The idea behind primary health care is to move the emphasis away from large institutions with professionally trained people and to share the responsibility for health care with ordinary people. The emphasis is not on curing health problems, but on preventing them. Information about health needs to be shared with everyone. Ordinary people who are helped with clear, simple information can prevent and treat many common health problems in their own homes. In 1978, over 150 governments from around the world signed the Alma Ata Declaration to support primary health care in their own countries.

In this issue we hope to open a discussion on how to encourage community based primary health care. We hope also to raise the difficult question of how primary health services should be paid for. Should community health workers (CHWs) be paid, and if so, how much and by whom?

Some primary health work appears to be very successful and involves the participation of the community in all sorts of ways. But other projects are split by problems with leadership, problems over funding, allegations of corruption or community health workers who refuse to work because they are not paid enough.

How can we encourage primary health care which really involves the community, which does not depend on outside funding to continue, and which brings self awareness and dignity to those involved? What part does our Christian motivation play in these matters? These are huge issues, but we can begin to look at some of the answers. We hope that the points raised will be helpful and thought provoking in your own work. While established projects cannot begin all over again, it is always possible to change the emphasis within health work. 

Isabel Carter