Comprehensive primary health care: Current state of research projects

Report
Comprehensive primary health care:
Current state of research projects
Ronald Labonté
Canada Research Chair
Globalization and Health Equity
Institute of Population Health
University of Ottawa
[email protected]
www.globalhealthequity.ca
Teasdale-Corti Project (1)
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4 year (2007 – 2011) initiative to develop/strengthen
research capacity comprehensive PHC using triads of
new researchers, research users and research mentors
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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
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India/South Asia
Latin America
Southern Africa
Aboriginal communities (Australia, Canada, Aotearoa/New Zealand)
Africa
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The Contribution of the Health Service Extension Program in
Promoting Comprehensive Primary Health Care in Tigray, Ethiopia:
the case of maternal and child health.
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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 indepth interviews; more focus groups and interviews underway
Report of preliminary findings expected March 2010
Africa
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The contribution of the Health Services Extension Program to
improve coverage and comprehensiveness of primary health care
services in Jimma Zone, Southwest Ethiopia.
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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
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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.
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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
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Exploring the complex contributions of a community based safe
motherhood program to comprehensive primary health care in North
Kivu, Democratic Republic of Congo
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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
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The Gauteng Province Community Health Worker Programme: The
extent to which it contributes to the provision of comprehensive
primary health care.
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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:
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#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
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Initiatives to Improve Access to CPHC for Māori in
Aotearoa New Zealand
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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
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CPHC in the Island Lake Communities: what does it
mean and how does it look?
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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
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Community Health Indicators Toolkit and Database
for Development and Evaluation of a CPHC Strategy
in the Athabasca Region of Saskatchewan
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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
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Wellbeing at Utopia: the role of the Urapuntja Health
Service
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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
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Historical analysis of CPHC at Victorian Aboriginal
Health Service, Fitzroy, Melbourne
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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
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Case study of the Male Health Program, at CAAC
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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
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Effectiveness of different strategies used for the
establishment of Comprehensive Primary Health Care
Programs in urban squatter settlements of Karachi,
Pakistan
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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
Community Health Program of AKU-CHS
21
Asia
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Contribution of Community Health Workers to
Implementation of CPHC in Rural Settings, Iran
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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.
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Policy and training program analyses, key informant interviews (18
provinces, 90 interviews)
Data gathering near complete, analysis underway with final report for
September
Asia
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Exploring Synergies between Empowerment and Gender
and Comprehensive Primary Health Care in three tribal
districts of Arunachal Pradesh
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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.
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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
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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
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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
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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
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GK Case Study and Participatory Action Research
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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
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Final proposal just completed; historical review to begin in March;
village PAR to begin in April pending financial support from intraGK and IDRC
Latin America
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Team El Salvador: Will examine community health
experiences (multiple outcomes identified by TeasdaleCorti proposal) based on CPHC activities which have
been carried out in El Salvador over the past 20 years.
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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
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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
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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
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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.

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