APHA San Diego: A passion for Primary Health Care

By Monica Dyer

Attending the Community-Based Primary Health Care workshop yesterday was one of the most invigorating experiences I have had in quite a long time. It was so fantastic to meet people carrying out work that I have been constantly thinking and talking about the need for. As my colleagues and I struggle to establish a comprehensive community health center in Gatineau, Haiti we are constantly trying to figure out whether or not we are actually implementing best practices. While we all value the importance of making decisions based on evidence and learning from others’ mistakes, it is incredibly challenging to find detailed information. Through this process and past research, I have been made especially aware of the need for more accessible and thorough documentation of both effective and ineffective practices and implementation experiences in global health.

This is not to be unexpected as organizations carrying out this work are usually so over-extended and resource constrained that documenting their processes and practices often becomes low-priority unless it is to meet the requirements of funders. However, when this is the purpose of such documentation the tone changes from factual reporting of successes and failures to trying to demonstrate efficacy so that a donors will keep sending money, so financial survival is not the best motivating factor for the objective documentation needed. In my own experience so far, although we have said that documenting and sharing the entire process of establishing a community health center would be a very useful activity that we would like to do, we have thus far been unable to follow through while dealing with all of the day-to-day logistics of running a clinic, seeking/maintaining funding and the planning of future programs and community organizing. If we had a volunteer historian or could work with students to take the documentation process on as a project for course credit, it might be much more feasible. However, with limited time to coordinate such efforts and so many critical activities competing for our resources, this honestly falls relatively low on our hierarchy of needs. 

I was encouraged when I recently heard about the Global Health Delivery Online www.ghdonline.org but somewhat disappointed that it thus far only includes HIV, TB and Technology discussion communities. Understandably, these are in the scope of the founding collaborators’ chief interests but I hope they will continue to expand this venue into other important realms in need of increased attention.

I was absolutely thrilled to be a part of the discussion of how
to better document and disseminate info surrounding community based primary health care. I am especially excited about encouraging the expansion of the Wikipedia entry on primary health care and even more so about becoming involved with the creation of a new open-access journal on global health practices. I have been increasingly interested in reform of the current system of publishing that puts the ownership of scientific research and knowledge, a true public good, in the hands of only a few major for-profit publishers. This transformation of individuals’ scientific knowledge into a commodity to be sold completely goes against a spirit of collaboration and the necessary sharing of information required for true advancement of science. Most individuals and institutions worldwide cannot afford the fees required to access articles. This is a barrier I have faced attempting to access information and it poses an even greater hurdle for those with even fewer resources, including those that need the information the most, public health practitioners in poor countries.

See Gavin Yamey’s recent article, Excluding the poor from accessing biomedical literature: a rights violation that impedes global health, in Health and Human Rights for a riveting discussion of the importance of the open-access movement in promoting health equity. www.hhrjournal.org.

Some resources that were mentioned in the Documentation and Dissemination discussion group yesterday:

1. Global Health Education Consortium www.globalhealthedu.org for modules that include case studies in global health
2. The Practice of International Health A Case- Based Orientation http://www.us.oup.com/us/catalog/general/subject/Medicine/PublicHealth/~~/dmlldz11c2EmY2k9OTc4MDE5NTMxMDI3Ng
3. Just and Lasting Change: When Communities Own Their Future http://www.press.jhu.edu/books/title_pages/1834.html
4. Revitalizing Health for All: Learning from Comprehensive Primary Health Care Experiences http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml
5. World Health Report 2008 Primary Health Care – Now More Than Ever http://www.who.int/whr/2008/en/index.html