There is at least one common characteristic between
different countries in the field of health is access to care. Needs of
health are insufficiently covered by the provision of health services.
Several policies have been implemented in this direction. Our present
work focuses on the primary health
care concept that became the basis
for the WHO following the
Alma Ata Declaration (1978) that should lead
to the goal of health for all. First, we discuss the similarities
between models of primary health care described by
Carl Taylor and those
described by other authors, and then identify the other models
described in the literature.
Analysis of Carl Taylor on PHC: similitude and contrast
Carl
Taylor identifies in its analysis on primary health care, four
approaches: Community-Oriented Primary health care (COPHC), the Alma Ata
Declaration, the Community-based primary health care (CBPHC) and
seed-scale.
- COPHC:
This is an approach
that is divided into four phases: the definition and characterization of
the community identify health problems of the community, the
development of interventions and monitoring the impact of interventions.
It is an approach developed from Kark’s experience conducted in South
Africa (“Pholela”) and was also presented by
Henry Perry in his
bibliography. There is a similarity between this approach and the
actions of the NGO "SEARCH" and "
Tiyatien health".
- Alma Ata:
Carl Taylor is one
of the actors of the conference of Alma Ata whose spirit is to provide
“essential health care based on practical,scientifically sound and
socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full
participation and at a cost that the community and country can afford”.
It includes promotive, preventive, curative, and rehabilitative
services. It also must be integrated into other development sectors such
as agriculture, education, food, etc. However, this idea has not been
successful and there is talk of selective primary health care based on
three pillars: equity, community participation and intersectoral
development.
- CBPHC:
CBHPC approach is a paradigm used by most authors on
the analysis of the concept of primary health care even if the content
varies from one author to another. According to Taylor C, it is an
approach that consists in adapting medical knowledge in socio-cultural
context of the population; he illustrates this by the traditional
practices of management of certain diseases, the use local medicines,
etc. However, according to Henry Perry it is a “process through which
the health programs and communities work together to improve health and
control disease”. This includes communications with families,
communities and individuals to improve key practices, social
mobilization and community planning, delivering and using of health
services and the provision of health care in the community, including
preventive services. Henry Perry illustrates his analysis by the
Integrated Management of Childhood Illness (IMCI). We find this approach
used in the first phase of the
project Jankhed, "community" that uses
community volunteers who are trained and subsequently loaded to deliver
primary health care services including prevention and peer education.
- Seed-scale:
This is an integrated approach developed by Carl
Taylor that considers the socio-economic and educational aspects into
the health programs.
Others models of primary health care
Carl Taylor, in his analysis of the models of primary
health care has probably considered paradigms that are still relevant.
In contrast, other approaches have been suggested by other authors.
Take for example the CBIO developed by H Perry. It is an approach based
on the definition of epidemiological priorities, defining community
priorities, delivering key services, monitoring progress and measuring
health improvement. There is a similitude between this approach and the
COPHC except that the focus of the COPHC is on evidence-based planning,
prioritization and evaluation. This approach is seen in the practice of
NGOs “
SEARCH” opposite of “Tiyatien Health”.
Another difference
between the approaches of Carl Taylor is with the other authors Care
practice groups or women's groups. This is used by the project “Jankhed”
through Women's self help groups.
Conclusion
In conclusion, we can say that the concept of health
care is very complex even if it seems simple in appearance. There is no
one model of primary health care even if the ultimate goal is the same.
It should integrate the different horizontal and vertical approaches to
achieve better access to care. Jankhed’s experience that integrates all
models seems to provide better results in India.
