Benard Ndwiga ( MPH, PMP)’s Post

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Public Health Expert & Health Supply Chain Specialist.

Historical perspective of Primary Health Care. The history of community Health can be traced back to late 1800’s in Russia, Feldshers who were trained as paramedics based majorly in rural areas where physicians were not present. However, unlike the Barefoot Doctors in China in 1920’s, Feldshers were literate and had a three-year formal training and authorized by the state to provide primary health care (PHC) services in the rural villages. The first documented large pool of CHW program was in 1920’s Ding Xian, China. Illiterate farmers  were taken through a three-month training course to record births and deaths, vaccinate against smallpox and other diseases, give first aid and health education talks, and help communities keep their wells clean. A growing crisis on skilled health care workers to serve the needs of rural and poor populations in the developing countries became apparent in 1960’s. This necessitated the need to explore an alternative and the concept of the Barefoot Doctors gained traction around the world serving as a guiding concept for early CHW programs in many countries including India, Tanzania, Indonesia, Venezuela, and Honduras. In 1975 WHO published a book Health by the People which was largely influenced by the Christian Medical Commission(CMC). The book was very instrumental in providing the intellectual premise for the International Conference on Primary Health Care at Alma-Ata, in 1978, which resulted in the famous Alma-Ata Declaration calling for achievement of “Health for All” by the year 2000 through PHC. This global recognition of the importance of community workers in the delivery of primary health care, marks the birth of the new approach to health care services delivery which has gradually been incorporated to the health care system in different countries to a varying degree.--------------- The aforementioned is meant to give a background and context as an invitation to some key pertinent questions. 1. With the increased focus in community health as key enabler to deliver UHC, is it time we equally focus on transitioning to a professionally driven community health service. 2. In addition to the link health facilities, should we consider expanding linkage by mapping duly licensed community pharmacies /chemists? 3. Is it time to review the community health assistant training program and scheme of service. 4. What lessons can be drawn from CUBAN health model, "family doctor and nurse". To reap the benefits of community health, policy makers need to think beyond implementation of 1920’s concept and instead develop a roadmap to transition community health services to professionals. 

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