Each of the speakers today will touch on what has led up to each of these landmark celebratory events and how the related programs have contributed to addressing greater equity and empowerment for communities. As we share the learning and gains from these programs, we will be providing the context and foundation to explore the opportunities and challenges of achieving primary health care. This will lead us into a discussion of where we are now and what we envision for the future of primary health care – how can countries, partners and communities work together to further advance health for all.
Overview of vision, principles and strategies of Primary Health Care. Now we’ve seen many advances in the past 35 years. We’re going to hear two examples provided by the next two speakers and in many ways this is what the Core group is all about so I won’t go into those achievement now…..There are also many lessons learned and lessons we want to apply to the future.
One lesson learned that we must not forget, that is central to the theme of this plenary, and in fact this entire meeting is – illustrated here.. Despite the many marvelous advances we have seen happen in the past 35 years – and the work that all of us doo – which is truly important …. The reality is that factors outside of the technical realm and the health system in general have been primary challenges in achieving the vision of health for all during the past 35 years. As Geeta Rao Gupta so eloquently pointed out in her keynote yesterday – it is political will that is required. And key to that political will is civil society – empowered/ mobilized/ activated communities. In the few minutes I have, I want to share some modest thoughts about a future PHC agenda.
1. SO my first modest contribution towards AN AGENDA FOR THE FUTURE OF PRIMARY HEALTH CARE is to look AT HOW TO IMPLEMENT OUR PROGRAMS/ PHC in a way that fosters community mobilization – on the community’s terms. We will be hearing from Laura and Ram in more depth about two successful programs that will allow us to look at lessons learned about successful community ownership that we can then apply to a future agenda for PHC. Full quote: Cuantas mas tienen que morir/ tu puedes ser la proxima. This is from a protest in spain to protest removal of healthcare cards from illegal migrants. This took place in september.
Second: We know that we must connect and integrate Community Health Workers into the larger health system. But how to do this in a way that still allows communities to feel the pride, ownership and sense of self-reliance that comes from a community-led project? How can we connect and integrate community health workers and community health projects into the larger health system while fostering community initiative? Ram’s presentation about the Nepali community health volunteers will give us some good lessons we can draw from and apply.
3. Our vision of PHC during the past 35 years is something usually taking place in a rural village. But with population shifts and urbanization our agenda for a future PHC must also look at how build and mobilize communities in a much more complex urban setting; rather than the relatively homogenous communities that are a self-defined geographic community. That means finding ways to work in new settings and with new and fluid definitions of community.
Sarah, I’m putting in three different options for images – you pick which you like best.
4. Non-communicable chronic diseases are a challenge that PHC must address in the future. This is a health challenge that is increasingly being felt by the communities we serve with PHC. It is a challenge, but it is also an opportunity
Non communicable chronic diseases are an opportunity for PHC – when you think about it – CHWs are perfectly situated to help an otherwise over-burdened health system deal with the growing wave of NCDs such as diabetes and hyptertension. Because of their understanding of local resources, the ability to build community trust and rapport, and their communications and relationships withint the community -- CHWs can play a critical and unique role to: Focus on health education and preventative care Can provide screening and referral Support those who are on treatment to manage their care Create and facilitate peer support Community organizing to address underlying issues – community gardens, exersize groups,
5. I’m already preaching to the choir here on this one – but it is really worth reflecting on the logic of integrating early childhood development into PHC. It IS CHWs that are engaging with the parents and caregivers during the first few years. Incorporating early childhood stimulation and psycho-social support into our Maternal Child Health work just makes sense!
[sorry short pitch for Hesperian’s materials in various digital formats … My final point is that new technologies DO bring new opportunities. A future agenda for PHC requires us to think creatively about how to harness those opportunities…..
But we must not lose sight that the end goal must remain – empowering community – what ever that community looks like -- so that the members of that community can demand change and can sustain change over time.
Equity and Empowerment_S. Shannon_10.17.13
EQUITY AND EMPOWERMENT
WHEN COMMUNITIES OWN THEIR FUTURE
Sarah Shannon, Executive Director, Hesperian Health
Laura Altobelli, Peru Countr y Director and Senior Health
Advisor, Future Generations
Ram Shrestha, Senior Quality Improvement Advisor for
Community Health and Nutrition, University Research Co,
Hanna Sarah Faich Dini, Policy Advisor, Community Health
Systems, One Million Community Health Workers
Campaign, The Ear th Institute, Columbia University
• 40 th Anniversar y of “Where There is No
• 35 th Anniversar y of Alma Ata and
Primar y Health Care
• 25 th Year of the Nepal Female
Community Health Volunteer program
PRIMARY HEALTH CARE
The declaration of Alma- Ata states
that primar y health care is essential
health care based on scientifically sound
and socially acceptable methods,
universally accessible to individuals and
families with their full par ticipation at a
cost that the community and the countr y
can af ford in a spirit of self-reliance and
self-determination. The ultimate goal of
primar y health care is health for all .
STEPS TOWARDS HEALTH FOR ALL
WHO has identified five key elements to achieving that goal:
Universal coverage to reduce exclusion and social disparities in health;
Service delivery organized around people’s needs and expectations;
Public policy that integrates health into all sectors;
Leadership that enhances collaborative models of policy dialogue; and
Increased stakeholder participation.
an Agenda for
October 17, 2013
Where There Is No Doctor
Where Women Have No Doctor
A Book for Midwives
Disabled Village Children
A Health Handbook for Women
Helping Children Who Are Blind
Helping Children Who are Deaf
Helping Health Workers Learn
Where There Is No Dentist
A Community Guide to
Principles and Practices
• “Health for All by the Year 2000”
• Principles – Accessibility, Affordability
• Strategies – Community Mobilization,
Appropriate Technology, and
Integrated Management of
Unique role of community health workers:
• Focus on health education and preventative care
• Provide screening and referral
• Support management of care
• Create and facilitate peer support for lifestyle
• Community organizing to address underlying
New technologies bring
Hesperian Health Guides
1919 Addison Street
Berkeley, CA 94704
At your tables:
• Please discuss these 2 questions
– What is your vision for the future Primary Health
– What are key challenges for achieving Health for
All and how can they be addressed?
• Write your answers on post-its
• Prepare to share in plenary ONE idea from
your discussion in ONE minute.
– Choose the idea your table is most excited about,
OR has the most impact, OR most central to Core
• As you go to lunch, stick ALL post-its on the
future timeline. Your ideas will be recorded.