Community Action for Health

Community Action for Health: the Role of Comprehensive Primary Health Care The purpose of this project is to identify and document contemporary episodes of community action for health (including large scale social movement activism as well as local community action) and to reflect upon the circumstances and transactions of these episodes and to reflect upon the implications for PHC practice and for health activist education. Goals

• to promote wider appreciation that support for popular mobilisation around the right to health care and action on the social determinants of health are core principles of PHC;
• to document contemporary episodes of community action for health and reflect upon the principles which might guide PHC agencies and practitioners in supporting it.

Background The active involvement of communities in the struggle for health (access to health care and action on the determinants of health) was an important part of the vision of Alma-Ata but has been ignored in the various versions of selective PHC (in particular, UNICEF’s GOBI FFF and the World Bank’s packages of cost effective interventions) which have overshadowed PHC since 1978. PHM sees action through civil society as a critical influence on health care quality and access and on the social determinants of health. The People’s Charter for Health calls for popular mobilisation to “demand transformation of the World Trade Organisation and the global trading system so that it ceases to violate social, environmental, economic and health rights of people and begins to discriminate positively in favour of countries of the South.” The need for such a transformation is illustrated by the current financial crisis which underlines the weaknesses of the current regime of global governance. The 1975 collection of case studies of PHC in action edited by Ken Newell (Health by the people. WHO: Geneva) was very influential in setting the scene for the Alma-Ata Conference. However, since then there has been relatively little by way of systematic research into this aspect of PHC practice. Indeed, under the influence of the selective PHC approach and the cost effective benefit packages the whole idea of popular mobilisation around the right to health and action on social determinants has receded, in the official policy literature, into a fleeting memory of a past era. The Final Report of the WHO Commission on the SDH (Closing the gap in a generation: health equity through action on the social determinants of health. 2008, WHO: Geneva) has returned social determinants and intersectoral action to centre stage but it is less explicit about the role of popular mobilisation as a core element of PHC; it is a disruptive idea. However, regardless of the discourses of the official high level policy analysts, when communities are facing desperate burdens they have no alternative except to struggle and if local PHC agencies and practitioners are at all responsive to those needs they will support communities in such struggle. The IPHU has been established within the PHM as a focus for activist education and research into activist practice. This project is directed to promoting wider understanding of popular mobilisation and how to support it. Objectives This project will:

• identify a range of contemporary episodes of community (and civil society) action on health (including both access and quality of health care and action on the social determinants of health) looking in particular for episodes which have been supported, at least in part, through agencies and practitioners based in primary health care settings;
• document these episodes in a systematic way: including the context, the issues at stake, how the engagement unfolded, how PHC agencies and practitioners were involved and the outcomes;
• analyse and reflect upon the collection of case studies with a view to describing and analysing the problems communities are facing; describing the dynamics of struggle; describing the role of PHC agencies and practitioners; drawing lessons for practice from the case studies;
• bring together the experience of PHC activists in different parts of the world;
• promote the ongoing collection of such case studies across the PHM including the systematic documentation, analysis, reflection and learning.

Watch this space!