In the first decades of the 21st century, despite major medical advances, women in the least developed parts of the world are dying in childbirth far more often than women in wealthier nations, and their children are far more likely to die before reaching age 5. The major reason for this is that healthcare in these areas lacks its foundation: basic primary maternal and child healthcare (MCH). Two early examples of primary MCH care showed that the high death rates for mothers and children could be reduced substantially at low cost: David Morley’s Under-Fives Clinic in Western Nigeria, which began in the 1960s, and the Aroles’ Jamkhed Project in Maharashtra State in India, which began in the early 1970s. The lessons learned from these two early projects were also highlighted as principles at the Alma Ata International Primary Care Conference in 1978. They included: 1. Integration of basic curative care with the various aspects of promotive/preventive care, the former building the trust required for full acceptance of the less-understood aspects of the latter, such as immunizations, family planning, and exclusive breastfeeding during the first six months of life. 2. Heavy reliance on well-supervised lower-level health workers (including community health workers) to reach entire target populations. 3. Reliable delivery of a limited formulary of common, low-cost medical supplies and medications. 4. Partnerships among government ministries of health, education, and finance with communities and with local, national and international non-governmental organizations, and, 5. Gradual buildup as the health system and the communities enhance their capacity to support the work, so that success builds on success. It is past time for building primary MCH and eventually total population-based care systems everywhere. The first and biggest benefit will be in least developed societies, where the present rate of preventable mother and child deaths is unconscionable.
A. Mushtaque R. Chowdhury and Henry B. Perry
Non-governmental organizations (NGOs) working in developing countries are chiefly a post-World War II phenomenon. Though they have made important contributions to health and development among impoverished people throughout the world, the documentation of these contributions has been limited. Even though BRAC and the Jamkhed Comprehensive Rural Health Project (CRHP) are but two of 9.7 million NGOs registered around the world, they are unique. Established in 1972 in Bangladesh, BRAC is now the largest NGO in the world in terms of population served—now reaching 130 million people in 11 different countries. Its programs are multi-sectoral but focus on empowering women and improving the health of mothers and children. Through its unique scheme of generating income through its own social enterprises, BRAC is able to cover 85% of its $1 billion budget from self-generated funds. This innovative approach to funding has enabled BRAC to grow and to sustain that growth as its social enterprises have also prospered. The Jamkhed CRHP, founded in 1970 and located in the Indian state of Maharashtra, is notable for its remarkable national and global influence. It is one of the world’s early examples of empowering communities to address their health problems and the social determinants of those problems, in part by training illiterate women to serve as community health workers. The Jamkhed CRHP served as a major influence on the vision of primary health care that emerged at the 1978 International Conference on Primary Health Care at Alma-Ata, Kazakhstan. Its Institute for Training and Research in Community Health and Population has provided on-site training in community health for 45,000 people from 100 different countries. The book written by the founders entitled Jamkhed: A Comprehensive Rural Health Project, describing its pioneering approach, has been translated into five languages beyond English and is one of the most widely read books on global health. These two exemplary NGOs provide a glimpse of the breadth and depth of NGO contributions to improving the health and well-being of impoverished people throughout the world.