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Dear friends and colleagues with an interest in primary health care and community health:
As I write this, the entire field of global health is being upended by our US government, with unconscionable effects on millions of people around the world, on advancements in global health research and its ethical foundations, and on the careers of thousands and thousands of people working in the field of global health. It will take decades to build back what has been destroyed, and the respect from the rest of the world for the United States and its values has plummeted. This is a tragic day for our country.
Nonetheless, I am pleased to be able to share with you a few items of possible interest.
Jimmy Carter was the antithesis of Donald Trump in so many ways. Following his death in December, the New York Times published this lovely article on his “quiet but monumental work in global health” (attached). His recommendation to Melinda French Gates at the outset of their work at the Gates Foundation is noteworthy: “…[M]ake sure you have the community bought in and they see it as their work…. That way they will own it and they will create lasting change.”
My long-time friend and colleague Dennis Carlson, at age 94, has just published a remarkable autobiography, available here <https://www.amazon.com/SCALPEL-SPIRIT-SEEDS-PROMOTING-ETHIOPIA/dp/166294.... When I was an MPH student at Johns Hopkins in 1970, Dennis had just joined the faculty of the Department of International Health, coming from a distinguished career first as a medical missionary and surgeon in Ethiopia and later as the founding dean of what was widely known as the Gondar School, training primary health care workers. It grew and has now become the University of Gondar, with 40,000 students. After his time at Hopkins he returned to work in Ethiopia off and on for the next two decades and helped to lay the foundation for Ethiopia’s widely admired flowering of primary health care and community health that began in the early 2000s. Many of Dennis’ students became national leaders in community health and at the Ministry of Health. Not only is this an inspiring personal story, it is also a major contribution to the historical record of the development of primary health care in Ethiopia.
My long-time colleague and friend Steve Hodgins, supported by a number of us working in the field of community health, has just made an important contribution to the literature on community health workers (attached). Entitled “Comparing apples with apples: A proposed taxonomy for ‘Community Health Workers’ and other front-line health workers for international comparisons,” he draws on classifications of the International Labor Organization’s (ILO’s) occupational groupings and definitions from the World Health Organization to develop a standardized terminology for community health workers that are consistent with these groupings and definitions regardless of the actual name such a worker may have in their country of work. He defines skills levels based on ILO criteria and their degree of integration into the government primary health care system. He recommends that the ILO add language in its International Standard Classification of Occupations to the task description for CHWs that reflects the fact that they are often involved in clinical tasks, not simply health promotion. This taxonomy of skills and tasks will be helpful for countries as they plan their future requirements for human resources for health.
The World Health Organization recently released a document entitled Compassion and Primary Health Care (attached) which emphasizes compassion as a core value for global health and vital for delivering quality health care. This is a product of the WHO and its Task Force for Global Health’s Focus Area for Compassion and Ethics. One of the report’s key messages is that compassion “can be the engine that propels future-focused action to reorient health systems toward PHC.” This document is a breath of fresh air amidst the technocratic focus that so often permeates our discourse.
The Lancet Regional Health – Southeast has recently published a series of articles entitled “Primary health care in South Asia” led by my friend and colleague Krishna Rao of the Department of International Health at Johns Hopkins. In their summary paper led by Susie Perera (attached), the authors highlight the need to strengthen the integration of non-communicable diseases into the PHC system, the need to develop contextualized urban models for PHC, and the need to strengthen existing community health worker programs and expand their deployment in urban areas. One of the papers, led by Prakriti Shrestha (attached) focuses on strengthening community health worker programs in South Asia. The paper calls for strengthening CHW programs and integrating them more strongly into national PHC systems. The other three papers in the series include “The state of primary health care in south Asia,” “Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared?”, and “Improving urban health through primary health care in south Asia.” These papers as well as four commentaries on the series can be accessed here <https://www.thelancet.com/series/primary-health-care-south-asia>.
Finally, Sultan and colleagues have just published a scoping review of competency-based education and training for community health workers (attached). Most of the reports are from high-income countries, particularly the United States. Learning programs tailored to CHWs with low literacy, with content tailored to local cultural contexts, and curricula that were co-designed with CHWs were identified in the literature as effective strategies for converting learning into practice.
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Warm regards,
Henry
Henry B. Perry, MD, PhD, MPH
Senior Associate, Health Systems Program
Department of International Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD, USA 21205
Hperry2@jhu.edu ; 443-797-5202
HIFA profile: Henry Perry is a Senior Scientist at the Johns Hopkins Bloomberg School of Public Health, USA. Professional interests: Community health and primary health care. hperry2 AT jhu.edu