Having worked in domestically in tertiary care at a well-funded institution (basically the opposite of CBPHC) for almost a year now, I searched for common ground with the international community-based primary care group, relying on my relatively brief but highly educative experiences in international public health. I of course am still interested in community health and primary care, but as others noted in an earlier blog entry from this conference, the funding for positions in that field is minimal.
At the workshop on Saturday, I realized just how many dedicated people there are focused on this area, and that our strength is in combining efforts to accomplish our goals. I often witnessed how a group’s synergy can greatly improve its effectiveness and creativity. At the workshop, we split into 3 groups, each one discussing the major actions needed to further the field of CBPHC, including, documentation and dissemination, raising awareness, and finding funding. My group was charged with discussing how to create or find more resources to implement programs in CBPHC.
Though each group had a different focus, each came to the same conclusion: there has to be more funding opportunities, and this would come with greater proof and awareness. To continue the metaphor of the bullets but no gun, it becomes apparent that funding is the gun. To find a less violent image, we have the medicine, we just need the properly-sized syringe to inject it into the proper arteries. At present, we have more “medicine”, or interventions that work, than we have syringes to distribute it. Major funders want to focus on more “sexy” solutions, one example being finding a vaccine for malaria. It’s very likely that vaccines for malaria, once discovered, would run into the same problems as other such interventions: the cold chain (the system in place to insure that vaccines are maintained at optimal temperatures, from producer to patient) breaks down, or drug companies won’t produce enough to combat the problem, because the problem only exists in low income areas and developing countries that can’t pay premium prices for the vaccine. Or people won’t want the vaccine because they don’t trust it, as has happened with other vaccines. This is just one example, and I am in no way advocating that discovering a vaccine for malaria is a bad thing, and I support any efforts in this area. After all, some medicine is better than none! However, there are medicines already in existence for malaria, not to mention bed nets, that work. The problem is in identifying the resources to provide it to the masses.
Truly community-based programs have the most chance at reaching the most people, for less money, for longer periods of time. They are cost-effective; to use an old adage, an ounce of prevention is worth a pound of cure. They are sustainable, because when the community is driving it, there is greater motivation to succeed and there is less risk that external funders will pull out to focus on something else. But we all already know that.
Then today, while traveling home, I noticed a posting for a lecture titled “Health Care as a means to Peace”, to be given tonight (10/30) by US senator Bill Frist, held at – believe it or not – my tertiary, domestic care institution. How nicely this seems to tie in with the topic of discussion at the World Federation of Public Health Associations / IH section breakfast yesterday morning, which was how the war in Georgia had impacted public health, and finally making the connection between health care and overall well-being doesn’t seem too far removed.
So, I encourage anyone willing to start by making connections and using the connections you have, to pass along the current evidence and petition our senators and congressmen, so they are aware that now is not the time to reduce our efforts in international aid and that community based primary care is where we can get the most bang for our weakening buck!
Here’s a link to that lecture:
Health care as a means of peace http://calendar.vanderbilt.edu/calendar/2008/10/30/dr-bill-frist-school-of-nursing-centennial-speaker.62291
6:00 pm – 7:30 pm, Central
To access the podcast after the event: www.vanderbilt.edu/news