In an era when poor lifestyle choices are resulting in swiftly increasing rates of chronic disease, disability, and behavioral health concerns the world over, the age-old adage, “An ounce of prevention is worth a pound of cure” is more relevant that ever before. In developed and developing countries alike, more and more deaths are attributed to largely preventable causes, including cardiovascular disease, diabetes, asthma, cancers, and accidental injuries or poisoning.
Emphasizing health promotion and disease prevention, as well as treating illnesses that have already become serious problems, are key elements of the primary care model, as is the development of effective community outreach services. This community-based web of support integrates healthcare into the overall framework of social services and increases opportunities to reach the broadest segment of the population. Within this network, primary care practitioners fulfill the critical function of ensuring patients receive the proper combination of health services and
educational information to meet their individual needs.
According to the World Health Organization (WHO), the ultimate goal of primary healthcare is better health for all. WHO identified five key elements of reform and integration that are necessary to achieve that goal:
- reducing exclusion and social disparities in health (universal coverage reforms);
- organizing health services around people’s needs and expectations (service delivery reforms);
- integrating health into all sectors (public policy reforms);
- pursuing collaborative models of policy dialogue (leadership reforms); and
- increasing stakeholder participation.
In a narrow sense, the concept of primary healthcare implies only medical care, but in the broader, more holistic sense, it also encompasses comprehensive health education, disease prevention, and sanitation − all while serving as an individual’s entry point into the healthcare system. As defined by WHO, primary healthcare is a process rooted in equity, intersectoral action, and community participation that yields health gains in an efficient, effective, and sustainable manner.
AIHA’s Primary Healthcare Program
AIHA’s Primary Healthcare Program helps mobilize a broad range of community stakeholders ranging from politicians, civic leaders, and clergy to educators, healthcare providers, and representatives of differing ages and socio-economic groups to gain important insight into their health-related needs as a first step to developing fit-for-purpose interventions, including practitioner training and mentoring.
After decades of neglect under a healthcare system that placed most of its emphasis and limited resources on specialization and hospital-based acute care medicine, the value of primary care gained recognition in the mid-to-late 1990s in countries across Eastern Europe and Central Asia. At that time, ministries of health in these countries began looking to strengthen primary care through health reform initiatives. Investments by international donors and lending agencies helped to rebuild and equip primary care facilities. Schools of the health professions started developing curricula to train a new generation of family physicians and nurses while seeking solutions to the daunting task of retraining tens of thousands of specialists to meet primary care needs.
With support from the United States Agency for International Development (USAID), AIHA launched 31 partnerships that were at the vanguard of critical efforts to refashion healthcare delivery systems in Eurasia starting in 1998. Most of these partnerships established model clinics, while the remainder worked to improve services and establish new community-based outreach programs. Regardless of their focus, each ensured the provision of integrated, accessible medical services ranging from preventive measures such as vaccinations, health literacy promotion, and early screening for illnesses to curative and rehabilitative treatment of acute and chronic diseases.
Prior to developing and equipping the new clinics, AIHA worked with our partners to conduct community health assessments to determine the healthcare priorities of the local population. Through these community health assessments and the creation of community advisory boards, AIHA ensured that the local ownership and commitment was effectively established and long-term sustainability was enhanced. This process has proven successful with many of the centers established between 1998-2006 still operational today.
Consistent with the community needs assessment, each partnership’s model clinic offered a broad, integrated range of health services — including programs focusing on mental and behavioral health — delivered in a manner designed to ensure a high level of patient satisfaction. In addition to serving as models for replication, the partnership clinics also served as training sites for primary care physician and nursing residents, thus providing a new generation of health professionals with much-needed practical experience.
To enable primary care professionals to carry out their role as effective caregivers, all AIHA primary healthcare partnerships established training programs and assisted in the development and implementation of evidence-based clinical practice guidelines.
Whether the goal is to address health concerns specific to an individual population, improve public awareness of health issues through education and outreach, or broaden the scope and accessibility of preventive screening and other clinical services, the success of these community-based alliances clearly illustrates that people are eager to play a more active role in improving both their individual health as well as that of their community. A financial benefit of this approach is that it supports a key health reform goal of many countries by helping them transition from a system heavily dependent on tertiary care to one that emphasizes primary care, prevention, and personal responsibility.
As reported in an external evaluation of AIHA’s primary healthcare partnerships, a key outcome was markedly improved access to care for an estimated 1.2-1.5 million people, which was achieved primarily through the:
- establishment of 28 model primary healthcare clinics and an estimated 270 replication sites;
- expansion of primary care into new areas of personal and public health; and
- integration of primary care into the socioeconomic fabric by adjusting local care packages to community-level social, environmental, and occupational risks.
In November 2020, AIHA launched a new primary health care project entitled Twinning Partnership Program to Strengthen Primary Health Care (PHC) in Ethiopia, supported by the Bill & Melinda Gates Foundation (BMGF). The goal of this project is to strengthen the International Institute for Primary Health Care – Ethiopia (IPHC-E) to serve as both a national and regional resource for the delivery of quality primary health care service for essential, curative, and preventive services in Ethiopia.
The project, which AIHA is co-implementing with Johns Hopkins University (JHU), strengthens the IPHC-E to deliver essential primary health care services in Ethiopia. Using a phase-based approach, and AIHA’s hallmark twinning methodology, this project has developed and is implementing a plan to transform the existing PHC system on a national and regional level. The goal is a comprehensive PHC delivery system can be achieved in five years—allowing the IPHC-E to become a fully functional independent entity. AIHA and its partners are providing technical assistance to fill the gap in designing standardized training curricula as well as TOTs on selected topics such as Maternal Child Health, Behavior Change Communication/Health Education and Communication, etc.
Working in collaboration with JHU, this project will strengthen the training programs for health care providers to improve Ethiopia’s PHC system. It will also contribute to the effective implementation of continuous capacity building programs for health sector leaders at different levels to help them become the change agents in PHC systems. AIHA and its partners are supporting the provision of technical assistance and training for the IPHC-E staff in pedagogy, research capacity, evidence-based practices for primary health care, etc. This will allow the institution to have its own pool of trainers that will be able to take on training moving forward.
It is envisioned that this project will transform the IPHC-E Institute into an independently registered Center of Excellence in PHC Training, Advocacy, and Evidence Generation and ultimately serve as the first WHO Collaborative Center on the African continent.