Overall Aims

• To facilitate students' ability to understand participatory methods in building community capacity to solve priority problems in varied health care settings
• To build on students' prior experiences and help them develop skills in learning how to use case studies in their own work and teaching
• To facilitate students' ability to scale up community-based successes from a local situation to general extension
• To help students clarify their own values and attitudes in developing partnership relationships with communities and colleagues

Expectations This course is designed for students who expect to promote and participate in community-based programs. It is not appropriate for those whose interests are in basic research dealing with numbers rather than people. The lectures will follow a textbook on community-based primary health care. Most lectures will focus on a case study or important concepts of community-based primary health care. For most case studies, there is additional background documentation available on the course Web site.

Course Objectives

• To learn practical methods of promoting participatory activities in communities and action groups
• To critically examine the conditions and practical techniques for developing partnerships to improve: bottom-up participation of communities, top-down support by officials, and outside-in stimulation by change agents
• To explore in-depth concepts of equity, justice, sustainability, scaling up, the tilting point in community empowerment and challenges in promoting changes in behaviours and social norms
• To analyze strategies of multi-sectoral collaboration and integration within health services
• To critically identify successes and failures or weaknesses of each case study and lessons learned from these
• To understand the key concepts of the SEED-SCALE paradigm for implementing community-based primary health care

Readings

The required textbook for the course is: Taylor-Ide, D & Taylor, C.E. (2002). Just and lasting change: When communities own their futures. Baltimore: Johns Hopkins University Press. A recommended textbook for the course is: Arole, M. & Arole, R. (1994). Jamkhed: A Comprehensive Rural Health Project. London: The MacMillan Press

Readings

Textbooks

The required textbook for the course is: Taylor-Ide, D & Taylor, C.E. (2002). Just and lasting change: When communities own their futures. Baltimore: Johns Hopkins University Press. A recommended textbook for the course is: Arole, M. & Arole, R. (1994). Jamkhed: A Comprehensive Rural Health Project. London: The MacMillan Press

Topic	Readings
General Readings
Primary Health Care	Slums (Chapter 9) in Polak, Paul. Out of Poverty: What Works When Traditional Approaches Fail. San Francisco, CA: Berrett-Koehler Publishers, 2008McLeary KR, et al. Community-based interventions. Am J Pub Health 2003;93:529-533 Taylor CE. Surveillance for equity in primary health care: Policy implications from international experience. Int J Epidemiol 1992;21:1043-1049 Keane D, et al. Community health workers and promotores in California. UCSF Center for the Health Professions, September 2004 Carl Taylor on incentives Taylor CE. What would Jim Grant say now? The Lancet 2010;375:1236-1237
Lecture Guides
Guides to selected lectures within the course	Roots for Community Based Primary Health CareNarangwal Part I - Field Research in Community Health Care - Conceptual and Technical Breakthroughs Jamkhed and Gadchiroli, India: Conceptual and Technical Breakthroughs in the Demonstration and Field Research about Community Health Care Pholela and the US Community Health Centers - Differences between the US and Developing Countries Applying the SEED SCALE Model - Lessons from Gaza, Mozambique Post-Conflict Afghanistan
Student Discussion Questions
Discussion Questions for Selected Lectures	Questions for Student Discussion on NarangwalQuestions for Student Discussion on Jamkhed and Gadchiroli Questions for Student Discussion on Pholela Questions for Student Discussion on China Questions for Student Discussion on Mozambique Questions for Student Discussion on Afghanistan Lessons Learned
Week 1
Roots of Community-Based Primary Health Care (Taylor)	Taylor C, Jolly R. The straw men of primary health care. Soc Sci Med 1988;226:971-977 Declaration of Alma-Ata Litsios S. The Christian Medical Commission and the development of WHO's primary health care approach. Am J Pub Health 2004;94:1884-1893 Taylor C. Overview: Primary health care before and after Alma-Ata. In: Primary Health Care and Health Sector Reform: 15 Years After Alma Ata. WHO, 1993
Week 2
The Narangwal Project and Student Discussion	Taylor CE, Parker RL. Integrating PHC services: Evidence from Narangwal, India. Health Policy and Planning 1987;2:150-161
The Jamkhed and Gadchiroli Projects and Student Discussion	Bang AT, Bang RA, Reddy HM. Home-based neonatal care: Summary and applications of the field trial in rural Gadchiroli, India (1993 to 2003). J Perinatol 2005;25:S108-S122
Bangladesh and BRAC	Perry H. Lessons for the future (chapter 7). In: Health for All in Bangladesh. University Press, 2000
Week 3
Pholela and the Origins of Community-Oriented Primary Care	Geiger HJ. The first community health centres: A model of enduring value. J Ambulatory Care Manage 2005;28:313-320 Mullan F, Epstein L. Community-oriented primary care: New relevance in a changing world. Am J Pub Health. 2002;92:1748-1755 McLeroy KR, et al. Community-based interventions. Am J Pub Health. 2003;93:529-533 Yach D, Tollman SM. Public health initiatives in South Africa in the 1940s and 1950s: Lessons for a post-apartheid era. Am J Pub Health 1993;83:1043-1050 Susser M. Pioneering community-oriented primary care. Bull WHO. 1999;77:436-438
The China Model Counties Project and Student Discussion	No Readings
Week 4
Community-Based Primary Health Care in the Western Hemisphere: Case Studies from Bolivia, Peru, Guatemala, and Haiti	Perry H, et al. Attaining health for all through community partnerships: Principles of the census-based, impact-oriented (CBIO) approach to primary health care developed in Bolivia, South America. Soc Sci Med 1999;48:1053-1067 Perry H, et al. Impact of a community-based comprehensive primary healthcare programme on infant and child mortality in Bolivia. J Health Popul Nutr 2003;21:383-395 Perry H, et al. Reducing under-five mortality through Hospital Albert Schweitzer's integrated system in Haiti. Health Policy Plan 2006;21:217-30 Perry H, et al. Long-term reductions in mortality among children under age 5 in rural Haiti: Effects of a comprehensive health system in an impoverished setting. Am J Public Health 2007;97:240-246
Week 5
Applying the Seed-Scale Model: Case Study from Mozambique and Student Discussion	Edward A, et al. Examining the evidence of under-five mortality reduction in a community-based programme in Gaza-Mozambique. 2007;101:814-822
Care Groups: Giving Census-Based Impact-Oriented Extra Power for Community-Based Primary Health Care	Edward A, et al. Examining the evidence of under-five mortality reduction in a community-based programme in Gaza-Mozambique. 2007;101:814-822 Perry H, et al. Averting childhood deaths in resource-constrained settings through engagement with the community: An example from Cambodia. In: Essentials of Global Community Health (Goffin J, Gofin R, eds.) Sudbury, MA: Jones & Bartlett Learning, 2011
Week 6
Women's Empowerment in Afghanistan and Student Discussion	Afghanistan Seven Tasks
Johns Hopkins Medical Institutions and the East Baltimore Community Case Study	Levine DM, et al. Community-academic health centre partnerships for underserved minority populations. JAMA 1994;272:309-311 Baker EA, et al. Principles of practice for academic/practice/community research partnerships. Am J Prev Med 1999;16:86-93
Week 7
SEED-SCALE: A Universal Process	No Readings
A Comprehensive Review of the Effectiveness of Community-Based Primary Health Care in Improving Child Health	Freeman P, et al. Accelerating progress in achieving the millennium development goal for children through community-based approaches. Global Public Health 2009 Nov 3:1-20 [Epub ahead of print]
Week 8
Case Studies in Primary Health Care: Lessons Learned	Declaration of Alma-Ata Margaret Chan puts the primary health care centre stage at WHO [editorial]. Lancet 2008;371:1811