Primary Health Care in the Americas: Conceptual Framework, Experiences, Challenges and Perspectives



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Primary Health Care in the Americas: Conceptual Framework, Experiences, Challenges and Perspectives

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Elaborated in August 2002

Printed in October 2002

Organization and Management of Health Systems and Services (HSO)

Division of Health Systems and Services Development (HSP)



Pan American Health Organization

World Health Organization

© Pan American Health Organization,2002
This document is not a formal publication of the Pan American Health Organization (PAHO), and all rights are reserved by the Organization. This document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, provided that full credit is given to the source and that the text is not used for commercial purposes.


Authors


Beverly J. McElmurry, EdD, FAAN

Professor, Public Health Nursing, and Associate Dean,

Director, WHO Collaborating Center for the

International Development of Primary Health Care,

University of Illinois at Chicago

College of Nursing



Beth A. Marks, PhD

Assistant Director, Rehabilitation Research and Training Center on


Aging with Developmental Disabilities

University of Illinois at Chicago



Rosina Cianelli, CNM, MPH, PhD Candidate

Pre-Doctoral Trainee

AIDS International Training and Research Program

University of Illinois at Chicago

College of Nursing

With contribution from Marli Mamede, PhD

Professor, WHO Collaborating Centre for Nursing Research Development

University of Sao Paulo

College of Nursing at Ribeirao Preto

Brazil

The authors acknowledge the contributions of the following persons in reviewing the documents: Naeema Al-Gasseer; Aaron Buseh; Gladys Canaval; Ilta Lange; Kathryn B. Lemley; Maricel Manfredi; Judith Popovitch, and Randy Spreen Parker.



Table of Contents

Authors v

Authors v

EXECUTIVE SUMMARY 1

EXECUTIVE SUMMARY 1

PRESENTATION 3

PRESENTATION 3

1. INTRODUCTION 5

1. INTRODUCTION 5

2. BACKGROUND 7

2. BACKGROUND 7

3. MODELS OF CARE 11

3. MODELS OF CARE 11

3.1 Models of Care for Health Care Practice, Education, and Research 11

3.1.1 Medical Model 11

3.1.2 Primary Health Care Model 12

4. Methodology 17

4. Methodology 17

5. Health Status in the Americas 21

5. Health Status in the Americas 21

5.1 Health Status 21



5.1.1 Communicable diseases 21

5.1.2 Non-communicable diseases 22

5.2 Health Risks 22



5.2.1 Socio-economic and environmental factors 23

5.2.2 Behavioral risk factors 24

5.2.3 Biological risk factors 25

6. COMPONENTS OF CARE 27

6. COMPONENTS OF CARE 27

6.1 Providers 27



6.1.1 Community Health Workers/Aides/Activists, Community Health Motivators/ Volunteers 28

6.1.2 Nurses, Midwives, and Nurse Practitioners 29

Table 1. Model Programs Developed by Nurses 30



6.1.3 Physicians 32

6.1.4 Partnerships: Health Professionals and Community Coalitions 32

6.2 Location of Services 33



6.2.1 Church-Based Health Programs 34

6.2.2 School-based Health Services and Health Education 35

Table 2. School-based Clinics 35



6.2.3 Work-Site Programs 37

6.3 Types of Programs 37



6.3.1 Family Models 37

6.3.2 Community Models 37

6.3.3 Health Care Programs 38

6.4 Health Concerns/Issues 39



6.4.1 Primary Health Care 39

Table 3. At-Risk Groups 39



6.4.2 Access and Equity 40

6.4.3 Priority Areas 41

7. Methodological and Measurement Issues 43

7. Methodological and Measurement Issues 43

7.1 Primary Health Care Model 43

7.2 Transforming Roles 43

7.3 Criteria Areas 44

8. Implications, Challenges, and Perspectives 47

8. Implications, Challenges, and Perspectives 47

8.1 Alternative Approaches to Care 47

8.2 Barriers to Change 48

8.3 Priorities for the New Century 48

8.4 Educational Issues 50



8.4.1. Educational Barriers 50

8.4.2 Educational Needs 50

8.5 Summary 50



8.5.1 Suggestions 51

9. REFERENCES 53

9. REFERENCES 53

Annex A: The Americas - 48 Countries and Territories 71

Annex A: The Americas - 48 Countries and Territories 71

Annex B: PAHO Strategic


and Program Orientations, 1999-2002 73

Annex B: PAHO Strategic


and Program Orientations, 1999-2002 73

Annex C: Primary Health Care in Brazil 75

Annex C: Primary Health Care in Brazil 75

The Sanitary Reform In Brazil 75



Methodology 75

Results 76

Chart 1 77

Chart 2 77

Chart 3 79

Chart 4 80

Chart 5 81

Chart 6 83

Chart 7 84

References to annex C 90




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