When I studied international and community health at Johns Hopkins in 1977, primary health care was a new emphasis. Our dean, Dr. Carl Taylor led a department full of passion about reducing illness and promoting health through primary care. But the amount of data about this approach was limited. Like many others, I found that the dream was charming, but not so easily implemented when I went to Ethiopia.
So I was encouraged to hear that now there are over 700 studies in the medical literature which support community based primary health care. Dr. Henry Perry and others at Johns Hopkins have published their findings in the Journal of Global Health here.
The evidence supports CBPHC as an important component of a comprehensively-designed maternal and child health program, not just for the direct effects on maternal and child morbidity and mortality, but because of its contribution to appropriate usage of hospital and clinic facilities. In other words, we need a balance of curative, preventative and promotive. The evidence is clear.
Here are some aspects of CBPHC:
- Engagement of women’s groups
- Innovation like puppet shows
- Paid and unpaid local workers and volunteers
- Strengthening the staff of peripheral health centers
- Using both medical professionals and non-professionals in complementary ways
- Regular home visits
- Community based case management
- Mobile teams
Dr. Perry points out that belief in curative medicine is very powerful; sometimes we are mesmerized by technology and curative care. While they have a very important place, we also know that a large percentage of illness can be mitigated, prevented or treated by non-medical means. We want to embrace good clinical care, of course, but balance this with sustained and intentional efforts to impact communities in broader, more ‘non-technical’ ways. CBPHC may not be technologically sophisticated, yet it can be powerful.
In terms of social justice, Perry points out the CBPHC can have a ‘pro-equity’ effect, avoiding the potential barriers to health care that institutions by themselves can have.
As we make disciples in our healthcare missions, let us remember to raise up both medical professionals and non-professionals, staff who work in institutions as well as those who work in communities. With needs pressing in around us, we must keep hospitals functioning well yet not consume all of our resources on them — but balance clinical care (tertiary and secondary care) with community based primary health care. We need not only doctors, but social workers, health promoters, and grandmothers who are willing to make the sacrifice to love and invest in communities in order to bring healing to the brokenhearted and hope to those suffering around us.
If we are outsiders to a culture (expats or missionaries) we shouldn’t be naive about the difficulty of such an approach. It often touches on deeply held values, dreams, and cultural approaches which are distorted by our own rebellion from God and the ways of His kingdom. But as we love individuals and learn to serve side-by-side in humility with local people, we can discover how great is our Lord Jesus and enable many to find fullness of life in Him.
4 thoughts on “Community based approaches to primary health care”
excellent post Paul. I think we need to add an additional player to your scenario of caring for people at the community level. It would seem to me that 90% plus of the cases that present themselves to the avg clinic are going to be pretty straightforward and can be handled by what I would simply call a Primary Healthcare Provider. (NP/PA level person) The world is never going to build enough med schools and educate enough physicians to fill the PHC needs of the world. We aren’t doing it in the US which has led to the explosion of NP/PA programs. Which I believe is a good thing. I believe a valuable contribution that we, as healthcare professionals who follow Jesus, can make is to strongly advocate for the recognition of these types of workers in all settings. Nurses are doing this anyway, they are just not being giving credit (nor appropriate pay) for the work they do. What do you think?
Yes, I agree Mike. We doctors have wonderful skills but we are not the whole body of Christ. We need both doctors and nurses and other health professionals – occupational therapists, health educators, community developers, program managers, public health specialists, physician’s assistants, etc. All of whom are servants, learning to serve Jesus from a heart transformed by Him. We also must think beyond “medicine” as a specialty to other aspects of health. For example some of our people right now are doing trauma healing training of local pastors and Christian lay leaders in Liberia and other countries. We can also think about hospice care, HIV care, caring for and enabling handicapped people, working with the deaf, etc. The ‘non-medical’ needs are probably wider and deeper than the medical ones. Agree! How can we do this? Who will God call into these ministries of Word and deed together?
Haven’t we come a long way, considering those beginning days in Ethiopia. Seems as if even here in the USA CBPHC could solve a lot of the big community and Health issues caused by our individualized lifestyles. Missing real grassroots community life, Paul !
Oh, Edith, don’t you remember the days when I came to you with all my youth and idealism, and said how we could change the infant mortality rate and all the other important statistics? You wisely suggested to me that I might be a tad idealistic, and that we need balance: caring for individuals, helping them to grow, reaching out to the community, yes. But to think that “our” program would solve the problems of the world… well, that’s just a little ambitious. Jesus can and does heal communities and he does so by changing and transforming individuals to enter His kingdom, love Him and love others, and join the ongoing work. Thanks for the wisdom you had serving as a nurse in a very forsaken and animistic community for so many years, seeing as Jesus gradually changed the community! Thank you!