Community Oriented Primary Care New Directions for Health Services Delivery (1983) / Chapter Skim
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Community Oriented Primary Care: An International Perspective
Community Oriented Primary Care: An International Perspective
Pages 104-118
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From page 104... ...
Secondly, I will describe the COPC carried out in Cali that involves surgery and surgical care, fields not very frequently concerned with primary care. 1 MOVEMENTS INFLUENCING COPC Considerable confusion exists around the concept of primary care.
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From page 105... ...
In the context of this movement primary care is synonymous with the care given by the general practitioner or family medicine specialist. The family medicine movement has been one answer to the health system crisis of industrialized countries characterized by extreme, dehumanized, and depersonalized health care.
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From page 106... ...
The leadership role of this movement has come primarily from the academic community. Several American foundations, notably Rockefeller and Kellogg, have contributed significantly to the development of this movement, which was defined by Moshe Prywes as the "the First-born" of a marriage between medical education and medical care.3 To the organizers of this meeting COPC is an approach to health care delivery that undertakes responsibility for the health of a defined population practiced by combining epidemiologic study and social intervention with the clinical care of individual patients, so that the primary care practice itself becomes a community medicine program.2 A strikingly similar definition was given by Lathem when he said: "Community Medicine is that branch of medical science which is concerned with the health needs and conditions and with dealing with these by appropriate methods and interventions, of population groups of known size and composition."3 So, although having had predominantly academic origins, the community medicine movement is actively contributing to improvements in the ways health services are provided to populations of the country or region.
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From page 107... ...
provision of essential drugs.7 As defined at Alma-Ata primary care requires participation of the individual and the community and can be delivered by health workers, professionals, nonprofessionals, technicians, and even empirical personnel. AlmaAta gave priority to the health agent or community health worker as a way to reach people in dispersed rural areas or on the periphery of the big metropolitan areas, where availability of health professionals is limited.
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From page 108... ...
Much of the semantic discussion can be overcome by visualizing these two pyramids (as in Figure 11. The top of the primary care pyramid imbricates into the base of the health care pyramid, indicating that the primary care problems requiring professional attention belong to the low-complexity section, and in few cases it may even belong to the secondary level.
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From page 109... ...
By the same token, pro jects related to the health of given populations or community medicine projects need not have the term primary care included. It is understood that the larger part of their efforts would be devoted to primary care, but, certainly, all levels of complexity will be touched.
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From page 110... ...
The other educational approach tO exposing health professionals to COPC has taken the form of a worldwide Network of Community Oriented Educational Institutions for Health Sciences. Under the auspices of the World Health Organization and support from the Rockefeller Foundation, several educational institutions with innovative approaches to community oriented medical education have organized a network with the primary objectives being the interchange of experience in this area and help in the diffusion of the concept.
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From page 111... ...
The Department of Surgery of the Health Division of Universidad del Valle undertook a large systematic study of the surgical care system of the Cauca Valley, one of the geopolitical divisions of Colombia, with the purpose of seeking ways to increase the coverage of the system. An inventory of physical and surgical manpower resources was carried out.
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From page 112... ...
2. The importance of the existing worldwide network of those involved in community oriented primary care, or whatever name may be the fashion of the time or place.
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From page 113... ...
COPC, as Tack Geiger described in his paper, on "bringing the poor into the mainstream." Most COPC activities in the developing countries have been trying to find ways to stretch very scarce resources to cope with the most high-priority problems (e.g., the development of village health workers, of essential drug formularies, etc.) and have not had much hope of achieving universal or even majority access for the mass of the population.
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From page 114... ...
Many years ago, Virchow said that "Politics is medicine writ large." We have learned from the international context, and especially from the transnational context, that the converse is also true. One need only think of recent international controversies over the promotion and marketing of infant formula, or over the export and use of banned pesticides, or over the behavior of the multinational pharmaceutical industry, to see very sharp and important examples of how larger political and economic issues affect,
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From page 115... ...
Back in the days of the Office of Economic Opportunity's Neighborhood Health Center Program, I remember food production cooperatives in Mississippi, lawyers in health centers working on such issues as lead paint in New York City, and a variety of other direct social and political initiatives that were at the heart of what that program was all about. This social activism in the cause of COPC is, I submit, as important as the other three central principles.
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From page 116... ...
Family care is very clearly described and documented with its virtues by Huygens in his classic book from the Netherlands on family medicine. Domiciliary care and the value of seeing the patient in his own home has been clearly shown by Dennis Gray in his lames McKenzie lecture to the Royal College of General Practitioners in 1977.
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From page 117... ...
All patients, as I have said, have access to health care through their general practitioners, and it therefore makes it much easier to implement policies of care related to the community the practitioners serve. Alongside the training of family doctors are parallel developments for the other members of the primary health care team.
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From page 118... ...
At present, I am in a working party with the Royal College of Nurses developing postgraduate training for practice nurses. In addition, there have been some experimental courses such as the one we are running at Exeter.
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