Primary Health Care (PHC)
Primary health care
The MMM approach to healthcare changed significantly in the 1970s when the focus shifted to the community. Two developments were instrumental in this change: the Alma Ata Declaration on PHC in 1978 and the decision of the 1979 Congregational Chapter that the main thrust of MMM healing ministry would be among the poor.
The Alma-Ata Declaration
At an international conference on primary health care, the Alma-Ata Declaration of 1978 was a major milestone of the twentieth century in the field of public health. It identified primary health care as the key to the attainment of the goal of Health for All. The following are excerpts from the Declaration:
- The Conference strongly reaffirms that health, which is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.
- The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, is politically, socially, and economically unacceptable and is, therefore, of common concern to all countries.
- The people have a right and duty to participate individually and collectively in the planning and implementation of their health care.
- Primary health care is 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 to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first elements of a continuing health care process.
- An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente, and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.
The Acts of the MMM 1979 Congregational Chapter stated:
‘The cry of the poor has become for us, at this point in our history, the call of Christ through His Church. Our preference for community health at the 1974 General Assembly, and our gradual discernment of the signs of the times, show much more clearly now that it is among the poor that our thrust for healing mainly lies. Seeking an obedient response in love, we opt for a greater solidarity with them as a further unfolding of our charism.’
Development of the concept
Interestingly, ‘an important influence for primary health care came from the experience of missionaries. The Christian Medical Commission, a specialized organization of the World Council of Churches and the Lutheran World Federation, was created in the late 1960s by medical missionaries working in developing countries. The new organization emphasized the training of village workers at the grassroots level, equipped with essential drugs and simple methods. In 1970, it created the journal Contact, which used the term primary health care, probably for the first time....
‘John Bryant and Carl Taylor were members of the Christian Medical Commission and in 1974 collaboration between the commission and the WHO was formalized. In addition, in Newell’s Health by the People, some of the examples cited were Christian Medical Commission programs while others were brought to the attention of the WHO by commission members. A close collaboration between these organizations was also possible because the WHO headquarters in Geneva were situated close to the main office of the World Council of Churches (and 50 WHO staff received Contact )’ (The Origins of Primary Health Care and Selective Primary Health Care, Marcos Cueto, PhD, Am J Public Health, 2004 November; 94(11): 1864–1874).
MMMs have worked with people in their local communities to provide these services.
Responding to new realities
More recently, the UN Millennium Project stated, ‘Although primary health care is now often equated only with community-based, low-tech health care, the Alma Ata Declaration very clearly recognized the importance of a facility-based health system with a strong referral network, of which outreach into communities was an integral part. As the director general of the WHO, Hafdan Mahler said in 1981, “A health system based on primary care cannot...be realized, cannot be developed, cannot function, and simply cannot exist without a network of hospitals.” Primary health care is a fundamental approach to health itself, based on the notion that services should be delivered as close to the community as possible, that the community could afford, in an integrated manner, with the participation of the community.’
A major problem with the primary health care concept was its affordability, largely because of the debt crisis in the 1980s and its effect on poorer countries. In the international health policy area it was later replaced with a more targeted approach aimed at a few conditions responsible for the highest numbers of deaths, and for which relatively inexpensive, safe, and effective interventions already existed. This was seen as a way to impact on health in the short term. For UNICEF the interventions included growth monitoring, oral rehydration, breastfeeding, immunization, food supplementation, family planning and female education.
From the UN Millennium Project 2005, Who’s Got the Power? Transforming Health Systems for Women and Children, Task Force on Child Health and Maternal Health, p 37
'Above all to learn the right approach to the people' (Mother Mary Martin, 1962 ).