Health as a Primary Care in modern era— Reflection On Carl

E.Taylor

Carl E. Taylor was a passionate proponent and a founder of

whole field of international health and a global leader of public
health care., he lived to see public health care since he was a
child. His major contribution was in initiating community
health and many primary health care projects in India .One
among his major activities is Narangwal project, a community-
based health care project in Punjab, India which actually played
a key role in international conference on Primary health care
and also led to the declaration of Alma-Ata which became the
guidance for world’s primary health care. The Alma Ata
Declaration stated that health was a fundamental human right
and that health services should be provided to everyone based
on the principles of primary care, community participation, and
social justice.

In the lecture titled ‘The Roots of Primary Health Care’, Carl

Taylor showed us that how the ancient systems of PHC work in
China, India, Greece, and Babylon. He spoke of many ancient
traditions and thoughts which are still followed and believed such as
the hot and cold foods, which means the foods are not
considered hot or cold either because of temperature or pepper,
but they are hot and cold because of what they do to the body
and also about new idea that came along that people thought
worked would be shared. There is a Worldwide sharing .

He spoke about Hippocrates, leader of Greece who discovered

the geographical pattern of disease and also about the ayurvedic
ancient herbs and researches done on some plants one such
example is the rise of Rauwolfia drugs for hypertension came
out of Indian Himalayan herbs. he also spoke about piracy
around the world of commercial companies going out and
tapping into all the accumulated knowledge and then taking the
medicine as a way from the countries so that the country doesn’t
profit ,they even eradicated the whole plants and disrupting the
ecosystem in one way or other this still continues even in this
modern era.

About the modern history of PHC, Carl told us about the first
model the Ding Xian project. In this project, John B. Grant and
his fellows tried to empower people in community level to be
trained as health workers. This system was picked up by Mao
Zedong and the communist government resulted in rise of the
‘bare-foot doctors’. During after the world war the fledging field
of public health was just began it is John B.Grant who actually
took bold ideas and led to create and develop foundations for
health systems .he is the father of primary health care creating
a new system of grassroots health centres linked with local
medical facilities and regional teaching hospitals ,all delivering
preventive as well as curative services.

Kark started a project in South Africa and adapted it as

community oriented primary care which is still followed .Kark
specified five attributes essential for primary health care
including accessibility ,comprehensiveness, coordination,
continuity and accountability. In addition ,elements of COPC
have existed in a number of public and private programs
(Indian Health Service ,community health centres ,family
practices ,health maintaince organisation).It existed in United
States health system which actually helped to assemble and
organise the existing data that describe the operation, costs In
1960s to 1970s, there were two projects in India, The Jamkhed
and Narangwal project.. Ding Xian, Jamkhed, and Narangwal
projects had a strong horizontal notion, Kark’s project was more
vertical in it’s concept.

One great contribution of Carl E.Taylor in modern PHC is SEED-

SCALE program a strategy for community change that was
identified on the basis of world-wide study of successes in
equitable and sustainable community change. Identification and
analysis of successful experiences were conducted by Daniel and
Carl Taylor with support from UNICEF, and the on-going
findings and conclusions were discussed with international
experts brought together periodically with support from the
Rockefeller Foundation. The methodology is simple to describe
and easy to remember. Its application in the field provokes
profound changes in the understanding of government,
communities, and outside change agents as to their roles and
responsibilities to achieve just and lasting development of
communities and their members. The four principles are: base
action on previous success, three-way partnership, local data,
and local planning.

Instead of accepting the traditional hospital -based treatment

model, Dr Bang has spent the last 26 years training up local
volunteers in Gadchiroli, one of the most deprived districts in
the Indian state of Maharashtra, to treat simple maladies at
home. Dr Bang is founder-director of SEARCH, an NGO that
provides community health care to the tribes of Gadchiroli
district in Maharashtra. this is the man who has revolutionised
healthcare for the poorest people in India and who has overseen
a programme that has sent infant mortality rates plummeting in
one of the most poverty-stricken areas of the world. The World
Health Organisation and Unicef have recently endorsed his
approach to treating newborn babies and the programme is
currently being rolled out to parts of Africa.

Coming back to Alma-Ata declaration has been called the

Atlanta of primary health care but it contradict on selective
/comprehensive primary care. As of one example many health
problems in poor countries can be addressed with simple and
inexpensive intervention but these are not usually the priorities
of the local people. These dilemma contradict over the Alma-Ata
PHC (horizontal) and selective PHC (vertical) which brought a
new paradigm called diagonalist. The concept is that both
vertical and horizontal programs need to co-exist. Unfortunately
after Alma-Ata, the vertical programs are more dominant and
the horizontals are left behind.

John Wyon told us about three kinds of public health: disease

oriented, service oriented, and community oriented. Each
complements the other like three legged stool. This might be the
best illustration about how the vertical and the horizontal need
to co-exist in the primary health care.

In my opinion, in order to attain the ideal PHC, we need to pay

more attention on these two statements from Carl Taylor.

Real social change occurs when officials and people with

relevant knowledge and resources come together with
communities in joint action around mutual priorities.”

“There is no universal solution, but there is a universal process

to find appropriate local solution.”

I strongly believe that all the contributions of Carl E. Taylor

helped with the introduction of primary health and also to
collecting data and assuming the success of the system set up .
John B. Grant, Kark, John Wyon have contributed and made
health services much better way to be coordinated and Dr
Bang has even went few steps ahead about modern public health
which might be aid in under developing and his approach was
revolutionised. i actually believe that health care works more as
a multi-sectoral influences on health that go far beyond medical
care. It includes education, nutrition, water and sanitation, and
more to the health care preventive and curative services, the
biomedical disease orientation, in which the patient is the
passive recipient of medical services versus the concept of
creating conditions and environments that are healthy or in a
way to promote health.

Primary health care needs governing support and resources to

sustain and maintain a coordinated approach. Primary health
care needs are achieved when people are educated with relevant
knowledge. And the main strategy should be to find each local
solution and to maintain equity. And ofcourse each country
would have different problems and strategies do change. The
combination strategy of horizontal and vertical should lies upon
the condition of the local community.