Equity and Empowerment_S. Shannon_10.17.13
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This document discusses equity and empowerment through community ownership of health. It celebrates the 40th anniversary of "Where There Is No Doctor" and the 35th anniversary of the Alma-Ata Declaration of Primary Health Care. The WHO has identified five key elements to achieving health for all: universal coverage, service delivery based on needs, public policy integrating health across sectors, collaborative leadership, and stakeholder participation. The document outlines principles and practices of primary health care since 1978 and notes that true primary health care is more than just the absence of a health system. It discusses challenges in both rural and urban communities and roles for community health workers in areas like non-communicable diseases and early childhood development. New technologies also present opportunities
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Equity and Empowerment_S. Shannon_10.17.13
- 1. EQUITY AND EMPOWERMENT WHEN COMMUNITIES OWN THEIR FUTURE Sarah Shannon, Executive Director, Hesperian Health Guides Laura Altobelli, Peru Countr y Director and Senior Health Advisor, Future Generations Ram Shrestha, Senior Quality Improvement Advisor for Community Health and Nutrition, University Research Co, LLC (URC) Hanna Sarah Faich Dini, Policy Advisor, Community Health Systems, One Million Community Health Workers Campaign, The Ear th Institute, Columbia University
- 2. CELEBRATING… • 40 th Anniversar y of “Where There is No Doctor” • 35 th Anniversar y of Alma Ata and Primar y Health Care • 25 th Year of the Nepal Female Community Health Volunteer program
- 3. PRIMARY HEALTH CARE The declaration of Alma- Ata states that primar y health care is essential health care based on scientifically sound and socially acceptable methods, universally accessible to individuals and families with their full par ticipation at a cost that the community and the countr y can af ford in a spirit of self-reliance and self-determination. The ultimate goal of primar y health care is health for all .
- 4. STEPS TOWARDS HEALTH FOR ALL WHO has identified five key elements to achieving that goal: Universal coverage to reduce exclusion and social disparities in health; Service delivery organized around people’s needs and expectations; Public policy that integrates health into all sectors; Leadership that enhances collaborative models of policy dialogue; and Increased stakeholder participation.
- 5. Primary Health Care: an Agenda for the Future CORE Group October 17, 2013
- 6. Hesperian Books • • • • • • • • • • Where There Is No Doctor Where Women Have No Doctor A Book for Midwives Disabled Village Children A Health Handbook for Women with Disabilities Helping Children Who Are Blind Helping Children Who are Deaf Helping Health Workers Learn Where There Is No Dentist A Community Guide to Environmental Health
- 7. Principles and Practices Since 1978 • “Health for All by the Year 2000” • Principles – Accessibility, Affordability and Acceptability • Strategies – Community Mobilization, Appropriate Technology, and Multisectoral Cooperation
- 8. Health for All by 2000?
- 10. Primary Health Care is NOT “Where There Is No Health System” http://www.utilitycycling.org/wp-content/uploads/ambulance-bike.jpg
- 11. What does Community look like in an Urban Setting? • • • • • • • Schools Workplaces Hair salons/Barbershop Places of worship Intramural sports Community Centers Local fairs/events
- 15. Integrated Management of Non-communicable Diseases Unique role of community health workers: • Focus on health education and preventative care • Provide screening and referral • Support management of care • Create and facilitate peer support for lifestyle change • Community organizing to address underlying issues
- 17. New technologies bring new opportunities Feature phones Smartphones Tablets and e-readers
- 19. Sarah Shannon Executive Director Hesperian Health Guides 1919 Addison Street Berkeley, CA 94704 www.hesperian.org (510) 845-1447 sarahs@hesperian.org
- 20. At your tables: • Please discuss these 2 questions – What is your vision for the future Primary Health Care agenda? – What are key challenges for achieving Health for All and how can they be addressed? • Write your answers on post-its • Prepare to share in plenary ONE idea from your discussion in ONE minute. – Choose the idea your table is most excited about, OR has the most impact, OR most central to Core Group’s mission. • As you go to lunch, stick ALL post-its on the future timeline. Your ideas will be recorded.
Notas do Editor
- Each of the speakers today will touch on what has led up to each of these landmark celebratory events and how the related programs have contributed to addressing greater equity and empowerment for communities. As we share the learning and gains from these programs, we will be providing the context and foundation to explore the opportunities and challenges of achieving primary health care. This will lead us into a discussion of where we are now and what we envision for the future of primary health care – how can countries, partners and communities work together to further advance health for all.
- Overview of vision, principles and strategies of Primary Health Care. Now we’ve seen many advances in the past 35 years. We’re going to hear two examples provided by the next two speakers and in many ways this is what the Core group is all about so I won’t go into those achievement now…..There are also many lessons learned and lessons we want to apply to the future.
- One lesson learned that we must not forget, that is central to the theme of this plenary, and in fact this entire meeting is – illustrated here.. Despite the many marvelous advances we have seen happen in the past 35 years – and the work that all of us doo – which is truly important …. The reality is that factors outside of the technical realm and the health system in general have been primary challenges in achieving the vision of health for all during the past 35 years. As Geeta Rao Gupta so eloquently pointed out in her keynote yesterday – it is political will that is required. And key to that political will is civil society – empowered/ mobilized/ activated communities. In the few minutes I have, I want to share some modest thoughts about a future PHC agenda.
- 1. SO my first modest contribution towards AN AGENDA FOR THE FUTURE OF PRIMARY HEALTH CARE is to look AT HOW TO IMPLEMENT OUR PROGRAMS/ PHC in a way that fosters community mobilization – on the community’s terms. We will be hearing from Laura and Ram in more depth about two successful programs that will allow us to look at lessons learned about successful community ownership that we can then apply to a future agenda for PHC. Full quote: Cuantas mas tienen que morir/ tu puedes ser la proxima. This is from a protest in spain to protest removal of healthcare cards from illegal migrants. This took place in september.
- Second: We know that we must connect and integrate Community Health Workers into the larger health system. But how to do this in a way that still allows communities to feel the pride, ownership and sense of self-reliance that comes from a community-led project? How can we connect and integrate community health workers and community health projects into the larger health system while fostering community initiative? Ram’s presentation about the Nepali community health volunteers will give us some good lessons we can draw from and apply.
- 3. Our vision of PHC during the past 35 years is something usually taking place in a rural village. But with population shifts and urbanization our agenda for a future PHC must also look at how build and mobilize communities in a much more complex urban setting; rather than the relatively homogenous communities that are a self-defined geographic community. That means finding ways to work in new settings and with new and fluid definitions of community.
- Sarah, I’m putting in three different options for images – you pick which you like best.
- Option #2
- 4. Non-communicable chronic diseases are a challenge that PHC must address in the future. This is a health challenge that is increasingly being felt by the communities we serve with PHC. It is a challenge, but it is also an opportunity
- Non communicable chronic diseases are an opportunity for PHC – when you think about it – CHWs are perfectly situated to help an otherwise over-burdened health system deal with the growing wave of NCDs such as diabetes and hyptertension. Because of their understanding of local resources, the ability to build community trust and rapport, and their communications and relationships withint the community -- CHWs can play a critical and unique role to: Focus on health education and preventative care Can provide screening and referral Support those who are on treatment to manage their care Create and facilitate peer support Community organizing to address underlying issues – community gardens, exersize groups,
- 5. I’m already preaching to the choir here on this one – but it is really worth reflecting on the logic of integrating early childhood development into PHC. It IS CHWs that are engaging with the parents and caregivers during the first few years. Incorporating early childhood stimulation and psycho-social support into our Maternal Child Health work just makes sense!
- [sorry short pitch for Hesperian’s materials in various digital formats … My final point is that new technologies DO bring new opportunities. A future agenda for PHC requires us to think creatively about how to harness those opportunities…..
- But we must not lose sight that the end goal must remain – empowering community – what ever that community looks like -- so that the members of that community can demand change and can sustain change over time.