Revitalisation of Primary Health Care

Revitalizing Health for All

A Call for Expressions of Interest (English and Spanish) to Participate in New Research and Research Training in Comprehensive Primary Health Care

Background
In 2007, an international network of researchers and people involved in building comprehensive primary health care (CPHC) received funding to support research and research capacity-building. This network, associated with the People’s Health Movement, includes individuals in India, Africa, Latin America, Europe, Canada and Australia (more detail).

The ideals of comprehensive primary health care were first launched internationally by the 1978 Alma-Ata Declaration on Primary Health Care. This Declaration was partly based on earlier primary health care successes in significantly lowering infant, childhood and maternal mortality rates and creating over all population health improvements in many parts of the developing world.
Since the Alma-Ata Declaration, however, most health systems reform in much of the world has been driven by ‘selective’ (single-disease or intervention focused) primary health care, and by increased marketization of health care services (e.g. user fees, privatization). This has led to increasingly complex, inefficient and inequitable health systems driven by an ever larger number of special ‘global health initiatives.’ Resulting problems of sustainability in selective primary health care programs, and the weakening of public health systems and their capacities to work intersectorally on the determinants of health and with communities in more authentic forms of partnership, has led to calls for the renewal of comprehensive primary health care by the World Health Organization, the Pan-American Health Organization, and health ministries and civil society groups around the world.

Our Project
With funding support from the Canadian Global Health Research Initiative and its ‘Teasdale-Corti’ Research Program, our project goals are to:
a. systematically review recent past experiences of comprehensive primary health care from different regions of the world to determine what we know about how it works, what it needs to work and what it has accomplished
b. train up to 20 early career primary health care researchers in undertaking new or augmenting existing CPHC research studies, in teams with ‘research users’ (health policy or program planners) and research mentors (experienced CPHC researchers)
c. provide financial support to these research teams to undertake their proposed studies
d. support the building of regional networks of researchers and research users (including civil society groups) to advance comprehensive primary health care as the basis for health system reform in their own countries
e. create a rigorously sound knowledge base on the role of comprehensive primary health care in improving health equity that can be used in the advocacy work of these regional networks
f. strengthen the People’s Health Movement in being a global voice for comprehensive primary health care

Call for Expressions of Interest
Our project is now seeking applications (‘Expressions of Interest’) from research teams committed to developing important new knowledge and action on comprehensive primary health care. These research teams will come from one of four different areas/regions in which are focusing our overall project work:
Region 1: India and South Asia
Region 2: Africa
Region 3: Latin America
Region 4: Indigenous/Aboriginal peoples in Canada and Australia

See full Call for Expressions of Interest, in English and in Spanish

Who?
Each team will be made up of:
• an early career researcher (someone who is just beginning to study primary health care)
• a ‘research user’ (someone who is working in health systems developing or implementing primary health care policies or programs, and who is in a sufficiently senior position to make or influence decisions based on new research knowledge)
• a mentor (a more senior researcher with experience in research on CPHC, health systems, health and development or other related social development area)

Research teams could come from universities, governments, non-governmental organizations or any other group that is involved in primary health care. At least one of the team members must work in an organization legally eligible to receive research grant funding.

Anyone needing assistance in creating a team (e.g. locating one or more potential team members) should contact the Research Coordinator, Dr. Corinne Packer ([email protected]).

What will participation in the project entail?
Each team will prepare a first draft of an Expression of Interest (essentially an outline of a research proposal) that will address an important question, or set of questions, about comprehensive primary health care. (See Writing your Expression of Interest). The proposals will be reviewed by members of our project coordinating group.
Up to 6 of these proposals from each of our four regions will be funded to attend a 2 week training program in 2008 on researching comprehensive primary health care. Research users will be encouraged to attend for the full 2 weeks, but where this is not possible it is essential that they attend the first week. During this 2 week training program, research teams will have an opportunity to develop their proposals in greater detail. Teams supported directly through this initiative will also be provided with some financial support to conduct their research. Teams not selected for this support may be invited to participate in the training program and subsequent regional meetings on a cost-recovery basis. Due to limited funding available through this initiative, all invited teams (whether funded by the initiative or participating on a cost-recovery basis) will be asked to indicate in their Expression of Interest what other sources of funding they already have, or may be able to access.
All teams who attended the first year training program will also be expected to attend a 3 day follow-up training programs in 2009, which will be accompanied by a 1 day regional meeting on CPHC. They will also be expected to attend a second regional meeting in 2010.
There will be four separate sets of training programs, one for each of the four regions.

Timeline:
31 March 2008: Deadline for Expressions of Interest
September – November 2008: Two week training program (see ‘Proposed Venues and Dates for Regional Training Programs’ at end of this Call for Expressions of Interest)
October 2008 – November 2010: New funded research studies
September – November 2009: First regional meeting and 3 day Training Program
September – November 2010: Second regional meeting
Sometime in 2011: A global meeting on overall project results (to be determined, based on obtaining new funding)

Writing Your Expression of Interest
The Expression of Interest should be no more than 5 pages long. It should be developed collaboratively between both team members (the researcher, and the research user). See the attached documents in Englishand in Spanishfor more detail regarding the writing of the EOIs.

Project’s Overall Research Questions
Your Expression of Interest should reflect how it will help to answer one or some of the overarching research questions that guide our project. These are:
1. What is the evidence of the effectiveness of comprehensive primary health care
2. What new knowledge do we need?
3. What approaches to research, and what research/evaluation tools and methods, are most useful in advancing understanding of, and action on, CPHC implementation?

Other General Questions Identified from the Literature Review

Policy
1. How have neoliberal economic and social policies affected CPHC?
2. How are policy-decisions made regarding comprehensive vs. selective primary health care?
3. How do government or donor contractual requirements for NGOs delivering PHC affect the comprehensiveness of their PHC services?
4. How have global health initiatives affected implementation of CPHC?
5. What has been the role of civil society in promoting equity-oriented CPHC?
6. What has been the impact of the global economy on CPHC?

Methodology
7. How can equity in health outcomes be measured and attributed to CPHC?
Impact
8. How does the quality of CPHC affect health outcomes?
9. What has been the role of community health workers in CPHC programs and related health outcomes?
10. What has been the effectiveness of CPHC in addressing gender and other forms of social inequalities?
11. What has been the role of CPHC care in mobilizing civil society and social movements relating to health?
12. How has ‘ownership’ by the community of CPHC services affected the success or sustainability of CPHC?

Population- and Region-Specific Questions Identified from the Literature Review
Research may also choose to address any of the following population- and
region-specific questions:

Aboriginal/Indigenous populations in Canada or Australia as well as in project regions with Aboriginal/Indigenous populations)
1. What constitutes ‘indigeneity’ in CPHC?
2. What is the extent of control over CPHC exercised by Aboriginal communities?
3. What are the similarities or differences between ‘holistic indigenous primary health care’ and CPHC?
4. Should, and if so, how can, CPHC better link traditional indigenous with modern Western health views?
5. How has colonialism affected CPHC development in Aboriginal communities?
6. What CPHC governance structure is most appropriate to Aboriginal health beliefs and values?
7. How does CPHC deal with/overcome racism?
8. How does CPHC build or enhance community participation in Aboriginal communities, with what impacts on health?
Latin America
9. What has been the impact of Cuban primary health care on equity in health in that country?
10. What has been the political sustainability of CPHC in Latin America?
11. How has, or how could, CPHC moved beyond a targeted intervention for the poorest to become a more universally accessed system for other groups?
12. How politically and financially sustainable over the longer term is a CPHC focus on the poorest?
13. What role has CPHC played in dealing with health determinants residing in the environment, urbanization processes, food access/security and non-medical determinants?

Africa
14. How have health programs receiving funds from Global Health Initiatives for selected technical interventions to address one or two diseases integrated (or not) actions dealing with social determinants?
15. How possible is it for a primary health care clinic to deliver CPHC?

India
All of the Indian/South Asian regional questions are the same as the ‘Other General Questions’ noted above.

The first round of research training courses to be presented through IPHU as part of the Revitalising CPHC project will be held from September to November 2008:

• Region 1: India and South Asia: Bangalore, India, 13-24 October 2008
• Region 2: Africa: Cape Town, South Africa, 3-14 November 2008
• Region 3: Latin America: Bogota, Colombia, 26 September - 7 October 2008
• Region 4: Indigenous/Aboriginal peoples in Canada and Australia: Adelaide, Australia, 20-31 October 2008

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See also: Research training curriuclum and program framework.