FBOs and Alma Ata II Renewing Primary Health Care

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FBOs and Alma Ata II Renewing Primary Health
Care

• Franklin Baer
• Carl Taylor
• Sarla Chand
• Frank Dimmock
• Samuel Mwenda

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Renewing PHC in the Americas
Create a vision and renewed sense of purpose for health systems development for a Primary Health Care-Based Health System. 1) Review the legacy of Alma Ata  2) Articulate  a strategy for PHC renewal 3) Lay out steps  to achieve this vision.
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Various Approaches to PHC(and the need for
complementarity)
Approach Emphasis
Alma Ata comprehensive PHC A strategy for organizing healthcare systems  society to promote health
Selective PHC Specific set of health service activities geared towards the poor
Primary care  Level of care in a health services system
Health  Human Rights approach A philosophy permeating the health and social sectors
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The renewed definition of PHCFocusing on the
health system as a whole

• Include public, private, and non-profit sectors
• Recognize PHC as more than provision of health
  services
• Differentiate values, principles and elements
• Highlight equity and solidarity
• Incorporate sustainability and a quality
  orientation.
• Specify measurable organizational functional
  elements
• Recognize dependency on other health system
  social processes
• Recognize need for each country to design their
  own strategy

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Role of FBOs in renewing PHC?

• No mention of FBOs, Faith, or church
• 1 mention of missionaries Christian (Annex C)
• The Christian Medical Commission was created by me
  dical missionaries working in developing countries
  . They emphasized training of village health
  workers
• 1 mention of private and non-profit sectors
• Renewing PHC should include public, private, and
  nonprofit sectors

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Faith-Based Health Care
Public
Private
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Renewing PHC Back to the Basics
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A is for Alma Ata

• The Alma Ata Conference (1978) defined PHC
• 10 Declarations of Alma-Ata
• The people have the right and duty to participate
  individually and collectively in the planning and
  implementation of their health care.
• 8 Essential Components of PHC
• 4 As of PHC (Accessible, Available, Acceptable,
  Affordable)
• 3 Aspects of PHC (Curative, Preventive
  Promotion)

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Community-Based Congregational-Based

• Role of the Church in Community-based Health Care
  
• Community Health Global Network Working Group
• Evidence-Based study of Community-Based PHC
• Community Health Evangelism (CHE)
• Care Groups
• Training for Transformation, Building our Lives

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Building Integrated Health Systems

• A 3-D conceptual model of a comprehensive
  health system based on PHC (1988, Smith
  Bryant)
• First Dimension PHC Program elements
• Second Dimension Functional Infrastructure
• Third Dimension Level of Service delivery

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Conceptual Model of a Comprehensive Integrated
Health System
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FBOs PHC Health Systems

• 1st PHC Program Elements
• Risk of becoming labeled as being single issue
• WIMEN CHD
• 2nd Support Systems
• ? ? ?

Water Sanitation Immunizations Mother Child
Care (FP) Essential Drugs Nutrition
Food Curative Care Health Education Disease
Control

• Essential Drug Systems
• Human Resource development
• 3rd Health System Levels
• Family Home
• Community-Based ( Congregation-Based)
• Health Facility-Based
• Health Districts
• National Level (FBO Health Networks)

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FBOs Renewing PHC

• 1) Review the legacy FBOs and  Alma Ata 
• 2) Articulate a strategy for FBO contributions to
  renewing PHC
• 3) Lay out steps to achieve this vision

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FBOs and Alma Ata IIRenewing Primary Health Care

• Franklin Baer
• Carl Taylor
• Sarla Chand
• Frank Dimmock
• Samuel Mwenda

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Medical Missions transition to Health Missions

• Christian Medical Commission of the World Council
  of Churches in Geneva
• 1960s Tubingen Conferences (Martin Scheel)
• Key Leaders
• Jack Bryant, Jim McGilvary, David Jenkins,
• Anthony Bloom, Hakan Hellberg, David Morley,
• Fred Sai, Nita Barrow, Caroll Behrhorst
• Surveys of ripple effect of health impact from
  hospitals
• Need to do more prevention and behavior change
• Christian Medical Commission Journal Contact
  pioneered the early explorations of what we now
  call Community Based Primary Health Care

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Rockefeller to WHO Christian Connections

• Ding Xian John B Grant, Jimmy Yen, CC Chen
• Second Generation Projects
• Hydrick in Jogjakarta, Indonesia
• Eloesser in Chile and China
• Kark in Pholela, South Africa
• Third Generation Projects
• Narangwal
• Jamkhed
• Christian Medical Commission projects (Litsios,
  AJPH)
• Health by the People (Newell, WHO)
• Alma Ata Conference in 1978 (Halfdan Mahler, WHO)
• Comprehensive vs Selective (top-down vs bottom-up)

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FBOs and Alma Ata IIRenewing Primary Health Care

• Franklin Baer
• Carl Taylor
• Sarla Chand
• Frank Dimmock
• Samuel Mwenda

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Faith- Based Maternal Newborn Health Care
Programs

• 1. Community-based
• - India ,Jamkhed, CRHP
• - Mozambique, World Relief, Care Groups
• 2. Congregational Health Model
• - Malawi, CCAP Malaria Prevention Program

• 3. National faith-based health networks
• Uganda , UPMB, UMMB
• Kenya, CHAK
• Tanzania, CSSC
• 4. District Health
• Co-Management
• - DR Congo, ECC-DOM,
• the SANRU Program

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1. Comprehensive Rural Health Project Jamkhed,
India
Since 1970 Jamkhed has empowered communities to
take health into their own hands through
principles of Integration, Equity and
Empowerment with leadership of village health
workers (VHWs). Christian principles of justice
and service provide an alternative model of
society to the inequitable Indian caste
system. The government of India started the
National Rural Health Mission (NRHM) chaired by
the Prime Minister. NRHM has adopted the
village health worker model of Jamkhed for this
country wide program.
YEAR 1971 2004 India 2004
Infant Mortality 176 24 62
Crude Birth Rate 40 18.6 23.9
Maternal Hlth Antenatal Care Safe delivery Family Planning 5.0 lt5.0 lt1.0 99 99 68 64 43 41
Children lt 5 DPT/Polio Malnutrition (weight for age) 5 40 99 5 70 47
www.jamkhed.org
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2. Congregational Malaria Prevention Program

• 26 out of 150 CCAP congregations in hard to reach
  areas of Northern Malawi trained women to
• 1) Deliver malaria prevention and treatment
  messages, and
• 2) To provide/sell mosquito nets and
  insecticide.

The Synods of Livingstonia Nkhoma, Presbyterian
Church of Central Africa, Malawi
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3. National faith-based health networks
UPMB/UMMB/UCMB Interfaith, public PNFP
This project trained providers, CORPS and
mobilized Religious Leaders to promote

• Uptake of Intermittent Preventive Treatment for
  Malaria
• Use of ITNs among pregnant women
• Capacity among providers to deliver focused ANC
  services
• Pregnant women coming early (first trimester) for
  ANC
• pregnant women receiving IPT1 increased 43 to
  94
• pregnant women receiving 1st IPT2 increased 63
  to 76

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4. District Health systems development and
Management

• SANRUs integrated and systems strengthening
• approach resulted in major achievements
• in maternal newborn care

Assisted births increased from 45 to 65
Prenatal Care increased to 80
SANRUs health system strengthening program
strengthens PHC interventions and encourages
co-management of health zones via FBO health
networks.
www.sanru.org
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Challenge for Faith Communities

• Save pregnant women and babies from preventable
  deaths Through Integrated, comprehensive
  community health programs
• Enable capacity building of partners in Africa,
  Asia and LA/C

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FBOs and Alma Ata IIRenewing Primary Health Care

• Franklin Baer
• Carl Taylor
• Sarla Chand
• Frank Dimmock
• Samuel Mwenda

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FAITH-BASED HEALTH NETWORKS IN AFRICA
Renewing the focus on Primary Health Care
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Christian Health Associations
active CHAs networks
evolving networks
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History and Coverage of Faith-based Health
Services
Appreciating Religious Health Assets
www.arhap.uct. ac.za
Interfaith Health Program Emory School of
Public Health University of Cape Town Dept of
religious Studies University of Kwa Zulu Natal
Theology and Development Program University of
Witwatersrand Department of Sociology
Research supported by the World Health
Organization
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LESOTHO GIS / PGIS 2006
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AIDSLink publication of the Global Health
Council
Community Realities in Africa Show FBO
Partnership Key to Global Scale-Up
Amidst the ongoing, often fierce, debate about
the role of faith-based organizations (FBOs) in
combating HIV/AIDS, a pilot study by the World
Health Organization (WHO) and research partners
in sub-Saharan Africa put to rest any doubts
about the huge role played by faith communities
in HIV care and treatment. It also reconfirmed
the urgent need for partnerships with the public
health community to achieve better health
outcomes. With the rate of HIV treatment
scale-up still averaging 50,000 new people per
month, it is evident that government-sponsored or
supported health services alone will not come
close to reaching the target of universal access
by 2010, which is another 6 or 7 million persons
living with HIV. It is also evident from an
examination of multilateral and bilateral funding
programs and health policies that there is a
failure to understand the influence of religion
in African health worlds.
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The study has recommended developing religious
and public health literacy through formal
courses, joint training, and shared materials to
improve understanding.
Time is of the essence for identifying religious
health assets that could help to scale-up
services, strengthen community support groups and
religious entities, and further link them to
nearby state-run hospitals, clinics and
dispensaries. Further examination of the nature
of intangible (spiritual encouragement, knowledge
and moral formation) health assets is needed to
more fully document the full extent of
possibilities for religious health assets.
There is an astonishing capacity possible in
religious communities to greatly enhance health
services, along with supporting people in their
care, stimulating the will to live, and building
communities. These are the added value of
enrolling FBOs as full participants in the health
system Building communities, saving lives, and
preventing the further spread of HIV.
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Rev. Canon Ted Karpf
karpft_at_who.int
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SO. What are we doing to support Christian
partners in Africa, Asia, and elsewhere to be
engaged and seize the opportunity to reach out
within communities and through their
Congregations ???
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Christian Health Associations in Africa
Bi-annual (almost) Assemblies

• Siavonga, Zambia Conference 9/2001
• Nairobi, Kenya Conference 5/2003
• Mangochi, Malawi Conference 11/2004

• BAGAMOYO CONFERENCE Tanzania 2007

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FBOs and Alma Ata IIRenewing Primary Health Care

• Franklin Baer
• Carl Taylor
• Sarla Chand
• Frank Dimmock
• Samuel Mwenda

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BAGAMOYO AFRICA CHAs CONFERENCE 2007

• STATEMENT OF COMMITMENT RECOMMENDATIONS OF 18TH
  JANUARY 2007
• Presented by Samuel Mwenda, CHAK

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Commitment agreed upon by the participating CHAs
partners

• The Bagamoyo conference reaffirmed the commitment
  to continue the healing ministry of Jesus Christ,
  serving the poorest of the poor and marginalised
  but also recognising the need to care for the
  carers in a biblical manner. In addition CHAs
  will continue to work in partnership with
  churches, governments and other development
  partners.
• The Bagamoyo conference recognised that much
  progress has been made since the last conference
  in Malawi (2004). The TWG on HRH which was
  supported by IMA had facilitated this process.

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Strengthening a Support Platform for all CHAs
in Africa.

• A small rotating secretariat to improve
  networking and communication between CHAs and
  associated organizations in Africa and elsewhere.
  CHAK agreed to host this secretariat for the
  initial 2-3 year time period. (TOR were to be
  developed)
• This secretariat would include a fulltime program
  officer who is fluent in both English and French
• The platform would facilitate discussion on
  specific issues concerning CHAs and would also
  facilitate the preparation of the next meeting in
  2009.
• A virtual platform for better communication would
  be hosted in such a network. IMA World Health and
  MMI would give technical assistance with other
  agencies contributing.

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2..

• The newly established office would also
  facilitate and promote the communication and
  collaboration between partners of the CHAs such
  as the capacity project (IMA), EPN, AIDS
  initiatives, the Healing Study (DIFAEM), Medicus
  Mundi International, CCIH and other collaborative
  partners.
• WCC, IMA, MMI, DIFAEM, CCIH and other partners
  working with CHAs will facilitate the lobbying
  and advocacy on behalf of CHAs, FBOs and
  Christian Health Services among churches and the
  international level.
• CHAs committed to follow up on the HRH
  recommendations and the TWG would continue to
  support this process.

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Participants at the Bagamoyo Catholic Mission
Cross which marks the entry point of
Christianity into East Africa also marked the
renewing of the CHAs commitment
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Progress made

• TOR for the CHAs Platform secretariat and a work
  plan were developed by CHAK
• Seed funds to start provided by WCC Difaem
• A CHAs Platform Secretariat officer has been
  recruited and hosted by CHAK in Nairobi, Kenya
• Work plan implementation has started.
• The 1st Africa CHAs Bulletin is expected in June
  2007
• One issue of WCCs Contact Magazine to focus on
  CHAs

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Way forward

• A CHAs Platform website needs to be created with
  a database of members and linkages to existing
  CHAs resources websites
• Africa CHAs Platform needs to establish an active
  working relationship with CCIH and its members
• Africa CHAs Platform members, stakeholders,
  partners and collaborators are invited to
  contribute articles, information news items for
  inclusion in the Bulletin
• New partners are invited to support the CHAs
  Platform with ideas, programs and resources
  towards making it a viable platform for engaging
  Africa Christian Health networks
• We should collectively begin putting our ideas
  together for the next Africa CHAs Conference
  which should be held in either Southern Africa or
  Western Africa in 2009

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FBOs and Alma Ata IIRenewing Primary Health Care

• 1) Review the legacy FBOs and  Alma Ata 
• 2) Articulate a strategy for FBO contributions to
  renewing PHC
• 3) Lay out steps to achieve FBO visions.

Create a vision and renewed sense of purpose for health systems development for a Primary Health Care-Based Health System. 1) Review the legacy of Alma Ata  2) Articulate  a strategy for PHC renewal 3) Lay out steps  to achieve this vision.
I plan to promote integrated primary health care
as a strategy for strengthening health systems.
--Dr Margaret Chan, WHO Director-General
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PAHOs Next Steps Building an International
coalition

• Frame PHC renewal as a priority
• Develop concept of PHC-based health systems as a
  feasible and politically appealing policy option,
  
• Capitalize on the current windows of opportunity
• the recent the anniversary of Alma Ata,
• the Millennium Development Goals (MDGs)
• current focus on strengthening health systems.