Community-Based PHC: So What's New??

by Janine Schooley, PCI Staff

Sometimes I get the question, "So what's new and innovative in CBPHC?" The answer is that there isn't anything new, and that's the point! We already know what we need to do. We have the bullets, as someone said, but the gun seems to be elsewhere or malfunctioning. I think it isn't that we don't have the gun. I just think we have misplaced it, or it needs some tinkering to get to work, or we need to remind ourselves how to pull the trigger. I really dislike this analogy for it's militaristic and violent connotations, but I couldn't come up with anything better..So, to continue this horrible analogy, we have several bullets and they are inexpensive, tried and true. We know the power of exclusive breastfeeding, good antenatal care, immunizations, long lasting insecticidal nets, good nutrition, and other low cost, low tech interventions in terms of saving lives and improving quality of life. We've been talking about this for decades, not just amongst ourselves, the practitioners in the field, but at the highest policy levels. As the September 13-19, 2008 Lancet reminds us, a major milestone, the Alma-Ata Declaration, was issued 30 years ago. So what's new isn't the need for what the Alma-Ata Declaration so eloquently calls for, but perhaps it's the realization that we still haven't gotten there. In other words, we don't need innovation. What we need is inspiration and, as Nike so aptly puts it "Just do it!".

It is easy to get a tad depressed when thinking about these past 30 years. Millions upon millions of dollars are being invested in the vertical diseases of HIV, malaria and TB. This is as it should be. These diseases deserve the world's attention. However, our investment in fighting these scourges should not be at the expense of what the bigger killers are and I'm talking about diarrhea, pneumonia, malnutrition, poverty.It can be very frustrating to know what we need to do, to know it is relatively inexpensive, and yet to know that we aren't doing it. Why?? Is it because it isn't "sexy"? Is it because it doesn't have a built-in corporate interest (and in fact, in some instances, bumps up against corporate interest as in the case of exclusive breastfeeding)? Is it because it is so process-oriented and diffuse that policy makers can't wrap their heads easily around it? Is it because we are too busy trying to do the work that we haven't figured out yet how to advocate for it, how to sell it? Is it because its primary constituents, women and children, are so disenfranchised that their voices can't be heard? Is it because the keys to its success are just so simple and basic that it's hard to get excited about them? These are the questions that can make you quite discouraged, especially since it seems that, with the world food crisis, the HIV/AIDS pandemic, the world economic crisis, global warming and other global trends, we are losing precious ground rather than gaining momentum.

But there are reasons to be optimistic and one of them happened this past Saturday at the APHA pre-conference workshop on CBPHC. The workshop featured work in advocacy, social mobilization and behavior change being carried out by Project Concern International and others as a way of injecting new life and on-the-ground examples into the discussion on CBPHC and the evidence for its importance. The group of 25-30 participants seemed far from discouraged. They were interested and energized and many of them were willing to volunteer time and energy to move the CBPHC agenda forward, in some cases adapting the very same approaches we discussed as working in our programs in the field to our own work as advocates and agents of change. However, in this case, the change we are bringing out is in the visibility and implementation of CBPHC approaches to scale.

As one of the facilitators of the workshop, it was gratifying to feel the energy in the room, as walked together to lunch, over lunch, as we walked back, and throughout the day. The group buzzed with ideas, passion and commitment. I know I can easily become discouraged about the fact that we have such good models and ideas and yet the funding seems to be elsewhere and so many opportunities missed. But on Saturday I was far from discouraged. I've been even more excited by the fact that the momentum continues as evidenced by blogging, the ongoing buzz and commitment that we are hearing and feeling. Unlike so many workshops, there actually has been residual impact. In fact, I'm so encouraged that I even more strongly feel that the quotation on the front of the recent Lancet, "Health for all need not be a dream buried in the past" is quite true and that this "timely reawakening of interest" in PHC will be the beginning of a new era, an era where we invest our not insubstantial global resources in the right way, on programmatic models and approaches that are cost-effective and that will save and improve the lives of the world's most vulnerable people. If the workshop this past Saturday is any indication, we do have something to be optimistic about.