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Community-Oriented Primary Care and Primary Health Care/Cueto Responds

Posted on: Wednesday, 11 May 2005, 03:00 CDT

Nowadays there is a renewed interest in the role of primary care as an essential component of the delivery of health care. Cueto's article on the role of the World Health Organization (WHO) in the emergence of primary health care1 is timely indeed and stimulates discussion about this dimension of health care.

We wish to direct attention to an approach not mentioned in Cueto's article that is taught, practiced, and written about extensively-the community-oriented primary care (COPC) model. The recent application and evaluation of COPC in various countries was reported in several articles published in the November 2002 issue of the Journal.

The conceptual roots of COPC were introduced and developed in the 1940s by Sidney Kark and Emily Kark in a rural area of South Africa. As family physicians, the Karks implemented a comprehensive approach to care, taking into account the socioeconomic and cultural determinants of health, identifying health needs, and providing health care to the total community. Their pioneering work, integrating preventive and curative care with significant community involvement, created a service network of a kind scarcely known then in that continent, with more than 40 community health centers established in different regions of the country.2 The Karks and their team developed this approach further at the Community Health Center of the Hadassah School of Public Health and Community Medicine in Jerusalem.3

In Sidney Kark's book Epidemiology and Community Medicine (published in 1974, before Alma Ata), he speaks of "community medicine and primary health care as a unified practice."4(p7) This approach, which later was denominated COPC,5 is considered an expression of the Alma Ata spirit.6,7

In our COPC teaching,8 we have had frequent discussions with international public health students, mainly Africans, concerning the similarities and differences between COPC and the primary health care approach of WHO. As an explicit expression of the role played by COPC in the development of the WHO primary health care approach, Litsios notes (also in the November 2004 issue of the Journal) that there is evidence of "many similarities between primary health care and Kark's work in Africa."9(p1890)

The renewed interest in primary care is particularly appropriate because primary care is the component of health services that addresses most of the health problems arising in a community, and when it is enhanced by a community orientation, it can be considered public health at the local level.10

Jaime Gofin, MD, MPH

Rosa Gofin, MD, MPH

About the Authors

The authors are with Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel.

Requests for reprints should be sent to Jaime Gofin, MD, MPH, Hadassah School of Public Health, PO Box 12272, Jerusalem 91120, Israel (e-mail: jaime@md.huji.ac.il).

doi:10.2105/AJPH.2004.060822

References

1. Cueto M. The origins of primary health care and selective primary health care. Am J Public Health. 2004;94:1864-1874.

2. Tollman SM. Community oriented primary care: origins, evolution, applications. Soc Sci Med. 1991;32: 633-642.

3. Kark SL, Kark E. Promoting Community Health: From Pholela to Jerusalem. Johannesburg, South Africa: Witwatersrand University Press; 1999.

4. Kark SL. Epidemiology and Community Medicine. New York, NY: Appleton-Century-Crofts; 1974.

5. Kark SL. The Practice of Community Oriented Primary Health Care. New York, NY: Appleton-Century-Crofts; 1981.

6. Susser M. Pioneering community-oriented primary care. Bull World Health Organ. 1999;77:436-438.

7. Ashton J. Public health and primary care: towards a common agenda. Public Health. 1990;104:387-398.

8. Gofin J. Planning the teaching of community health (COPC) in an MPH program. Public Health Rev. 2002;30:293-301.

9. Litsios S. The Christian Medical Commission and the development of the World Health Organization's primary health care approach. Am J Public Health. 2004;94:1884-1893.

10. Kark SL, Kark E, Abramson JH, Gofin J, eds. Atencion Primaria Orientada a la Comunidad [in Spanish]. Barcelona: Ediciones DOYMA SA; 1994.

CUETO RESPONDS

I am grateful for Gofin and Gofin's letter mentioning an important dimension of primary health care that I did not examine in my article. One reason for its absence is that I did not find the term "community-oriented primary health care" very frequently in the archival materials of the late 1970s and early 1980s of the World Health Organization, the United Nations Children's Fund, the Rockefeller Foundation, and the Pan American Health Organization. My article was the first result of 2 years' investigation based on the archives of these official health agencies. My research is ongoing, and I am certain that in the future I will find many remarkable cases of community-oriented primary health care that may have been missed by the official agencies.

I very much agree with Gofin and Gofin that the work of Sidney and Emily Kark is crucial for anyone interested in primary health care. Their letter suggests the need for more research on the history of primary health care, and I thank them for it.

Marcos Cueto, PhD

About the Author

Requests for reprints should be sent to Marcos Cueto, PhD, Facultad de Salua Pblica, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, Lima 31, Peru (e-mail: mcueto@upch.edu.pe).

doi:10.2105/AJPH.2005.062521

Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses.

Text is limited to 400 words and 10 references. Submit online at www.ajph.org for immediate Web posting, or at submit.ajph.org for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the department editor, Jennifer A. Ellis, PhD, at jae33@ columbia.edu.

Copyright American Public Health Association May 2005

Source: American Journal of Public Health

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