PHA-Exchange> PHM applying for a 4-year grant in Canada

Fri Aug 11 06:25:42 PDT 2006

Revitalizing Health For All:  

Learning From Comprehensive Primary Health Care Experiences

Background

The visionary goal of 'Health for All,' and the contributions that health systems based upon comprehensive primary health care, remains as vital today as it did when it was first expressed in the Alma-Ata Declaration on Primary Health Care in 1978. Indeed, policy and program interests in models of comprehensive primary health care are rising on many national and global institutional agendas, for two main reasons:

  1.. Despite impressive developments in bio-medicine over the last few decades, there has been mixed progress in improving health. 
  2.. Studies from many parts of the world find that inequalities in both wealth and health have increased over the past decade, and in many countries and age-groups health status has stagnated or even worsened.  Emphasis on selective, vertical and disease centered approaches, driven by narrow applications of cost-effectiveness analysis, has led to an unsustainable patchwork of health interventions that is increasingly recognized as an impediment to making progress on the Millennium Development Goals in many parts of the world. 
There has also been a long and impressive experience with alternative approaches to health systems planning and delivery based on the concept of Comprehensive Primary Health Care (CPHC). This approach seeks to improve equity in health outcomes across population groups through access to quality health care, intersectoral action, provision of services/resources addressing the underlying health determinants and effective citizen participation. The emphasis on participation is intended, in part, to overcome historic gender, class and caste, as well as ethnic-based forms of social exclusion in the planning and implementation of services and policies affecting health care. The ethos of CPHC is one of community empowerment: strengthening the capacities of people to participate in decision-making about health services and health determinants, and to engage with the public and private sectors to have their basic human rights respected, including the right to health.  

There have been numerous programs attempting to put CPHC into practice at local, regional and national levels. Too often, however, the evaluation and lessons from these CPHC experiences have been converted into 'selected interventions' that need to be 'scaled-up,' with too little attention given to the importance of the local context within which CPHC efforts have taken place. PHM is participating in a project to fill this 'contextual' gap in knowledge, by bringing together practitioners, researchers and research users to document more fully CPHC the lessons from the past, and to research in rigorous ways CPHC activities being  implemented at present. 

The 'Teasdale-Corti' Project 

To meet this challenge, an international group of community health practitioners, researchers and activists, under the broad umbrella of the People's Health Movement and the International People's Health University (IPHU), is setting up and strengthening a global network to increase the understanding of, and support for, CPHC as a basis for health systems renewal among researchers, practitioners, policy-makers and civil society organizations (CSOs).

Our group has been short-listed for a four-year 'Teasdale-Corti' grant (funded by a number of Canadian health research agencies) that will help us to initiate new research and network-building, as well as sustaining activities in five regions: Africa, India, Latin America and amongst Indigenous people's groups in both Canada and Australia. Our project objectives (and some of our planned activities) are:

1.      To develop a common framework for describing and evaluating the impact  CPHC has had (Year 1).

2.      To undertake a rigorous retrospective assessment of publicly available materials describing the features and experience of CPHC programs in partner countries/regions (Year 1).

3.      To train a cohort of junior/mid-level researcher activists (university or CSO-based) in partnership with research users (practitioners, policy-makers) in the participating countries/regions (Years 2, 3 and 4). 

[These training partners will be familiar with CPHC and oriented to producing knowledge that will inform policy, management and practice in CPHC. There will be three different regionally-based training events: one on CPHC and research methodologies appropriate to the evaluation studies proposed (Year 2); one on research analysis and documentation (Year 3); and one on 'research to action' knowledge translation (Year 4). Core faculty for these learning events will be drawn from the International People's Health University faculty writing this proposal, as well as from committed individuals in training institutions with a history of engaged research and activism in CPHC in each of the five regions].  

4.      To initiate and support a program of participative action research on critical issues related to Comprehensive Primary Health Care development and its sustainability.

[Each partner group will have access to funding to develop its own research proposals or to begin new research on important CPHC questions particular to their local or regional context. The development of these questions will be guided by the broadly stated research questions of our proposal as a whole (see below). The training events in Years 2 and 3 are designed to offer feedback on the new research and to strengthen the capacity of the research partners to analyze and implement new actions based on their findings].  

5.      To establish links between researchers and research users and to pioneer strategies for ensuring that ongoing research is relevant, responsive and accessible to various research users.

[This will be accomplished by convening regional meetings that involve the partner groups and other key researchers, practitioners, policy-makers and civil society organizations. These meetings will take place in Years 2 and 3, alongside the training events].

6.      To develop a sustainable infrastructure (based on the International People's Health University) within PHM for ongoing capacity building in CPHC including a research capacity.

[The purpose of the training programs and regional meetings is to build a stronger network to sustain activities beyond the limited period of the Teasdale-Corti grant].

7.      To strengthen the People's Health Movement members' capacities and skills in participatory action research and to establish links with other networks of researchers and research users.

[A final international colloquium is planned for the end of Year 4 to bring together all facts that have been learned to that point in time].

8.      To evaluate the impact of the entire program on CPHC in partner countries.

Throughout the  project, the core group will work to build sustainable structures and funding mechanisms. The goal of our work is to build a strong, evidence-based movement in the area of CPHC; the Teasdale-Corti project is simply our launching pad to do so.

For more information on the project, or if you have specific comments, you can contact Rakhal Gaitonde (subharakhal at gmail.com) or Maija Kagis (maija.kagis at sympatico.ca).

In health and solidarity,

David Sanders  (South Africa)             

Ronald Labonté (Canada)

[affiliations below]

sandersdav at yahoo.com.au                        rlabonte at uottawa.ca           

Research Questions Guiding the Overall Project 

1.      What is the evidence of the effectiveness of comprehensive primary health care as relates to:  

a.      increased equity in access to health care and other services/resources essential to a better health

b.      reduced vulnerabilities through changes in community empowerment (and enhanced capacities) 

c.      reduced exposures to risk through changes made in the social and environmental determinants of health

d.      improved participation opportunities and political clout of marginalized population groups served by comprehensive primary health care initiatives

e.      more equitable health outcomes in the overall population.

2.      Through what strategies or mechanisms have these outcomes been achieved in different contexts?

3.      How can the evidence base of the effectiveness of CPHC be strengthened? 

4.      How do the development level and the political and policy context of countries with CPHC (or in-country inequities in wealth and/or regional differences) affect CPHC's impact? 

5.      What combinations of resources, policy and state - civil society - academic arrangements facilitate and sustain appropriate and effective comprehensive primary health care?

6.      What strategies or forms of mobilisation have achieved the above and the organisational arrangements of CPHC? 

7.      What are the enabling and constraining international conditions for establishing sustainable comprehensive primary health care? 

8.      How have the macro-economic and health sector reform (HSR) policies of the industrialized countries and international financial institutions influenced CPHC?  

9.      What basic research and implementation skills and values are required for the advocacy component of CPHC in differing countries to succeed?

10. What lessons have been learned regarding research, capacity development and going from research to action in the case of CPHC schemes?

11. How will this project advance the conceptualisation of and skills to implement CPHC among project participants?  

The Teasdale-Corti proposal team

      Team Member 
     Institutional Affiliation

      Ronald Labonte

      Canada
     Professor and Canada Research Chair, Globalization and Health Equity Unit, Institute of Population Health, University of Ottawa, Peoples Health Movement

      David Sanders

      South Africa
     Professor and Director of School of Public Health, University of the Western Cape, Peoples Health Movement

      Francoise Barten

      Netherlands (& Central America)

      francoiseb at gmail.com
     Senior Lecturer, Institute for International Health, UMCN R. University of Nijmegen. Honorary Lecturer of CIES, UNAN Managua, and of FM-UNAN Leon, (Nicaragua) and of FM-Universidad Mayor de San Simon, Cochabamba (Bolivia), International Peoples Health University 

      Maija Kagis

      Canada

      maija.kagis at sympatico.ca
     Canadian Alliance of Community Health Centre Associations (CACHCA) and Peoples Health Movement

      David Legge

      Australia

      d.legge at latrobe.edu.au
     La Trobe University, Director of China Health Program, International Peoples Health University

      Fran Baum 

      Australia

      fran.baum at flinders.edu.au
     Department of Public Health and South Australia Community Health Research Unit, Peoples Health Movement

      Claudio Schuftan

      Vietnam

      Claudio at hcmc.netnam.vn
     Peoples Health Movement

      Rakhal Gaitonde

      India

      subharakhal at gmail.com
     Peoples Health Movement

      Eduardo Espinoza  

      El Salvador

      porsiviajo at yahoo.com
     Observatorio de Políticas Públicas y Salud, Universidad de El Salvador 

Our final proposal will be submitted in late September, and we expect to hear whether we will be funded by the end of December.  If we are successful, our project will start in early 2007.
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