FBOs and
Alma Ata II
Renewing Primary Health Care
 Franklin Baer
 Carl Taylor
 Sarla Chand
 Frank Dimmock
 Samuel Mwenda
Renewing PHC
in the Americas
Create a vision and renewed sense
of purpose for health systems
development for a Primary Health
Care-Based Health System.
1) Review the legacy of Alma Ata
2) Articulate a strategy for PHC renewal
3) Lay out steps to achieve this vision.
Various Approaches to PHC
(and the need for complementarity)
Approach
Emphasis
Alma Ata
A strategy for organizing healthcare
“comprehensive PHC” systems & society to promote health
Selective PHC
Primary care
Health & Human
Rights approach
Specific set of health service
activities geared towards the poor
Level of care in a health services
system
A philosophy permeating the health
and social sectors
The renewed definition of PHC
Focusing on the health system as a whole

Include public, private, and non-profit sectors

Recognize PHC as more than provision of health services:

Differentiate values, principles and elements

Highlight equity and solidarity;

Incorporate sustainability and a quality orientation.

Specify measurable organizational & functional elements

Recognize dependency on other health system & social processes

Recognize need for each country to design their own strategy
Role of FBOs in renewing PHC?


No mention of FBOs, Faith, or church
1 mention of missionaries & Christian (Annex C)


The Christian Medical Commission was created by medical
missionaries working in developing countries. They emphasized
training of village health workers
1 mention of private and non-profit sectors

Renewing PHC should include public, private, and nonprofit sectors;
Faith-Based Health Care
Public
Private
Renewing PHC: Back to the Basics
“A” is for Alma Ata
The Alma Ata Conference (1978) defined PHC :
 10 Declarations of Alma-Ata

The people have the right and duty to participate individually and
collectively in the planning and implementation of their health care.
8 Essential Components of PHC
 4 A’s of PHC (Accessible, Available, Acceptable, Affordable)
 3 Aspects of PHC (Curative, Preventive & Promotion)

Community-Based &
Congregational-Based
•
•
•
•
•
•
Role of the Church in Community-based Health Care
Community Health Global Network Working Group
Evidence-Based study of Community-Based PHC
Community Health Evangelism (CHE)
Care Groups
Training for Transformation, Building our Lives
Building Integrated
Health Systems
A 3-D conceptual model of a comprehensive
health system based on PHC (1988, Smith & Bryant):

First Dimension: PHC Program elements

Second Dimension: Functional Infrastructure

Third Dimension: Level of Service delivery
Conceptual Model of a Comprehensive
Integrated Health System
FBOs & PHC Health Systems

1st: PHC Program Elements
Risk of becoming labeled as being “single issue”
Water & Sanitation
 WIMEN & CHD

Immunizations
Support Systems
Mother & Child Care (&FP)
???
 Essential
Drug Systems
Essential Drugs
 Human Resource development
Nutrition & Food
 3rd: Health System Levels &
Curative Care
 Family & Home
Health Education
 Community-Based (& Congregation-Based)
Disease Control
 2nd:



Health Facility-Based
Health Districts
National Level (FBO Health Networks)
FBOs & Renewing PHC
1) Review the legacy FBOs and Alma Ata
2) Articulate a strategy for FBO
contributions to renewing PHC
3) Lay out steps to achieve this vision
FBOs and
Alma Ata II
Renewing Primary Health Care
 Franklin Baer
 Carl Taylor
 Sarla Chand
 Frank Dimmock
 Samuel Mwenda





Medical Missions’ transition to Health Missions
Christian Medical Commission of the World Council of Churches
in Geneva
 1960’s Tubingen Conferences (Martin Scheel)
Key Leaders:
 Jack Bryant, Jim McGilvary, David Jenkins,
 Anthony Bloom, Hakan Hellberg, David Morley,
 Fred Sai, Nita Barrow, Caroll Behrhorst
Surveys of ripple effect of health impact from hospitals
Need to do more prevention and behavior change
Christian Medical Commission Journal “Contact” pioneered the
early explorations of what we now call Community Based Primary
Health Care






Rockefeller to WHO: Christian Connections
Ding Xian: John B Grant, Jimmy Yen, CC Chen
Second Generation Projects:
 Hydrick in Jogjakarta, Indonesia
 Eloesser in Chile and China
 Kark in Pholela, South Africa
Third Generation Projects:
 Narangwal
 Jamkhed
 Christian Medical Commission projects (Litsios, AJPH)
Health by the People (Newell, WHO)
Alma Ata Conference in 1978 (Halfdan Mahler, WHO)
Comprehensive vs Selective (top-down vs bottom-up)
FBOs and
Alma Ata II
Renewing Primary Health Care
 Franklin Baer
 Carl Taylor
 Sarla Chand
 Frank Dimmock
 Samuel Mwenda
Faith- Based Maternal &
Newborn Health Care Programs
1. Community-based
- India ,Jamkhed, CRHP
- Mozambique, World
Relief, Care Groups
3. National faith-based
health networks
-
2. Congregational
Health Model
- Malawi, CCAP Malaria
Prevention Program
Uganda , UPMB, UMMB
Kenya, CHAK
Tanzania, CSSC
4. District Health
Co-Management
- DR Congo, ECC-DOM,
the SANRU Program
1. Comprehensive Rural Health Project
Jamkhed, India
YEAR
Infant Mortality
Crude Birth Rate
1971
176
2004
India
2004
24
62
40 18.6
23.9
Safe delivery
Family Planning
5.0% 99%
<5.0% 99%
<1.0% 68%
64%
43%
41%
Children < 5
DPT/Polio
Malnutrition
(weight for age)
Integration, Equity and
Empowerment with leadership of
village health workers (VHWs).
Maternal Hlth
Antenatal Care
Since 1970 Jamkhed has empowered
communities to take health into their
own hands through principles of
5% 99%
40%
5%
70%
47%
Christian principles of justice and service
provide an alternative model of society to the
inequitable Indian caste system.
The government of India started the National
Rural Health Mission (NRHM) chaired by the
Prime Minister. NRHM has adopted the
village health worker model of Jamkhed for
this country wide program.
www.jamkhed.org
2. Congregational Malaria Prevention Program
26 out of 150 CCAP congregations in hard to reach areas of
Northern Malawi trained women to:
1) Deliver malaria prevention and treatment messages, and
2) To provide/sell mosquito nets and insecticide.
The Synods of Livingstonia & Nkhoma, Presbyterian Church of Central Africa, Malawi
3. National faith-based health networks
UPMB/UMMB/UCMB – Interfaith, public & PNFP
Contribution of Christian Health Networks to the
National Health Sector in Select African Countries
FBO
•
•
•
•
100
90
80
70
60
50
40
30
th
o
e
so
Le
ba
bw
m
bi
a
Za
a
aw
i
M
al
an
i
da
nz
Ta
ga
n
ny
a
n
da
Su
Ke
U
Zi
m
So
ut
h
on
go
na
RC
D
G
ha
ria
20
10
0
Li
be
Facilities
This project trained
providers, CORPS and
mobilized Religious
Leaders to promote:
MoH
Uptake of Intermittent Preventive Treatment for Malaria
Use of ITNs among pregnant women
Capacity among providers to deliver focused ANC services
Pregnant women coming early (first trimester) for ANC
% pregnant women receiving IPT1 increased 43% to 94%
% pregnant women receiving 1st IPT2 increased 63% to 76%
4. District Health systems development and Management
SANRU’s integrated and systems strengthening
approach resulted in major achievements
in maternal & newborn care:
Prenatal Care
increased to 80%
www.sanru.org
Assisted births increased
from 45% to 65%
SANRU’s health system strengthening
program strengthens PHC interventions and
encourages co-management of health zones
via FBO health networks.
Challenge for Faith Communities

Save pregnant women and babies from
preventable deaths Through
Integrated, comprehensive community
health programs

Enable capacity building of partners in
Africa, Asia and LA/C
FBOs and
Alma Ata II
Renewing Primary Health Care
 Franklin Baer
 Carl Taylor
 Sarla Chand
 Frank Dimmock
 Samuel Mwenda
FAITH-BASED
HEALTH NETWORKS
IN AFRICA
Renewing the focus on Primary Health Care
AFRICA
Christian Health Associations
active CHAs
networks
evolving networks
History and Coverage of Faith-based Health Services
Appreciating Religious Health Assets
www.arhap.uct. ac.za
Interfaith Health Program & Emory School of Public Health
University of Cape Town – Dept of religious Studies
University of Kwa Zulu Natal – Theology and Development Program
University of Witwatersrand – Department of Sociology
Research supported by the World Health Organization
LESOTHO GIS / PGIS 2006
ARHAP
Theory Matrix
Religious Health Assets
Religious Health Assets
Intangible
Tangible
Prayer
Resilience
Health-seeking Behaviour
Motivation
Responsibility
Commitment/Sense of
Duty
 Relationship: Caregiver &
“Patient”
 Advocacy/Prophetic
 Resistance - Physical and/
or Structural/Political



















Infrastructure
Hospitals - Beds, etc
Clinics
Dispensaries
Training - Para-Medical
Hospices
Funding/Development
Agencies
Holistic Support
Hospital Chaplains
Faith Healers
Traditional Healers
Care Groups
NGO/FBO - “projects”
Direct
uum
n
i
t
Con
Health Outcomes
 Individual (Sense of
Meaning)
 Belonging - Human/Divine
 Access to Power/Energy
 Trust/Distrust
 Faith - Hope - Love
 Sacred Space in a
Polluting World (AIC)
 Time
 Emplotment (Story)
 Manyano and other
fellowships
 Choir
 Education
 Sacraments/Rituals
 Rites Of Passage
(Accompanying)
 Funerals
 Network/Connections
 Leadership Skills
 Presence in the “Bundu”
(on the margins)
 Boundaries (Normative)
Indirect
AIDSLink publication of the Global Health Council
Community Realities in Africa Show FBO Partnership Key to Global Scale-Up
Amidst the ongoing, often fierce, debate about the role of faithbased organizations (FBOs) in combating HIV/AIDS, a pilot study
by the World Health Organization (WHO) and research partners
in sub-Saharan Africa put to rest any doubts about the huge role
played by faith communities in HIV care and treatment. It also
reconfirmed the urgent need for partnerships with the public
health community to achieve better health outcomes.
With the rate of HIV treatment scale-up still averaging 50,000
new people per month, it is evident that government-sponsored
or supported health services alone will not come close to
reaching the target of universal access by 2010, which is another
6 or 7 million persons living with HIV. It is also evident from an
examination of multilateral and bilateral funding programs and
health policies that there is a failure to understand the influence
of religion in African ‘health worlds.’
The study has recommended developing religious and public
health literacy through formal courses, joint training, and shared
materials to improve understanding.
Time is of the essence for identifying religious health assets that
could help to scale-up services, strengthen community support
groups and religious entities, and further link them to nearby staterun hospitals, clinics and dispensaries. Further examination of the
nature of intangible (spiritual encouragement, knowledge and moral
formation) health assets is needed to more fully document the full
extent of possibilities for religious health assets.
There is an astonishing capacity possible in religious communities
to greatly enhance health services, along with supporting people in
their care, stimulating the will to live, and building communities.
These are the added value of enrolling FBOs as full participants in
the health system: Building communities, saving lives, and
preventing the further spread of HIV.
Rev. Canon Ted Karpf
karpft@who.int
SO….
What are we doing to support Christian partners in
Africa, Asia, and elsewhere to be engaged and seize
the opportunity to reach out within communities and
through their Congregations ???
Christian Health Associations in Africa
Bi-annual (almost) Assemblies
• Siavonga, Zambia Conference 9/2001
• Nairobi, Kenya Conference
5/2003
• Mangochi, Malawi Conference 11/2004
BAGAMOYO CONFERENCE – Tanzania 2007
FBOs and
Alma Ata II
Renewing Primary Health Care
 Franklin Baer
 Carl Taylor
 Sarla Chand
 Frank Dimmock
 Samuel Mwenda
BAGAMOYO
AFRICA CHAs
CONFERENCE 2007
STATEMENT OF COMMITMENT &
RECOMMENDATIONS OF 18TH
JANUARY 2007
Presented by Samuel Mwenda, CHAK
Commitment agreed upon by the
participating CHAs & partners

The Bagamoyo conference reaffirmed the
commitment to continue the healing ministry of
Jesus Christ, serving the poorest of the poor and
marginalised but also recognising the need to care
for the carers in a biblical manner. In addition
CHA’s will continue to work in partnership with
churches, governments and other development
partners.

The Bagamoyo conference recognised that much
progress has been made since the last conference
in Malawi (2004). The TWG on HRH which was
supported by IMA had facilitated this process.
Strengthening a Support Platform
for all CHA’s in Africa.

A small rotating secretariat to improve networking and
communication between CHA’s and associated organizations
in Africa and elsewhere. CHAK agreed to host this secretariat for
the initial 2-3 year time period. (TOR were to be developed)

This secretariat would include a fulltime program officer who is
fluent in both English and French

The platform would facilitate discussion on specific issues
concerning CHA’s and would also facilitate the preparation of
the next meeting in 2009.

A virtual platform for better communication would be hosted in
such a network. IMA World Health and MMI would give
technical assistance with other agencies contributing.
…2..

The newly established office would also facilitate and
promote the communication and collaboration between
partners of the CHA’s such as the capacity project (IMA),
EPN, AIDS initiatives, the Healing Study (DIFAEM),
Medicus Mundi International, CCIH and other
collaborative partners.

WCC, IMA, MMI, DIFAEM, CCIH and other partners
working with CHA’s will facilitate the lobbying and
advocacy on behalf of CHA’s, FBO’s and Christian Health
Services among churches and the international level.

CHA’s committed to follow up on the HRH
recommendations and the TWG would continue to support
this process.
Participants at the Bagamoyo Catholic Mission Cross
which marks the entry point of Christianity into East Africa
also marked the renewing of the CHAs commitment
–
Progress made

TOR for the CHAs Platform secretariat and a
work plan were developed by CHAK

Seed funds to start provided by WCC & Difaem

A CHAs Platform Secretariat officer has been
recruited and hosted by CHAK in Nairobi,
Kenya

Work plan implementation has started.
The 1st Africa CHAs Bulletin is expected in June 2007
 One issue of WCC’s Contact Magazine to focus on

Way forward

A CHAs Platform website needs to be created with a database
of members and linkages to existing CHAs resources &
websites

Africa CHAs Platform needs to establish an active working
relationship with CCIH and it’s members

Africa CHAs Platform members, stakeholders, partners and
collaborators are invited to contribute articles, information &
news items for inclusion in the Bulletin

New partners are invited to support the CHAs Platform with
ideas, programs and resources towards making it a viable
platform for engaging Africa Christian Health networks

We should collectively begin putting our ideas together for the
next Africa CHAs Conference which should be held in either
Southern Africa or Western Africa in 2009
FBOs and
Alma Ata II
Renewing Primary Health Care
1) Review
the legacy
FBOs and
AlmaofAta
Create
a vision
and renewed
sense
purpose
for2)health
systems
development
for a Primary
Articulate
a strategy
for FBO contributions
to
Health
Care-Based
renewing
PHC Health System.
1)
legacy
of Alma FBO
Ata visions.
3) Review
Lay outthe
steps
to achieve
2) Articulate a strategy for PHC renewal
I plan to promote integrated primary health
3) Lay out steps to achievecare
this vision.
as a strategy for strengthening health
systems.
--Dr Margaret Chan, WHO Director-General
PAHO’s Next Steps:
Building an International coalition



Frame PHC renewal as a priority
Develop concept of PHC-based health systems as a
feasible and politically appealing policy option,
Capitalize on the current windows of opportunity
 the recent the anniversary of Alma Ata,
 the Millennium Development Goals (MDGs)
 current focus on strengthening health systems.