contemporary health care, which Trisha Greenhalgh explores in this highly praised new text. She provides perceptive and engaging insights into primary health care, focussing on: its intellectual roots its impact on the individual, the family and the community the role of the multidisciplinary team contemporary topics such as homelessness, ethnic health and electronic records. Concise summaries, highlighted boxes, extensive referencing and a dedicated section on effective learning make this essential reading for postgraduate students, tutors and researchers in primary care. "Trish Greenhalgh, in her frequent columns in the British Medical Journal...more than any other medical journalist spoke to her fellow GPs in the language of experience, but never without linking this to our expanding knowledge from the whole of human science. When I compare the outlines of primary care so lucidly presented in this wonderful book, obviously derived from rich experience of real teaching and learning, with the grand guignol theatre of London medical schools when I was a student 1947-52, the advance is stunning." —From the foreword by Julian Tudor Hart "Trish Greenhalgh is one of the international stars of general practice and a very clever thinker. This new book is a wonderful resource for primary health care and general practice. Every general practice registrar should read this book and so should every general practice teacher and primary care researcher." —Professor Michael Kidd, Head of the Department of General Practice, University of Sydney and Immediate Past President of The Royal Australian College of General Practitioners "This important new book by one of primary care's most accomplished authors sets out clearly the academic basis for further developments in primary health care. Health systems will only function effectively if they recognise the importance of high quality primary care so I strongly recommend this book to students, teachers, researchers, practitioners and policy makers." —Professor Martin Marshall, Deputy Chief Medical Officer, Department of Health, UK