Abstract
This study is a critical look at the narrow implementation of the Primary Health Care (PHC) approach to development through rural community health worker programs. I focus on agricultural involvement as a lens through which to view the comprehensive nature of PHC projects. In the landmark Declaration of Alma-Ata in 1978, the Primary Health Care approach to development was set forth as the means to achieve “Health for All” by 2000. At the core of this radical goal was the belief that health and participatory health care are human rights, and that a basic level of health for every person on the planet is within reach if countries alter the way they view health care—from a single sector to one that is tied to everything from education to agriculture, and intimately linked to social justice.
I review a variety of interpretations of “Comprehensive Primary Health Care” to see how public health scholars and policy-makers describe the scope of “comprehensive.” The range is from truly comprehensive to quite narrow and biomedically-focused. In rural settings, primary health care should, logically, connect to the agricultural practices of the population it exists to serve. An examination thus far suggests that though many types of networks of community health workers have been set up in rural areas of less developed countries, agricultural projects have not been directly incorporated into rural Primary Health Care. At best, agriculture is mentioned only in passing in the literature about community health workers; even those programs with a strong agricultural component have not published articles about or evaluating the effect of this aspect of their work. I argue that to truly address the social determinants of health, effectively promote nutrition and hygiene, and strive toward “Health for All,” rural primary health care as implemented through community health worker systems must embrace a comprehensive, intersectoral approach at the heart of Primary Health Care and connect agricultural practices to public health at the community level.
