Primary health care: a training experience with the community

In 1982-83 we organized training schemes for various people involved in primary health care at local authority level. These schemes were part of the pattern of similar activity carried out with trained professional staff of the mother-and-child care and school health services. What was new was the participation of non-professional users (or their representatives) of health services, i.e. local politicians, representatives of associations, etc. The training sessions brought together 20-25 participants for two or three days and there were occasionally follow-up meetings of one or two days. The participants, divided into small groups of five or six, played an active part in the meetings, which were based on known information about the local authority area and the participants' own contributions. The initial task was the identification of health problems. For this to be a relevant exercise, the many political, cultural and personal factors which influence people's lives had to be considered. The fact is that the usual epidemiological data are inadequate if they are based solely on a review of symptoms and their distribution among the population as a whole. The procedure begins with the group concerned, and priority in selecting problems is decided with and within the group itself. The solutions that are required will thus be based on the experience and reasoning of the people themselves. A procedure of this type ought to show the factors which affect the community (working conditions, environment, habitat, cultural background, etc.) and which influence health. If we understand the structures of the community and the resources at its disposal, we can adapt our response accordingly. In assessing our experiment, we found that the training sessions produced a local awareness and a mutual recognition of the various participants, both professional and non-professional. Each person began to understand his limits since his role was constantly being reviewed. At the same time the requirements voiced by health care users became more apparent to the professionals with their preconceived ideas about people's needs and requirements.