Community Health
Community-based Approaches for Primary Health Care
One of the most promising and low-cost approaches for reducing under-five child mortality in resource-poor settings is community-based primary health care (CBPHC) - programs that reach beyond the walls of clinics to provide basic health services and partner with communities.
To understand the effectiveness of these approaches, faculty from the Future Generations Graduate School led a systematic review of the global evidence. The late, Dr. Carl Taylor, chaired the review. Dr. Henry Perry, Co-Chaired the Task Force carrying out the review. Future Generations colleagues, Dr. Raj Arole from Jamkhed, India and Dr. Abhay Bang, are members of the Expert Review Panel.
The Task Force is part of the Working Group on CBPHC of the American Public Health Association. More than 70 people have been involved. Along with Future Generations, the World Health Organization, UNICEF, and the World Bank have all provided grants for this work and anticipate the findings to play an important role in guiding their funding and program policies in child health.
To download a copy of the report, How Effective is Community-based Primary Health Care in Improving the Health of Children, click <here>.
This study reviewed 469 published articles and program documents, affirming the effectiveness of 19 key community-based interventions. The study reviews approaches that:
- Improve the nutritional needs of children
- Improve perinatal and neonatal health
- Prevent and treat childhood pneumonia, diarrhea, and malaria
- Expand coverage of immunizations
- Promote behavior changes in the home such as handwashing and family planning
- Prevent mother-to-child transmission of HIV infection
- Improve child health through non-health interventions
Community-based primary health care is a sustainable alternative method to facility-based care. Common features include training community health workers, promoting partnerships between community and health programs, committment to equity, adapting the program to local conditions, and fostering long-term sustainability.
More evidence shows that joining packages of community-based health care into part of an extensive set of development and health services is very effective. By integrating interventions such as maternal and child health care and family planning, a more sustainable approach and a locally-adapted solution is adopted by each community.
International attention focuses on innovative ways to scale up CBPHC across large regions and nations to improve child health. Two examples of comprehensive, large-scale approaches are provided here.
The first is the Comprehensive Rural Health Program in Jamkhed, a 40-year old program in Maharashtra that has trained illiterate women as village health workers in 300 villages, reduced caste discrimination, and improved food security and the environment through organic agriculture. Jamkhed also serves as an international training center, having trained 11,000 people from India and 2,000 from 100 other countries. Master's degree students of the Future Generations Graduate School also visit Jamkhed to be trained in these skills as part of their one month residential in India.
The second is the Society for Education, Action, and Research in Child Health (SEARCH), where community health workers carry out home-based interventions that have reduced neonatal mortality by 70% and deaths from pneumonia by 55%. Their approach in improving the home-based care of neonates has been adopted by other organizations and by the Indian government.
More awareness about the potential impact of CBPHC in the global health community needs to be shared. Field sites can be learning centers and outreach sites need to be increased.
