From medical relief to community health care: A case study of a Non-Governmental Organisation (Frontier Primary Health Care) in North West Frontier Province, Pakistan
Patterson, Margaret Madeline
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This case study is designed to answer the question whether refugees can make a positive contribution to host countries, not simply as individual participants in economic activity, but by contributing to welfare. The thesis provides a detailed study of an NGO originally established to provide medical relief for refugees but which now provides basic health care for local people. Since 1995 this NGO has adopted a policy of providing the same basic care to refugees and to people in local Pakistani villages, thus making no distinction between refugees and the residents of a specific geographical area. The case study also shows that an NGO can be an appropriate and effective provider of primary health care (PHC) as promoted by the 1978 Declaration of Alma Ata. The thesis uses several approaches to demonstrate why this happened and how it was achieved. Firstly, it narrates the history over the twenty-year period 1980-2000 of an international health project originally started for a group of Afghan refugees, and its transformation in 1995 into an indigenous Pakistani NGO called “Frontier Primary Health Care (FPHC)”. Secondly, the study explores the theoretical utility and limitations of the PHC strategy generally. Thirdly, the thesis provides an analysis of the extent to which the underlying principles or “pillars” of PHC, that is, participation, inter-sectoral collaboration and equity have affected the process and outcomes of the project. Locating the case study in the Pakistani context provides evidence of the persistent difficulties and shortcomings of official government basic health care in Pakistan, particularly for rural poor people, showing that the field is open for other providers of health care, such as NGOs. The thesis goes on to discuss strengths and weaknesses of NGOs in general, and particularly as health care providers. In investigating characteristics of the NGO sector in Pakistan, the study pays special attention to the discrete health care system for Afghan refugees created in the early 1980s, including its introduction of Community Health Workers. In order to assess the impact of the NGO on people’s health, the study uses data from mother/child health and family planning programmes (as far as available) demonstrating that this NGO is a more effective provider than the other two agencies i.e. the Government of Pakistan and the Afghan Refugee Health Programme. Placing the NGO in this context also shows that it has a better understanding of the underlying “pillars” and has made more determined and effective efforts to implement them, especially in regard to community involvement. It is unusual for a project initially refugee-oriented to have matured sufficiently to be making a contribution, as a matter of formal policy, to basic welfare in the host country, itself a developing country. The study concludes that the significant factors in its success are continuity of leadership; boundaries of population, geography and administration; dependable income and material resources; rigorous supervision; support, but not takeover, by experienced consultants; capacity to use learning to adapt and move on; and sensitivity to local cultural norms. All these have enabled the project to survive and develop as an indigenous autonomous organisation beyond the twenty years covered by the case study. FPHC is still operational in 2004.