Hodges' Model: Welcome to the QUAD: primary health care

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label primary health care. Show all posts
Showing posts with label primary health care. Show all posts

Sunday, November 09, 2025

c/o HIFA - Publications re. primary health care & community health

Dear [HIFA] friends and colleagues with an interest in primary health care and community health:

Since my last communication with you more than 6 months ago, the entire field of global health has continued to be 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 around the world in the field of global health. As I said before, and I repeat now the obvious, it will take decades to build back what has been destroyed and to regain respect from the rest of the world for the United States and the values that most of us hold dear.

William Foege, eminent global health leader and former Director of the Centers for Disease Control and Prevention wrote this biting editorial <https://www.statnews.com/2025/08/18/rfk-jr-public-health-threats-william-foege-smallpox/> in which he said, among other things, 

"We will live through this drought of values, principles and facts and again apply our talents to improving global health and happiness. Do not back down.”
Atul Gwande, now one of the foremost champions of primary health care and community health of our time (even though he is, like me, an erstwhile surgeon!) and former Director of the USAID Bureau of Global Health during the Biden administration, gave an eloquent presentation of his perspective on the aftermath of the destruction of USAID on 28 April 2025 at the Harvard School of Public Health.

You can watch this here:
<https://www.bing.com/videos/riverview/relatedvideo?q=Atul+Gwande+presentation+at+Harvard+School+of+Public+Health+April+28%2c+2025&mid=26DA144398CF1F613D0A26DA144398CF1F613D0A&FORM=VIRE>.

Here are a few items of possible interest:

The Fourth International Symposium on CHWs will be held virtually next week.

I was most fortunate to be able to attend the second International Conference on Primary Health Care was held in Addis Ababa, Ethiopia, from October 6-10. It was a glorious event, with 750 attendees, mostly from Africa but with strong representation from UNICEF, WHO, Africa CDC, and other international organizations. 

The conference was sponsored by the International Institute for Primary Health Care – Ethiopia. <https://iphce.org/> Directors of PHC from 45 different African countries were present along with at least 50 community health workers from across Africa. There was palpable enthusiasm for the growing momentum for PHC across Africa.

Abhay and Rani Bang are world-renowned champions of community-based primary health care through their work with SEARCH <https://www.searchforhealth.ngo/> (Society for Education, Action, and Research) in Gadchiroli, India, with tribal people. Their seminal publications on the effectiveness of community-based primary health care and community health workers as well as their contributions to India’s national program for reducing neonatal mortality through home-based neonatal care, among others, have gained for them global recognition. Attached is an English translation of an article about their life’s work that was published in April Der Spiegel in the leading German magazine, Der Spiegel.

Nicholas Kristof has continued to share with the world some of the heart wrenching effects of the collapse of the United States Agency for International Development. The New York Times opinion columnist wrote <https://www.nytimes.com/2025/09/20/opinion/trump-usaid-cuts.html> on 20 September 2025 on the human dimension of the shutdown of USAID, citing estimates that 690,000 will die in 2025 and 829,00 will die in 2026 as a result of cutbacks in USAID funding, and 3.1 million children will die during Trump’s second term from these cuts (a PDF is attached if the link doesn’t work for you [mod: HIFA does not carry attachments]).

Two recent publications on novel approaches to reducing child mortality have gained widespread attention.

One study <https://www.nber.org/system/files/working_papers/w34152/w34152.pdf> in Kenya provided a one-time transfer of $1,000 to poor families and observed a decline of nearly half in under-5 mortality as well as in infant mortality. Another study reported that wrapping

A recently reported study <https://pmc.ncbi.nlm.nih.gov/articles/PMC12462887/> from Uganda found that giving mothers fabric treated with permethrin, a long-acting insecticide to protect against mosquito-born illnesses, as a baby wrap dramatically reduced malaria infections in the infants carried in them. There were 66 percent fewer cases among those children compared with babies in the untreated wraps. By the end of the six-month study, only 16 percent of children in the treated wrap group had been sick with malaria, compared with 34 percent in the untreated wrap group, many of whom had multiple malaria episodes.

Now available for purchase on Amazon.com are several important publications related to community-based primary health care and community workers.

Feel free to share this email and these resources with anyone else or with any relevant listserve you may have access to.

You are receiving this email because of your interest in primary health care and community health.

If you know of anyone that you think would like to be included in the listserv, just send me the person’s name and email address.

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 AT jhu.edu

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

Thursday, August 01, 2024

Hodges' model? Simple: it's a rich, complicated, complex picture

In wider reading (relations, maths... and) drafting a post concerned with 'universal construction' I came across:

Rasanathan, K., Montesinos, E. V., Matheson, D., Etienne, C., & Evans, T. (2011). Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health. Journal of Epidemiology and Community Health (1979-), 65(8), 656–660. http://www.jstor.org/stable/23050931


Figure 2 stood out for rather obvious reasons:

individual
|
INTERPERSONAL : SCIENCES
humanistic ------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group







Figure 2 'works' and not merely because it is clearly 'all political', but I would have swapped 'leadership reforms' with 'service delivery forms'. Trying to emphasize leadership at the individual level empowered to actually effect change. This could quickly change as per the situation. I also appreciate the jigsaw graphic.

You soon appreciate the complex nature of health care:

Primary, Secondary, Tertiary, Quaternary care and prevention. Add social care, welfare, all the fields of medicine, surgery, nursing, education, policy, information, literacies, human rights, consent, mental capacity, mental health law, forensic psychiatry, self-care, local, national and global health, urban, rural, remote, virtual environments, ethics, developed and developing nations, ecosystems and funding.

And this just scratches the surface ...

Monday, June 03, 2024

Implementing the primary health care approach: A primer

Overview

This Primer is about the 'how' of primary health care (PHC) and brings together best practices and knowledge that countries have generated through 'natural experiments' in strengthening PHC with the best available research evidence. Despite the progress made towards PHC globally, the concept is still often misunderstood, even within the public health community. The Primer offers a contemporary understanding of PHC and more conceptual clarity for strengthening PHC-oriented health systems. It does so by consolidating both scientific evidence and an extensive sample of practical experiences across countries for the needed evidence to address practical implementation issues. 

The Primer is organized in three parts. Part I explains the PHC approach, its history, core concepts and rationale, and draws out lessons for transformation. Part II addresses operational and strategic levers that make PHC work. It covers governance, financing and human resources for health, medicines, health technology, infrastructure and digital health, and their role in implementing change. Part III concludes with a cross-cutting view of the impacts of PHC on the health system, efficiency, quality of care, equity, access, financial protection and health systems resilience, including in the face of climate change. 


Rajan D, Rouleau K, Winkelmann J, Kringos D, Jakab M, Khalid F, editors. Implementing the Primary Health Care approach: a primer. Geneva: World Health Organization; 2024 (Global report on primary health care). Licence: CC BY-NC-SA 3.0 IGO. 
https://www.who.int/publications/i/item/9789240090583

Sunday, May 28, 2023

Seventy-sixth World Health Assembly

WHO Note for Media, 26 May 2023

Read online:

https://www.who.int/news/item/26-05-2023-seventy-sixth-world-health-assembly---daily-update--26-may-2023

Text of note follows and a Comment from me below.

Gearing up for a historic UN High-Level Meeting on Universal Health Coverage

Member States expressed alarm that millions of people cannot access life-saving and health-enhancing interventions. Out-of-pocket spending on health catastrophically affects over 1 billion people, pushing hundreds of millions of people into extreme poverty. The situation has worsened due to the COVID-19 pandemic.

In response, Member States agreed a resolution supporting preparations for the United Nations High-Level Meeting (HLM) on Universal Health Coverage (UHC) in September 2023. UHC means that all people have access to the full range of quality health services they need without financial hardship.

In a transformative policy shift, Member States across high-, middle- and low-income countries expressed strong commitment to reorient their health systems based on primary health care (PHC) as a foundation for achieving health for all and reaching the furthest left behind first. About 90% of UHC interventions can be delivered using a PHC approach; from health promotion to prevention, treatment, rehabilitation and palliative care, potentially saving 60 million lives by 2030.

The Member States emphasized the importance of demonstrating the highest-level political commitment at the HLM in September with the aim of achieving resulting in a concise, action-oriented declaration for UHC.

[...]

COMMENT (NPW): I would add that quality of care is just as important as access and affordability. As we have discussed on HIFA, a 2018 Lancet paper estimated that 5-8 million deaths are caused by poor quality care every year (as we pointed out at the time, the true figure is probably much higher higher because it did not include care in the home or community before reaching a health facility). The Lancet paper did not estimate the number of deaths due to poor-quality primary versus secondary care. Quality of care is fundamentally dependent on the timely application of reliable healthcare information, and most deaths are probably (arguably, as we do not know the numbers) avoidable through the timely application of reliable healthcare information, even with minimal physical resources.

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil AT hifa.org

HIFA - my source.