Update on publications and events related to primary health care and community health (2)

3 November, 2022

Dear Henry (Perry), thank you so much for your recent update


One of your recommendations was a video by Jon Rohde: History of Community Primary Health Care, available here: http://www.bit.ly/JRohde-Lectures

I have just viewed this and found it fascinating.

Jon Rohde has a long and illustriuos experience as a Harvard trained public health specialist and pediatrician, international public health consultant, with special interest in community-based health care. He relates how he arrived in East Pakistan (later Bangladesh) and quickly realised that "people's health had a lot more to do with people's behaviour, environment, poverty, and *their knowledge* [my emphasis] than the care of medical professionals'

Working with Rockefeller, USAID, UNICEF acros the world, Jon describes the timelines in community health from China's 'barefoot doctors' (catalysed by the work of John Grant in the 1920s, which was the seed for the global expansion of CHWs over the coming decades) through to the blossoming of community-based health services in the USA in the 21st century.

He tals about child diarrhoea: As I witnessed for myself in Peru in the 1980s, there is a tragic misconceptioon that "If it's coming out the bottom, stop putting it in the top". This is causing countless parents to stop giving fluids to their sick child, with tragic mortal consequences. Through the 1980s, women CHWs in Bangladesh taught every mother in each household how to make and give home-made oral rehydration therapy out of water, sugar and salt. People began to see that ORT worked. In the 1980s, 13 million mothers were trained 1:1 in their homes how to make fluid. Diarrhoea mortality fell by two-thirds.

We hear also about the Alma Ata Declaration, 1979, which aimed to provide essential health services for all by 2020. Jon had a conversation at the time with the new UNICEF director, Jim Grant (son of John Grant). They recognised that it is simply possible to take on the full range of services for everyone, which led to UNICEF's focus on GOBI: nutrition, breastfeeding, oral rehydration, and immunisation. Critics called this 'selective PHC', but James Grant was a master in securing political commitment, with the 1990 UN World Summit for Children leading to the 2000 Millennium Development Goals Declaration, and the launch of the SDGs in 2015.

The falls in child mortality over the past few decades have been outstanding. But there is still a long way to go.

'In India, for example, a national survey [2015/2016] found that more than half of children with acute diarrhoea receive less to drink than normal (and one in 20 receive no fluids at all), thereby tragically increasing their risk of death. The survey also showed that 1 in 5 children with diarrhoea seen by a health worker are inappropriately given antibiotics. Such basic errors in care contribute to hundreds of child deaths from diarrhoea every day in India alone. https://www.hifa.org/about-hifa/why-hifa-needed

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Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization. Twitter: @hifa_org neil@hifa.org