Community Based Health Care

(CBHC) emphasizes-community
1. CBHC

encourages
ownership
by
the
community
2. CBHC responds to the needs of the people.
Standard medical care starts with planners,
projects and governments. CBHC starts with
the people, helps them identify their needs
and works with them in finding answers.

3. CBHC leads to self-reliance.

Standard medical care often introduces two
unwanted side-effects-a dependence on
medicines and a dependence on doctors.
CBHC aims to bring about healthy, self reliant
communities. People become armed with
knowledge so they depend less on out-siders.

4. CBHC helps to encourage community life.

Traditional practices are encouraged unless
they are positively harmful. New ideas are
introduced with sensitivity.
The aim of the health worker is always to
build up confidence and dignity, never to
cause offence or humiliation.

5. CBHC moves outwards to where the people

live.
Care wherever possible, is based in the
community, not the clinic or hospital.
It is decided according to the needs of the
community, rather than the convenience of
the doctor or health worker.

6. CBHC moves forwards to the next generation.

Children become a focal point of health
activities. They are not simply targeted for
improved health care but are involved in
bringing it about.
Healthy patterns of living absorbed by
children today, become the accepted
practices of tomorrow.

7. CBHC helps to bring about behavioural

change.
Through the excitement of discovering new
ideas and different practices, real changes in
lifestyle start to occur and health begins to
improve.

8. CBHC includes all.

The poorest, neediest and most at risk are given
priority. The rich and powerful are included
where possible, through never allowed to
displace the poor or become too dominant.
9. CBHC depends on co-operation and integration.
Wherever possible other doctors, practitioners
and development workers are consulted and
included. Other voluntary programmes are
welcomed and ideas mutually shared.

10. CBHC aims for a new community order.

This is based on :
Justice : where the rich are no longer allowed to
exploit the poor, nor the strong allowed to
oppress the weak.
Equity: where all have sufficient and the
differences between rich and poor are reduced.
Unity: where individuals and community groups
learn respect and where by working towards a
common goal they overcome tribal , ethnic and
other differences.

Community based Health Care

emphasizes Health
1. CBHC is involved more in health care than in
medical care.
CBHC opposes PPNN a pill for every
Problem, a needle for very Need. Instead it
emphasises that well-being is largely brought
about through healthy living patterns and
enlightened attitudes.

2. CBHC emphasizes appropriate cure.

CBHC tries to ensure that a rational list of
essential, life-saving drugs are always
available, affordable and appropriately used.
3. CBHC follows a comprehensive and
integrated model of health care. It aims to
include:
Health education.
Mother and child health services.
Control of infectious diseases.
Adequate nutrition
Immunization

Improvements in water supply and sanitation

Referral systems
Monitoring and evaluation
Effective management

CBHC always links in to

community development.

other forms of

What Community Based Health

Care is Not
CBHC is not opposed to doctors and hospital
CBHC is not simply adding new structures on

to old foundations.
CBHC is not a second rate health service for
the poor, as long as it is correctly set up and
adequately supervised.

How does Community Based

Health Care fit into other health
care systems
In 1978 health planners from 134 member

states of the United Nations met at Alma Ata,

capital of Kazakhstan) to draw up a health
charter aiming to bring basic health services
with in reach of every community and
individual.
The World Health Organization has re
launched this as Health for All in the twentyfirst century with 10 global health targets and
the G8 group of nations with 8 new
development targets.

CBHC is based on principles set out by the

WHO and increasingly seems to offer the only

practical way of bringing about Health for All
to the worlds poorest people. The peoples
Health Assembly Movement is a strong new
coalition aiming to bring this about.

We can observe 3 distinct stages:

Stage 1: The traditional health
system
Stage 2: The standard medical

system
Stage

3: The Community Based

Health Care system

How Can Community Based Health

programmes help to remove the

root cause of ill health Poverty?

Understanding the causes of Poverty.

This will help us to be more compassionate

towards the community and more realistic
in our planning
Realising that although we can do little by

ourselves, we can do a great deal as we

work together with others.
Seeing CBHC as a multiplication process,

not an addition process.

Starting with the skills which we do have

Including community development as soon as

we are able.
Encouraging people to claim their rights

under the law of the country.

Altering traditional patterns of life as little as

possible unless they are actually harmful.

Resisting injustice

What new challenges face

Community Based Health Care
in the 21st century?
Although there have been many advances in

health care in the past 20 years, the majority

of the poor have received no benefit. The
WHO estimates that 1.2 billion people one
person in five- live in extreme poverty and
that half the owrlds population has no regular
access to health care.

Examples:
Emerging and re-emerging diseases: Malaria,
TB, HIV infection, dengue fever, schistosomiasis
and antibiotic resistance are all getting worse
and in some areas are out of control.
Most of these problems are best solved by
community based approaches that are well
managed and well co-ordinated.
Diseases associated with ageing eg. Heart
attacks, strokes, cancer- and ageing itself.
Most care will need to remain in the community
but where family structures are breaking down
we need to explore new models of care.

Increase

in war, civil strife, international

terrorism and fear. This can threaten years of
development activity as well as generating
vast refugee problems-there are over 25
million displaced people at the time of writing.
But refugees themselves can be empowered
and trained whether they stay in semi
permanent camps or resettled elsewhere.
Modified forms of CBHC are highly effective in
refugees situation and can help bridge the
gap between disaster relief and long term
development.

International

debt , striping the poorest

countries of basic health services, and
economic collapse and creating the new
poor. Here again low cost CBHC , with an
emphasis on prevention and treatment at an
early stage will reduce the number so those
becoming
seriously
ill
and
needing
unaffordable medical care.

Increased in the use of Drugs, alcohol and

tobacco growth in prostitution and sexual

abuse of women and children. These problems
are now affecting communities almost
worldwide both urban and rural.
Local community based solutions offer the best
chance of control and of creating healthier
lifestyles.

Thank You