Integrating personal and population approaches to health care: A Perspective from Africa

1. Integrating personal and population approaches to health care: A Perspective from Africa Steve Reid Primary Health Care Directorate University of Cape Town

7. Video - WDO

9. Borders North South Urban Rural Adequate resources Few resources Rich Poor Individual Community Clinical care Population health

11. 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

13. HEALTH FOR ALL HEALTH FOR ALL POPULATION AT RISK PRACTICE POPULATION PATIENT - PRACTITIONER

14. 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

17. HEALTH FOR ALL HEALTH FOR ALL POPULATION AT RISK TERTIARY HOSPITAL

18. HEALTH FOR ALL HIGH SPEED CONTINUOUS INTERNET PEN AND PAPER! INTER-MITTENT DIAL -UP PC

19. Drs Sidney and Emily Kark

20. 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

21. HEALTH FOR ALL HEALTH FOR ALL Case-finding Early detection Follow -up PRACTICE POPULATION “Outreach” Mobile clinics Screening Home visits

22. Gruen RL, Pearson SD, Brennan TA. Physician-Citizens – public roles and professional obligations. JAMA 2004; 291:94-98

23. Brazil – Family Health Programme Programa de Saúde da Família (PSF) Total population 180m, rural population 40m 30 000 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

24. HEALTH FOR ALL HEALTH FOR ALL PRACTICE POPULATION POPULATION AT RISK

25. 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

26. 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

27. Creativity – Roger van Oech www.creativethink.com

29. “Umuntungumuntungabantu” A person is a person by virtue of other people

30. “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.”

31. 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."

32. Video - WDO

33. www.ahp.org.za