Update on publications and events related to primary health care and community health

6 September, 2022

Dear friends and colleagues with an interest in primary health care and community health:

You are receiving this email because I know of your interest in primary health care and community health. If you would like to be removed from this listserv, kindly let me know. If you know of anyone that you think would like to be included in the listserv, just sent me the person’s name and email address.

After a lapse of a few months, I am pleased to share with you some items that I hope will interest you. [*see note from HIFA moderator below]

Item 1: The International Institute for Primary Health Care virtual pre-conference event September 7 and 8.

The International Institute for Primary Health Care (IPHC-E) in collaboration with the Ethiopian Ministry of Health (MoH-E) and supported by the Johns Hopkins University Bloomberg School of Public Health is organizing the very first International Conference on Primary Health Care in the wake of the Astana Global Conference on Primary Health Care held by the World Health Organization and partners on October 2018. Preceding the main conference in 2023, IPHC-E plans on organizing a virtual pre-conference event on September 7-8, 2022. The pre-conference is an integral part of the bigger conference as it will offer a glimpse of the main conference’s offerings, jumpstart discussions, and launch a longer-term networking platform.

The workshop will last 2 hours on Wednesday September 7 and another 2 hours on Thursday September 8 from 11:00 am to 1:00 pm Universal Time (7:00-9:00 am New York time). Registration is free. Further information and registration is available here<https://conference.iphce.org/>.

Item 2: Lancet Commission Report on Financing Primary Health Care

In April of this year, The Lancet published the findings of The Lancet Global Health Commission on financing primary health care: putting people at the centre.<https://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900005-5> Led by Professor Kara Hanson of the London School of Hygiene and Tropical Medicine along with a distinguished group of global health experts, this 58-page report highlights the need to better understand the reasons for the under-investment in PHC and approaches to expanding resources for PHC, with a focus on low- and middle-income countries. The report provides an in-depth overview of the critical need to expand financing for PHC in low- and middle-income countries, and it provides a set of practical approaches for achieving this. The report that will help to move the agenda forward for providing PHC services with the funds they need to be effective. At present, low-income governments spend only $3 per capita of their own funds for PHC, while external donors spend $8 per capita and out-of-pocket payments amount to $12 per capita. PHC benefits most those with little political voice, and PHC expenditures by governments are largely invisible within government budgets. The Commission forcefully argues that we need to reform the ways in which PHC government expenditures are tracked and to set standards for levels of these expenditures on a per capita basis, with increasing local autonomy over how these funds are spent. Unfortunately, from my perspective, community-based primary health care and community health workers did not receive the emphasis that they should have.

Item 3: New journal supplement on community health systems

In January 2022, the International Journal of Health Policy and Management released a special issue entitled The multiple lenses on the community health system: implications for research and action<https://www.ijhpm.com/issue_707_708.html> that was co-edited by faculty from the School of Public Health, University of Zambia, Lusaka, Zambia, the Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; and the School of Public Health and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa. There are two collectively authored framing papers contain the following: (1) Four key lenses on the community health system (which they term programmatic, relational, collective action and critical lenses); (2) a report on a research agenda prioritization exercise carried out by the writing team, and a manifesto for strengthening research and practice in community health systems. The nine papers which follow illustrate the different lenses and describe experiences within community health systems in Zambia, Tanzania, Sweden, South Africa, India and Australia. The contributors are all embedded researchers and practitioners close to country policy processes, providing contextually attuned observations of community health system dynamics. The authors define the community health system as “a complex, overlapping set of systems, involving actors spanning various societal levels and concerned with the production of health at the interface between top-down building block of the health system and bottom-up mobilization of community responses” (Ryneveld at al, 2022). The papers touch on a diverse range of themes - community dynamics in rural health worker retention, politics of the community health policy process, collective action during the COVID crisis, mechanisms of responsiveness, and the wider health system’s influence on the community health system. Trust is repeatedly mentioned as central to effectiveness of community health systems. The strengthening of community health systems as a necessity for the achievement of Universal Health Coverage is an overarching theme of this important contribution to the literature.

Item 3: Pioneering article demonstrating remarkable declines in under-5 mortality through routine systematic visitation of all homes by community health workers

A landmark article was published in June 2022 in BMJ Global Health which builds on principles of what I call the census-based, impact-oriented (CBIO) approach which is based on the routine visitation of all homes. In this article, “Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial”<https://gh.bmj.com/content/bmjgh/7/7/e008909.full.pdf> by Ashish Satav and colleagues from the MAHAN Trust, Dharni, Amaravati, Maharashtra, India, the authors developed a cooperative partnership with local communities. They worked together with these communities to identify and decide on their heath priorities. They planned and implemented a program based on these priorities. The interventions included regular planned home visits carried out by community health workers. There was a decline of 65.8% in under-5 mortality while the U5MR actually increased by 16.6% in the control area during the same period. The study period lasted 15 years (2004-2015), making it one of the longest studies demonstrating the effectiveness of community-based primary health care in reducing under-5 mortality impact so far. This is the first report I am aware of that integrates home-based neonatal care with integrated community case management (iCCM) for the post-neonatal period into an integrated program. This is one of the first reports that I am aware of that demonstrates the mortality impact of iCCM – other reports have shown no mortality impact of iCCM. Earlier studies and the Cochrane Review of iCCM found no impact on child mortality in part due to the lack of systematic outreach to all homes leading to only 15-20% of symptomatic children being treated by a CHW. The implementation strategy reported in the article by Satav and colleagues was integrated into the government healthcare system, and ongoing monitoring demonstrated continuing decline in the under-5 mortality. There was no strengthening of facility-based care in the Intervention Arm, showing that major gains in mortality reduction can be made without this.

Item 4: Forthcoming day-long conference on community health workers in Boston November 5 on the theme “Community Health Workers at the Dawn of a New Era”

The annual workshop of the Community-based Primary Health Care Working Group of the International Health Section of the American Public Health Association will take place on Saturday, November 5, from 8:00 am to 5:00 pm at the Boston Convention and Exhibition Center. All the details for the workshop are posted <https://apha2022sessions.hubb.me/SessionDetail.aspx?id=989391> online in APHA's official conference program. All workshop attendees are required to register via Eventbrite. The formal registration closes on September 30, 2022. The cost is $35 for practitioners from developed countries, $25 for students, and $15 for CHWs and for practitioners from developing countries. You don't have to register for the APHA conference in order to be able to attend. Even though formal registration closes on September 30, registration after that date can be made by contacting Andrew Herrera <mailto:andrew@curamericas.org>. Submissions of poster presentations from community health workers and students on the workshop theme are being accepted as well.

Feel free to share this email with anyone who might have an interest.

Warm regards to all,


Henry B. Perry, MD, PhD, MPH

Senior Associate, Health Systems Program

Department of International Health

Johns Hopkins Bloomberg School of Public Health

Baltimore, MD, USA 21205

Hperry2@jhu.edu<mailto:Hperry2@jhu.edu>; 443-797-5202

HIFA profile: Henry Perry is a Senior Scientist at the Johns Hopkins Bloomberg School of Public Health, USA. Professional interests: Community health and primary health care. hperry2@jhu.edu

[*Note from NPW, moderator: Many thanks Henry. The original message had two attachments, which are not carried by HIFA. Hopefully the above URLs will suffice to access these.]