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Integrating personal and population approaches to health care: A Perspective from Africa
Steve ReidPrimary Health Care Directorate
University of Cape Town
Video - WDO
Borders
North South
Urban Rural
Rich Poor
Individual Community
Adequate resources Few resources
Clinical care Population health
The “Inverse Care” Law
“The availability of good medical care tends to vary inversely with the need for it in the population served."
– Dr Julian Tudor Hart : 1971
PRACTICE POPULATION
POPULATIONAT RISK
HEALTHFOR
ALL
HEALTH FOR ALL
PATIENT - PRACTITIONER
THE PRACTICE POPULATION• The patients we know• People who present themselves for care• Those who can afford to come• Those who are not too old or to young to present themselves when they are ill• Those who do not live too far away• Those who know or believe that they need help
THE POPULATION AT RISK• People who are not yet ill but are likely to become so• Sick people who do not present themselves for care• Those who do not know or believe that they need help •Those who are scared•Those who cannot afford the transport costs to get care• Those without medical insurance• Children and the elderly• Those who live in remote rural areas
TERTIARY HOSPITAL
HEALTHFOR
ALL
POPULATIONAT RISK
HEALTH FOR ALL
HIGH SPEEDCONTINUOUS
INTERNET
HEALTHFOR
ALL
DIAL-UP
PCINTER-MITTENT
PEN AND PAPER!
Drs Sidney and Emily Kark
Community Oriented Primary Care
“A continuous process by which primary health care is provided to a defined community on the basis of its assessed health needs, by the planned integration of primary care practice and public health”.
Abramson, 1988
PRACTICEPOPULATION
HEALTHFOR
ALLCase-finding
Early detection
Follow -up
Home visits
Screening
“Outreach”
Mobile clinics
HEALTH FOR ALL
Gruen RL, Pearson SD, Brennan TA. Physician-Citizens – public roles and professional obligations. JAMA 2004; 291:94-98
Brazil – Family Health Programme Programa de Saúde da Família (PSF)
Total population 180m, rural population 40m30 000 Family Health Teams provided by municipalities• 1 family doctor• 1 nurse• 1 nurse assistant• 4 to 12 CHWs• Community orientation• Treatment and prevention and health promotion
PRACTICE POPULATION
HEALTHFOR
ALL
POPULATIONAT RISK
HEALTH FOR ALL
Types of Boundaries in healthcare
• Geographic / Socioeconomic– North - South– Urban - Rural
• Organizational / Structural– Individual - Community– Clinical practice - Population Health
• Philosophical / Process– Flexibility in application– Innovation and creativity
Types of Engagement
• HIV+ patients on ARVs – whole population• Hospital staff – wellness • Diabetics on treatment & community screening• Faith-based organization – Sunday clinics• School teachers – healthy lifestyles• Premature mothers support group• Clothes bank at hospital• Apple project – handouts in waiting room
Creativity – Roger van Oech
Explorer
Artist
Judge
Warrior
www.creativethink.com
“Umuntu ngumuntu ngabantu”
A person is a person by virtue of other people
“Intersubjectivity”
“I am defined in and through my meeting with you.
And you are defined by your reflection in my eyes.
By looking at me, you see yourself more clearly, and vice-versa.”
Eudora Welty
"My continuing passion is to part a curtain, that invisible veil of indifference that falls between us and that blinds us to each other's presence, each other's wonder, each other's human plight."
Video - WDO
