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Lesley Magnussen, John Ehiri, and Pauline Jolly Comprehensive Versus Selective Primary Health Care: Lessons For Global Health Policy Health Affairs, May/June 2004; 23(3): 167-176. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Integration and Informatics: New Health Tools

Maulik V Baxi   ( 4 May 2004 )

Community-based approach to achieving Alma-Ata’s tenets

Lesley Magnussen, Lesley Magnussen, John Ehiri, and Pauline Jolly   ( 14 October 2004 )

Integration and Informatics: New Health Tools 4 May 2004
Maulik V Baxi, Associate editor (Biology and Biomedicine) Journal of Young Investigators Send comment to journal: Re: Integration and Informatics: New Health Tools maulik_baxi{at}rediffmail.com Maulik V Baxi	Lesley Magnussen and colleagues have made valid observations and proposed many idealistic solutions in their article. Measures like making health a basic right of the people and showing a strong political, social, and economic resolve have led to improved health statistics over the years in many parts of the world. However, there are areas that, due to the geopolitical situation, remain underdeveloped -- which is often reflected in their health statistics also. Health staff may not reach every place in time and save lives. Local involvement in people's own health management is the key to empowering the impoverished. Remarkably, most of the world’s underdeveloped areas have their indigenous "health services" and "practitioners." They are more trusted and accepted by semiliterate and semiskilled masses. Integration of modern and traditional medicine would help in the spread and acceptance of primary health care and also reduce costs. The approach has been implemented successfully in India, where Ayurvedic practitioners also work at Primary Health Centers performing equally well.(1) Another way to achieve a healthy population is liberal use of information technology apparatus for health education and communication. Mass media and advocacy through television and radio have always been the preferred preventive tools. With spreading information technology, satellite and wireless communications could prove a vital connection between a tertiary care hospital and an inhospitable primary care center. Reference: 1. M.V. Baxi, "eHealing Globalized India," Internet Health 3, no. 1 (Jan-June 2004), www.internet-health.org/ih200431e01.html
Community-based approach to achieving Alma-Ata’s tenets 14 October 2004
Lesley Magnussen, Lister Hill Fellow University of Alabama at Birmingham, School of Public Health, Lesley Magnussen, John Ehiri, and Pauline Jolly Send comment to journal: Re: Community-based approach to achieving Alma-Ata’s tenets LMagnussen{at}ms.soph.uab.edu Lesley Magnussen, et al.	We would like to respond to Dr. Baxi’s informative comments and suggestions regarding the topics raised in our paper. He mentions the underlying yet overpowering issue of geopolitical instability working to the detriment of communities in underdeveloped nations. While this is not an issue that is tackled easily or only by health practitioners, there are avenues that can be utilized to improve the situation in which we spend our time, energy, and resources. Dr. Baxi mentioned local, community-based commitments and involvement by the recipients of services themselves to sustain services even during times of upheaval. We agree that sustainability and long-term health improvement must begin at this level. However, in order to provide communities with resources and power, much still needs to be changed at the top-most levels of government and bureaucracies to empower those communities [1]. Specifically, we speak of money and funding; so often the strictures applied to grants influence a great deal of what occurs in the field. The system of grants fragments the work that can be done, parceling out tiny goals and small achievements in order to secure more funding and future activities. The mindset must be changed both at the Ministry level and at the grantor level; seldom has it been proposed that a grantor offer money to change the entire structure of a health system. Instead, small-scale adjustments are made, often using intermediate outcomes which do little to change the overall health status of the population [1,2]. Governments that did attempt to absorb some of the lessons of Alma Ata are struggling, since they lack guidelines and recommendations to guide their transitory journey [3,4] For example, the Ministry of Health in Jamaica determined that the best way to build community acceptance and allow for their input into the health services was to decentralize their health services. While this enormous task was implemented in 1996[5], local health centers and parish offices are still not in control of decisions regarding provision of services, changes in policies, implementing effective programs, or their budget. The tension between dispersed parishes and health centers and the governing bodies of the Ministry of Health prevents decisions from being made at the parish level where they might do the most good. In addition to the administrative tension is the institutional memory that exists among residents of the country. Many remember a time when the government paid for everything associated with health care; now, in a move to generate ownership and reduce costs, user fees and medication costs are passed on to the client. This change can make people resentful of public health services. Dr. Baxi also notes that high-tech advances could prove very fruitful for health education and prevention. Although we recognize the potential of this technology, the cost implied in creating this infrastructure could outweigh the benefits received by the local population. Again, being able to cure one individual at a remote location using satellite imagery is an important technological achievement; however, we believe that the resources that would be devoted to this technology could be more efficiently spent on developing and strengthening more grassroots programs that are dedicated to improving access, affordability, and quality services for a greater majority of the population. References: 1. G. Walt and K. Buse, “Partnership and Fragmentation in International Health: Threat or Opportunity?” Tropical Medicine and International Health 5, no. 7 (2000): 467-71. 2. J.E. Ehiri and J.M. Prowse, “Child Health Promotion in Developing Countries: The Case for Integration of Environmental and Social Interventions?” Health Policy and Planning 14 no. 1 (1999): 1-10. 3. D. Werner et al., Questioning the Solution: The Politics of Primary Health Care and Child Survival. (Palo Alto, California: Healthwrights, 1997). 4. D. Sanders, "Twenty-five Years of Primary Health Care: Lessons Learned and Proposals for Revitalization." University of Western Cape, South Africa, 2003, www.asksource.info/rtf/phc-sanders.RTF (20 August, 2004). 5. Pan American Health Organization. “Country Health Profile: Jamaica”. http://www.paho.org/English/DD/AIS/cp_388.htm (23 August, 2004).