Community-Oriented Primary Care: New Relevance in a Changing World

Abstract

Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa. We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility. COPC has important values and methods to offer disparate but powerful movements in public health worldwide.

Orientação comunitária e enfoque familiar: avaliação de usuários e profissionais da estratégia saúde da família

“…Ainda na década de 1940, esses recursos já eram utilizados em comunidades rurais da África do Sul, sendo esses trabalhos a base do que veio a ser conhecido por Community-Orientation Primary Care (COCP) 3 .…”

“…A atenção básica orientada para a comunidade combina habilidades epidemiológicas e clínicas para regular os programas e acessar as necessidades prioritárias de saúde de uma população definida 2 . As questões para o desenvolvimento do cuidado primário orientado para a comunidade foram sintetizadas em um ciclo composto pelas seguintes etapas: diagnóstico da comunidade, priorização dos problemas de saúde encontrados, avaliação detalhada do problema, planejamento da intervenção, implementação e avaliação 3 . Por sua vez, o atributo enfoque familiar considera a família (em todas as suas expressões) e compreende sua influência sobre o indivíduo, procurando envolvê-la como parceira nos cuidados de saúde 4 .…”

Holding On and Letting Go: A Perspective from the Keystone IV Conference

“…• Building learning communities 44 and communities of solution 45,46 that combine Big Data with deep, on-the-ground relationships to reinvent community-oriented primary care [47][48][49] • Fighting against the widespread adoption of a line-worker approach to mass production that has largely been discredited in manufacturing but that is being applied full bore to public education and to delivering fragmented, depersonalized commodities of health care 50 -56 • Standardizing what is common but not mistaking this for what is important: making room to take time with the particulars 31 of person and place, family, and community • Conducting research not as something that is done to rats, or to people treated like rats, or to subparts of people, and calling that "precision medicine," but as generating relevant new knowledge in partnership with practices, patients, and communities; adding stories to the statistics, narratives to the numbers 57,58 -personalized medicine that requires knowing the person • Integrated care 59 -61 • Embracing the measurement culture at arm's length 16 ; working to assess what is important, empowering those on the front lines to move beyond metrics of central tendency toward personalized care, and making space and time for the important wonders that are beyond measurement • Being the change we want to see 62 I do not know if being countercultural is the proper political stance now. I do know that every day family physicians fly in the face of the fragmenting pressures of greed, anger, and fear, trying to do the right thing for individuals, families, and communities.…”

The National Health Insurance, the decentralised clinical training platform, and specialist outreach

“…[8,9] In 1940, the concept of primary healthcare (PHC) and community health centres (CHCs) was pioneered by Drs Sidney and Emily Kark at Pholela in rural Natal, and was highly regarded as 'a continuous process by which primary care is provided to a defined community on the basis of its assessed health needs' . [10,11] Because of the emphasis on PHC, this philosophy is included in strategies for the SA National Health Insurance (NHI) and in the decentralised clinical teaching platform (DCTP)/community-based training in a PHC model (CBTPHCM). Such principles are well founded, but to achieve a comprehensive system they must go hand-in-hand with curative healthcare, with a specialist component.…”