This is a copy of one of my term papers on a course I took on the Coursera express.
Happy viewing:
As stated by Carl Taylor, when discussing primary health care issues, "There is no universal solution, but there is a universal process to find appropriate local solutions.”
Over the years several groups and individuals have tried different approaches to solve this universal problem. Some efforts have recorded high success rates, while others were only marginally successful.
Can we then conclude that the best methods have gotten the best results?
As seen in the case studies discussed and in the lectures, it is clear that the vertical or selective approach has been favored over the horizontal or wholistic approach and seems to have gotten us some results in the last three decades. It also seems to be perfect for health systems that are on a tight budget since it focuses on specific and clear goals making it less capital intensive than the horizontal approach. Another plus is that It is quick to execute;which enhances speedy results. This is evident in the results Jim Grant got with the oral rehydration (ORS) packets and immunization programs.
The Millennium Development goals and GOBI-FFF( Growth monitoring,oral rehydration,breast feeding,immunization,food supplementation, female literacy, family planning) programs failed to effectively deliver the set objectives.
This reality has begun to challenge the effectiveness of the selective vertical approach, which was initially proposed as a short term solution.
The horizontal approach though more expensive to operate has been seen to get better results over longer periods of time as this deals with the total man and not just some of his perceived health needs. The approach aims at improving the quality of life of individuals and communities using families as an important unit of influence while incorporating other community programs and health systems.
The Alma ata declaration of 1978 proposed three main pillars which may be achieved to a greater extent using the horizontal approach : equity, intersectoral development and community participation.
The concept of community participation was well utilized by the Society for Education, Action and Research in community Health (SEARCH ) project in Gadchiroli India (as explained by Dr Abhay Bang). Members of the community met yearly to discuss their health challenges and the way forward.
The barefoot doctor concept which was first tried in the Ding Xing project in China (100 miles from Beijing ) was also used here and infant mortality rate was reduced by 70 percent.
The last mile program also utilized the bare foot doctor approach and got significant results in Conovo Liberia where healthcare was made available to the people in remote villages by training a barefoot doctor "Zarkpa" whom under appropriate supervision and training has helped to double the percentage of villagers that can have access to the treatment of common community illnesses like pneumonia and malaria.
The Jamkhed comprehensive rural health program is a good example of the horizontal approach. For example, the life of a woman that had tested positive to HIV was totally
transformed ten years after diagnosis, health wise, economically, psychologically and emotionally. Female empowerment was also one of their areas of concentration. The program went beyond just the provision of health services at grass root level to address the issue of nutrition by the provision of good food through Agricultural programs which were sustained by community participation and promoted intersectoral development.
The house hold production of health, an Alma ata concept was also utilized by the Jamkhed project.
Having looked through some of the primary health care projects carried out in different communities over the years, one would observe that the interventions with lasting impact were those that incorporated the Alma ata concepts in their program. They not only cured diseases, but stopped them from recurring. They not only gave out food to the hungry but provided a means for sustaining food production.
Today, almost four decades since the Alma ata declaration, the world is still faced with some of the same health challenges we were trying to solve then. Definitely, changes need to be made in our approach to primary health care. This has brought the question of vertical versus horizontal approach.
Both methods have their advantages and current thinking is that a diagonal approach which incorporates both the horizontal and vertical approach needs to be embraced.
This way the good potentials of both approaches will be maximized.
The global fund to fight AIDS, Tuberculosis and malaria recently came up with the need for the consideration of community participation in health systems, this is an example of a combination of both approaches.
I would love to end with the words of Dr Abhay Bang " think locally and act globally " this will help to find community based solutions to primary health challenges and get us optimal results as we begin to incorporate both the horizontal and the vertical approach in solving health problems at this point in history.
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