Effects of the institutionalization of primary health care.

Abstract

This paper address the institutionalization of the primary health care program in Cornwall County Jamaica, supervised by the Ministry of Health. Under this program, 59 new health centers were constructed and 28 existing ones remodelled. The primary health centers were decentralized and an administrative unit of a hierarchy of health centers was established and classified as type 1 through type 4. Type 1 health center was the smallest and the simplest health unit, and both type 2 and 3 health unit functioned as referral units for patients from type 1 health center. The type 4 health center had an additional administrative block for senior staff of the parish. The implications of this health system to Cornwall county in 1976 were 1) a decline in community health aides per health center, 2) additional child welfare, prenatal family planning, and medical clinics were held, 3) the number of rural families utilizing health care increased, 4) community health workers made significantly fewer home visits as a result of additional clinic units and in turn child health care declined significantly, 5) health workers carried out more curative activities and fewer preventive duties, 6) an increase in data collection through defaults in the system lead to non-utilization of the data for policy planning purposes, 7) shortage of staff to support the increased patient load and duties at health centers. Consequently, the health system could not cope with this well intentioned policy change which emphasized shifting from community outreach to health center-based activities.