Comprehensive primary health care:Current state of research projects

Ronald LabontéCanada Research Chair

Globalization and Health EquityInstitute of Population Health

University of Ottawarlabonte@uottawa.ca

www.globalhealthequity.ca

Teasdale-Corti Project (1)

4 year (2007 – 2011) initiative to develop/strengthen research capacity comprehensive PHC using triads of new researchers, research users and research mentors University of Ottawa/University of Western Cape and others People’s Health Movement/International People’s Health University Funded by the Global Health Research Initiative, Canada; managed by

the International Development Research Centre

4 regions India/South Asia Latin America Southern Africa Aboriginal communities (Australia, Canada, Aotearoa/New Zealand)

Africa

The Contribution of the Health Service Extension Program in Promoting

Comprehensive Primary Health Care in Tigray, Ethiopia: the case of

maternal and child health. Mr Yohannes Tewelde, Mr Awala Equar, Mr Araya Abrha, Prof. Yemane Berhane

An evaluation of the comprehensiveness of the PHC services of the

Relief Society of Tigray (REST), an NGO that serves the needs of

refugees displaced by the civil war in Sudan; examine the feasibility of

establishing a PHC clinic to deliver CPHC; examine the contributions of

primary health care workers and CHWs; and assess the role of donor

funding in enabling or constraining ‘comprehensiveness’ of PHC

programs

Completed 720 surveys in 3 districts, 5 focus groups and 12 in-depth

interviews; more focus groups and interviews underway

Report of preliminary findings expected March 2010

Africa

The contribution of the Health Services Extension Program to improve

coverage and comprehensiveness of primary health care services in

Jimma Zone, Southwest Ethiopia. Mr Abera Asefa Dheressa, Dr Mirkuzie Woldie Kerie, Prof Morankar Sudhakar

Narayan

Is assessing the role of CPHC principles and practice in the health

sector reform efforts in Jimma Zone, Ethiopia. In particular, the team

is identifying the contributions of village health workers in the

implementation of CPHC as well as community participation and

local resource mobilization.

Interviews and household surveys in 9 villages across 3 districts

completed September 09; secondary data analysis initiated

December 09

Preliminary report of findings expected march 2010

Africa To assess the uptake, implementation and impact of the roll out of

the ‘Community Strategy Approach’ on maternal and child health outcomes in selected districts in Kenya. Ms Clementine Gwoswar, Mr Jack A. Buong’, Prof Dan Kaseje

Studying the effectiveness of community participation in improving the performance of District Health Services using three examples (immunization, access to treated water, and availability of insecticide-treated nets (ITNs) for children and pregnant women) and client satisfaction as the outcome measure.

Household surveys (n = 3000) completed September 09; qualitative data gathering slower and still underway, expected completion in early 2010

Africa Exploring the complex contributions of a community based safe

motherhood program to comprehensive primary health care in North Kivu, Democratic Republic of Congo Mrs. Gwendolyn J. Lusi, Dr Jean Robert Likofata Esanga, Dr. Richard Bitwe

Evaluating the interface of HEAL Africa’s community-based programs with state PHC service delivery; expansion of community outreach and other PHC services as a social reconstruction strategy in post-conflict situation; and use of HEAL Africa’s Safe Motherhood model as a means of rebuilding community health services in a context of fluctuating human security.

Focus groups and interviews in selected communities, two health zones completed; secondary data analysis completed

Preliminary report of findings expected March 2010

Africa The Gauteng Province Community Health Worker Programme: The

extent to which it contributes to the provision of comprehensive primary health care. Ms Salamina Hlahane, Ms Nonhlanhla Nxumalo, Dr Jane Goudge

Examines how well the potential role of CHWs to improve access to the formal health system is realized in practice, by documenting patient experience of barriers to care, patient experience of CHW services, and assessing whether and how CHW activities reduce the affordability, availability and acceptability barriers to the formal health system.

Two case studies undertaken: #1 completed participant/observation of 3 CHWs over 3 days, 2 focus

groups, preparation of network maps, 8 key informant and 6 patient interviews

#2 will use similar method; data collection initiated late 2009

Indigenous: New Zealand Initiatives to Improve Access to CPHC for Māori in

Aotearoa New Zealand Tania Forrest, Rowena Gotty, Dr Pat Neuwelt

This study is exploring explore selected initiatives to improve access for Māori to primary health care services, currently undertaken by member organisations, with the aim of ultimately developing a tool for evaluating the accessibility to Māori of a primary health care service in Aotearoa New Zealand.

Indigenous: Canada 1

CPHC in the Island Lake Communities: what does it mean and how does it look? Grace McDougall, Alex McDougall, Dr. Marcia Anderson

Is assessing CPHC governance structures most appropriate to the health beliefs and values of the residents of the four First Nations communities. The research is documenting four First Nations communities’ conceptualizations of health and CPHC, and linking a CPHC governance model to these conceptualizations. Data collection is currently underway and will be complete mid-2010.

Indigenous Canada 2

Community Health Indicators Toolkit and Database for Development and Evaluation of a CPHC Strategy in the Athabasca Region of Saskatchewan Dr. Jennifer Poudrier, Melissa Stoops, Sandra Hansen

A “Community Health Indicators Toolkit and Database” has been formulated to develop and evaluate a CPHC strategy in Saskatchewan. This framework is being tested and further developed to address changes in community empowerment and improved participatory mechanisms. Data collection (primarily qualitative) is planned for early 2010.

Indigenous Australia 1

Wellbeing at Utopia: the role of the Urapuntja Health Service Sarah O’Dogherty, Ricki Tilmouth, Kevin Rowley, Coral Tilmouth

Gary Jones

The project describes the history and current activities of Urapuntja Health Service, and how its focus on comprehensive primary health care may be contributing to the wellbeing of Utopia community, with a focus on reducing obesity, diabetes and CVD as outcomes.

Indigenous Australia 2

Historical analysis of CPHC at Victorian Aboriginal Health Service, Fitzroy, Melbourne Joann Luke, Rob Hall, Rod Jackson, Olivia Bartley

The case study Victorian Aboriginal Health Service (VAHS) History is analyzing CPHC at the VAHS, including its overall role to better meet the needs of the community. The project is identifying the main players in VAHS history, the community and organizational constraints and opportunities, the political issues, and the challenges in its delivery of CPHC.

Indigenous Australia 3

Case study of the Male Health Program, at CAAC Stephanie Bell, Clive Rosewarne, John Liddle, Korey Summers,

Gai Wilson

This case study of the Central Australian Aboriginal Congress Male Health Program is examining how the program is and can better address the underlying social determinants of Aboriginal male health in Alice Springs and surrounding areas. This initiative models many aspects of comprehensive primary health care, seeking to have promotive, preventative, curative and rehabilitative (comprehensive) care.

Asia

Effectiveness of different strategies used for the establishment of Comprehensive Primary Health Care Programs in urban squatter settlements of Karachi, Pakistan Dr. Parvez Nayani, Dr. Agha Ajmal, Dr. Yousuf Memon

Aim is to assess the effectiveness of different strategies used for establishment of CPHC in urban settlements within Karachi, Pakistan, which have a collective population of over 150,000. The project aims to determine which of three PHC delivery models is more effective, comprehensive and sustainable: institution-led, community-led, partnership-based. Mixed methods: policy review, secondary data analysis,

qualitative interviews (30) and focus groups (10) Almost all data collected and transcribed, analysis commencing

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Community Health Program of AKU-CHS

Asia

Contribution of Community Health Workers to Implementation of CPHC in Rural Settings, Iran Dr. Sara Javanparest, Dr. Gholamreza Heidari, Dr. Fran Baum

Aim is to study the implementation of CPHC in rural areas in Iran, where there remains a range of challenges (such as impeded engagement in program planning, supervision, and workload) for the community health workers. The research examines ways to enhance the contribution of community health workers in the implementation of CPHC in Iran. Policy and training program analyses, key informant interviews (18

provinces, 90 interviews) Data gathering near complete, analysis underway with final report for

September

Asia Exploring Synergies between Empowerment and Gender

and Comprehensive Primary Health Care in three tribal districts of Arunachal Pradesh Dr. Tage Kanno, Dr. Hage Tam, Dr. Menjunath Shankar, Dr. Betsy Taylor

Explore the synergies between the empowerment of women and the participation of communities to reduce gender inequalities and sustain changes in health behaviour in culturally diverse tribal groups across three districts of Arunachal Pradesh in northeast India. Mixed methods: interviews (47), focus groups (4), participant

observation (5 sites), photovoice (3) Qualitative data complete, analysis underway; pre-test of quantitative

health behaviour survey complete with administration March - April Final research report in September

Asia The contribution of Accredited Social Health Activist

(ASHA) under National Rural Health Mission (NRHM) in the implementation of Comprehensive Primary Health Care in East Champaran district, Bihar (State) India Dr. Anil Cherian, Dr. Jameela George, Dr. Sara Bhatacharji

Research on the training, role, understanding and practice of Accredited Social Health Activists (ASHAs) is developing local comprehensive primary health care Mixed methods, 165 villages: interviews (519), health behaviour survey

(306), PRAs (49), focus groups (69) All data collected, analysis partially completed, final research report

September

Asia

GK Case Study and Participatory Action Research Mahidul Islam and A. Nunyan, Gonoshasthaya Kendra

Undertake a comprehensive historical review of GK’s work in establishing and maintaining 35 CPHC centers and over 750 ‘medical camps’

Initiate a two-village PAR in remote areas to increase access by poorest to CPHC, and begin new actions on social determinants of community health Final proposal just completed; historical review to begin in

March; village PAR to begin in April pending financial support from intra-GK and IDRC

Latin America

Team El Salvador: Will examine community health experiences (multiple outcomes identified by Teasdale-Corti proposal) based on CPHC activities which have been carried out in El Salvador over the past 20 years.

Team Uruguay: Will investigate the role of CPHC in the community policlinics in the new National System for Integrated Health, determining the extent to which health care reforms support the application of CPHC, as well as the extent to which “ownership” of health services by the community affects the sustainability of CPHC.

Latin America

Team Argentina: Will identify deficiencies observed in the development of CPHC strategies in Argentina. These will be based on a comparative study of CPHC in two different CPHC efforts in the country. There will be a special focus on a large socially excluded population of internal migrants as well as migrants from Paraguay and Bolivia; both groups represent a special challenge to CPHC in the region where they are largely congregated.

Latin America

Team Brazil: In Brazil in 1994, the Ministry of Health created the “Family Health Programme”, intended to be a vertical program targeting vulnerable populations at risk. It was later transformed into the principal strategy for the reorganization of the health system based on PHC principles based on the guarantee of universal access. This study will determine how well principles and practices of CPHC have advanced or could advance beyond an initiative targeted at a vulnerable group, and evolve into a more universal system of access for other groups.

Latin America

Team Colombia: The Government of the City of Bogota adopted in 2004 the PHC model to secure the right to health and reduce inequalities in health and access to health care. A initial study was undertaken to analyze its implementation from 2004-2008. The aim of this team’s research is to examine where and how improvements could be made in terms of impacts on health and health equity, i.e. moving from implementation to outcomes.