Three Lessons We Can Learn from 40+ Years of Community Health Worker Programs (3) Family physicians, primary care clinicians and NCDs

5 July, 2018

Dear Laura

Your piece was very powerful.

We've been struck by the absence of discussion about the role of family physicians and other primary care clinicians such as pharmacists, nurses and physiotherapists.

The latest Time To Deliver report http://www.who.int/ncds/management/time-to-deliver/en/ mentions the role of nurses and CHWs, but not primary care physicians. This matters because the diagnosis of NCDs is not straightforward, particularly in countries where there are major challenges of infection too and we need neighbourhood-based expert generalists (FPs!)* to support the development of appropriate responses.

The expert group on Time to Deliver included experts in nursing and CHWs, but not FPs/GPs.

We have a particular interest in respiratory disease - and amongst NCDs it probably gets the least amount of attention, despite the prevalence of asthma and COPD particularly in LMICs. See https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30293-X/fulltext

There is a real need to improve recognition, diagnosis and treatment of chronic respiratory disease that already exists, as well as to improve public awareness of risk factors: tobacco smoke, indoor air pollution and outdoor air pollution.

That can't all be done by CHWs! In our FRESH AIR programme (European Union's Horizon 2020 research and innovation programme under grant agreement No 680997, TRIAL ID NTR5759) we have worked successfully with CHWs in Uganda but with GPs, primary care teams and other parts of the system in Vietnam, Crete and Kyrgyzstan. www.ipcrg.org/freshair

The other thing missing from Time To Deliver was anything in the Best Buys on chronic respiratory disease.

For example:

There's no mention of any tobacco dependence treatment (Behavioural counselling + NRT etc) for those millions already dependent on tobacco

There's nothing on managing asthma, the most common chronic disease in children - where inhaled medicine is essential.

Siân

*The best definition of family physician we have found comes from Michelle Drage:

Family physicians are neighbourhood-based expert generalists who:

- Deal compassionately with patients’ needs

- Provrovide person-centred care: relating to patients as individuals

- Usse problem solving to help patients through uncertainty

- Marginallise danger without medicalising normality

- Take a collaborative approach to manage co-morbidity + coordinate complex care

- UUnderstand + utilise environment of their practice population

- Understand + utilise interrelationships between health, social + family care

- Approach problems holistically by understanding annd respecting: patients’ values, preferences, priorities, cultures and family beliefs; how these will affect the experience and management of illness and health

(Adapted from M Drage)

HIFA profile: Sian Williams is Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. sian.health AT gmail.com