Visualising Primary Health Care: World Health Organization Representations of Community Health Workers, 1970–89

Abstract

For the World Health Organization (WHO), the 1978 Alma-Ata Declaration marked a move away from the disease-specific and technologically-focused programmes of the 1950s and 1960s towards a reimagined strategy to provide ‘Health for All by the Year 2000’. This new approach was centred on primary health care, a vision based on acceptable methods and appropriate technologies, devised in collaboration with communities and dependent on their full participation. Since 1948, the WHO had used mass communications strategies to publicise its initiatives and shape public attitudes, and the policy shift in the 1970s required a new visual strategy. In this context, community health workers (CHWs) played a central role as key visual identifiers of Health for All. This article examines a period of picturing and public information work on the part of the WHO regarding CHWs. It sets out to understand how the visual politics of the WHO changed to accommodate PHC as a new priority programme from the 1970s onwards. The argument tracks attempts to define CHWs and examines the techniques employed by the WHO during the 1970s and early 1980s to promote the concept to different audiences around the world. It then moves to explore how the process was evaluated, as well as the difficulties in procuring fresh imagery. Finally, the article traces these representations through the 1980s, when community approaches came under sustained pressure from external and internal factors and imagery took on the supplementary role of defending the concept.

Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

“…In the worldwide effort to achieve universal health coverage (UHC), community health workers (CHW) play a key role in the provision of health services due to their close proximity to end users, socially adapted service delivery and engagement with families and communities 1 2. CHWs’ contributions to reaching global and national health goals have been recognised since the 1978 Alma-Ata Declaration, which was strongly influenced by China’s ‘barefoot doctors’ and similar programmes and policies 3. More recently, successful models in Brazil, Ethiopia, Iran, Malawi, Rwanda and elsewhere have provided further impetus to promote CHWs and conceptualise them at the centre of a ‘full-fledged sub-system’ of primary healthcare called the ‘community health system.’4 Yet the nature of health action at community level remains poorly understood, particularly as this extends beyond care seeking from formalised cadres, which represents only one dimension of families’ experience of healthcare and health seeking.…”

How social networks affect policy implementation: An analysis of street‐level bureaucrats' performance regarding a health policy

“…This policy aims at providing primary health care services in the domestic environment in an attempt to humanize service provision, tackle health issues in their social contexts, and address health risk factors detected inside residences (Gale et al, ; Silva & Dalmaso, ). It is part of a broader strategy that exists in different countries of “close‐to‐community workers with no specialized medical training who traditionally operate as links between doctors, nurses and remote or hard to reach groups” (Medcalf & Nunes, , p. 403).…”

Task-shifting must recognise the professional role of nurses

“…7 The term has also been used interchangeably with 'community health workers', 8 a term synonymous with 'lay health workers'. 9 For this study to influence policy appropriately, the definitions for these ambiguous terms need to be clarified.…”