Insights into primary health care: similar and different perspectives through authors.

Insights into primary health care: similar and different perspectives through authors. 

Fortuné GANKPE, Aubin BALEBA

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.