Community-oriented, primary health services: lessons drawn from international experiences of the W. K. Kellogg Foundation.

Abstract

Primary health care projects in Latin America aided by the W K Kellogg Foundation (WKKF) aim to provide comprehensive care--maternal-infant health immunization dental care and home visits by health aides for example--to all members of the family as a unit. The Cotia Hospital project in a semi-rural community outside of Sao Paulo Brazil and the University of El Valle project at both urban and rural sites in Cali Colombia embody the Foundations approach to community-oriented primary health care. The Cotia Hospital Association provides a complete range of acute care disease prevention and health promotion services to over 80000 people as well as continuing education to physicians nurses dentists administrators and community volunteers. The Cali project is a model of regionalized health care and integrated community development programs aimed at family-oriented primary health care delivery. In addition this project has conducted research and development in 4 geographic regions provided continuing education for health personnel and generated data on the impact of innovation on mortality and morbidity the cost-effectiveness of services rendered and acceptance of services by the community. Initially the WKKF encountered resistance to the concept of family practice as a specialty but acceptance has broadened over the past decade. Among the lessons learned from the Foundations 50 years of experience in international project support are the importance of comprehensive and multidisciplinary approaches articulation between teaching and service tapping into the creative energies of the private sector drawing on both Western-based and traditional medical principles sustained local leadership and community involvement and obtaining support for a project from several founders.