Community Based Primary Health Care

In This Section


Community Based Primary Health Care

Statement of Purpose

Approaches to improving the health of populations in developing countries continue to rely heavily on top-down, issue-specific strategies such as immunizations, child survival, reproductive health, HIV/AIDS, tuberculosis and malaria. While "top-down," issue-specific approaches are necessary in order to obtain the support of policymakers and donors, these approaches too often fail to give adequate attention to strengthening the health service delivery system at the community level, nor do they necessarily take the needs and interests of the local community into account. These "top-down," issue-specific approaches too often fail as well to give adequate attention to involving communities in making the health service delivery system more effective and to building the community's capacity to identify and address its own health problems.

Growing evidence from many countries supports the concept that community-based approaches can be highly effective in improving the health of populations, especially when these approaches are connected to other community-based activities for social and economic improvement. Local communities, even when they are composed of mostly illiterate people, have the capacity to work as partners with governments, with health and development agencies, and with non-governmental organizations in identifying local priorities and in implementing appropriate strategies. Such approaches also promote empowerment of individuals and communities, social justice, equity, community participation, and inter-sectoral approaches to health improvement – principles endorsed in the 1978 Alma Ata Declaration of Health for All.

The Working Group affirms that community-based approaches represent one of the most effective public health tools available for improving the health of poor populations. In spite of substantial progress in improving the health of poor populations in recent decades, more than 10 million children are dying each year from readily preventable or treatable conditions, 585,000 pregnant women are dying each year from readily preventable or treatable conditions, 40.3 million people are infected (as of December 2004) with HIV, and 3.1 million people died in 2004 from this preventable condition. Furthermore, very few people living in developing countries have access to health care services that incorporate current standards of care -- not only for HIV/AIDS but for other serious, common readily treatable conditions.

The Working Group considers how the health problems of local communities (as the local people themselves define them and as local epidemiological data define them) and how the underlying determinants of these health problems can be addressed by giving community members a leadership role in working with government agencies, non-governmental organizations, and technical advisors in the design, implementation, and evaluation of health improvement activities.

The "Global Strategy Framework on HIV/AIDS," prepared by UNAIDS, states: "It is at the community level that the outcome of the battle against AIDS will be decided…. Local capacity for prevention, care and support efforts need to be recognized, affirmed and strengthened." As it is with AIDS, so it is also with the other major causes of readily prevent-able or treatable causes of serious morbidity and mortality throughout the developing world.

The Working Group seeks to encourage interest in and knowledge about this approach, to promote awareness of successful examples of using this approach, and to encourage the scaling up of this approach to regional and national populations. The Working Group also seeks to encourage the recognition of the value of this approach in health policies and in the funding of health programs. Finally, the Working Group promotes networking and information sharing among its members, who share a common interest in community-based approaches to health improvement. In summary, the Working Group aims to help strengthen the role of the community in health improvement in resource-poor populations.