Health for All in Primary Healthcare esay

Our course lecturer for Health for All, Henry Perry said, “the term primary health care means many things to many different people”. According to this premise we must acknowledge that Health for All through primary health care will need to be approached and implemented differently depending on the local context.

I currently work in an urban setting in southeast London as a community engagement officer in the health and community sector. Before this I worked in rural Guatemala supporting an indigenous women’s organisation that operated a small-scale rural healthcare programme. These are two very different realities yet both have relatively poor health outcomes for their local populations. I hope to use the knowledge gained from this course to improve health outcomes for local communities, here in the UK and abroad in Guatemala. In this essay I will consider three actions that I want to take as a result of having taken this course. I will also discuss some of the barriers and challenges that I might encounter while suggesting possible solutions to overcome these challenges.

 Actions

I will take action to increase the awareness of the reality of access to primary healthcare for the majority of the developing world while promoting the effectiveness of the Health For All approach to primary care to my wider network here in the UK and abroad. 

One specific activity will be to advocate taking this course, and the principles that I have learnt with two international students currently working with my organisation who are from Sierre Leon and Nigeria studying a Masters in Hospital Administration in London. They were placed with Healthwatch to better understand the importance of valuing the patient experience, and what can be achieved through working with and empowering the patient. The students have expressed that there is a organisational culture in their countries to implement top down approaches to healthcare dominated by international donors’ objectives while the local community’s needs are overlooked or dismissed. Dr. Abhay Bang from Last Mile Doctors and Carl Taylor’s approach, one of the founders of Health for All is to ‘begin with the people’.  I will use examples of success from this course such as Brazil and Bangladesh to illustrate the importance of working with local communities. I will also provide examples of the impact patient and community involvement have on improving health outcomes in primary care and the wider health system through my own experience working in Healthwatch. These two students will then take this learning back to their universities and prospective countries to achieve Health for All through primary health care. 

I intend to use the approaches and successes in projects like Jamakhed and BRAC to help develop a new project within my role at Healthwatch on a new project called ‘Breathing Well”. As part of the project we have to train volunteer ‘champions’ to promote healthy living lifestyles, identify people who have breathing difficulties and signpost them to the appropriate service or health facility. This model reflects that of Dr. Abhay Bang from Last Mile Doctors said ‘go where there are problems rather than where the facilities are’. This is a key principle in Health For All for primary healthcare. We intend to train local volunteers who are active members of the diverse communities of the borough. They will  provide signposting to primary healthcare services, identification of illness, and promote healthy living lifestyles in a way that is easy to understand to their own community members. Although we are not short of health facilities in the UK in comparison to countries like India or China, there are issues around access for those living in deprivation or for those who have English as a second language. It is hoped that by using community champions, which have a similar role to the Community Health Workers in projects like Jamkhed, will improve health outcomes and reduce health inequalities in the borough.

The champion role is very similar to the role of Community Health Workers which feature as a key player in health for all. We will train local actors to take on the role of health promoters to reach the most marginalised communities. In particular for those communities who have considerable barriers to access healthcare, for example for people who do not speak English as a first language. Seeing the success of BRAC in Bangladesh, I am hopeful that this new way of working will bring success for our Breathing Well project.

 I plan to return to work with AMA (the indigenous women’s organization in Guatemala) as part of my Masters programme in Participation, Power and Social Change. AMA already applies many of the approaches that Henry Penry highlights in our course: full community involvement, addressing the health priorities as identified by the community, intersectional work, and training local actors to provide care in the community to name a few. They also promote the use of traditional Mayan health practices where appropriate, such as the Mayan sweat baths and the use of herbs to assist in childbirth. Utilising and building on local knowledge is something Carl Taylor advocates in his lecture of the history of primary healthcare for all in week two. With the knowledge from this course, I can assess where if at all the health programme can improve. Retention of volunteers is often a challenge for the organisation which we learnt from examples in the course can be overcome by using financial incentives, providing regular training, and holding weekly meetings. I will also promote the concepts of Health For All to other projects based in Guatemala with whom I come into contact. All too often foreign NGOs use top down approaches relying on outside aid and foreign staff capacity. This model is not sustainable and does not adequately involve the agency of local communities.

 Challenges/obstacles

Volunteer retention is a challenge for most projects, I envision this being a difficulty in the Breathing Well Project. Volunteers who are easier to find for ‘champion’ roles such as this one tend to be involved in many different projects and therefore have limited time for an additional role or ‘burn out' from too many commitments. In BRAC Community Health Workers are required to have 10 years experience and be over 25 years old to qualify. As an organisation we need to be selective in terms of who we choose although the restrictions might differ to BRACs to adapt to the local context. We need to consider using community leaders who have strong links to their communities so that they are unlikely to leave the area while having a personal investment in making the project a success. We could also consider financial incentives as a tool to improve volunteer retention.

 As we saw through the lectures in the course, funding is always an issue. Funding programmes under primary healthcare is a challenge because there are less ‘quick wins’ like some of the top down disease-orientated models where outcomes are clearly visible relatively quickly. AMA has historically struggled to fund their Mayan Health programme over projects like the ‘smokeless cook stoves’ because they are more tangible and therefore more appealing to donors. Another personal action will be writing a paper to promote the benefits of using the concepts of health for all primary care in Guatemala. The paper can be shared with donors and I will highlight successes in countries like Brazil and Bangladesh drawn from the course’s resources.

Lastly, I foresee a challenge in trying to implement my learning within AMA because of my identity as a foreigner, and the fact that I am not medically trained. AMA’s methodology, quite rightly applies the principles of community development: local actors are the agents of change in their own communities. Therefore it would not be appropriate for me to attempt to implement lessons learned from this course, that is the job of the locally trained community facilitators. However, persuading donors of the importance of funding approaches like Health For All is appropriate and extremely useful. This will be another action I can take forward thanks to this course.

To conclude, I have identified three if not more actions to take forward as a result of this course, I have analysed the potential challenges involved in applying these actions, and I have suggested how these challenges can be overcome. As I discussed at the beginning of this essay, “the term primary health care means many things to many different people”. Therefore our role as advocates and leaders in Health For All must to be to share the principles of Alma ATA and this course with local partners, while empowering them to adapt and apply the principles to the local context in an appropriate, effective, and sustainable way.