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

摘要

This case study is designed to answer the question whether refugees can make a positiveudcontribution to host countries, not simply as individual participants in economic activity, butudby contributing to welfare. The thesis provides a detailed study of an NGO originallyudestablished to provide medical relief for refugees but which now provides basic health careudfor local people. Since 1995 this NGO has adopted a policy of providing the same basic careudto refugees and to people in local Pakistani villages, thus making no distinction betweenudrefugees and the residents of a specific geographical area. The case study also shows that anudNGO can be an appropriate and effective provider of primary health care (PHC) as promotedudby the 1978 Declaration of Alma Ata.udThe thesis uses several approaches to demonstrate why this happened and how it wasudachieved. Firstly, it narrates the history over the twenty-year period 1980-2000 of anudinternational health project originally started for a group of Afghan refugees, and itsudtransformation in 1995 into an indigenous Pakistani NGO called “Frontier Primary HealthudCare (FPHC)”. Secondly, the study explores the theoretical utility and limitations of theudPHC strategy generally. Thirdly, the thesis provides an analysis of the extent to which theudunderlying principles or “pillars” of PHC, that is, participation, inter-sectoral collaborationudand equity have affected the process and outcomes of the project.udLocating the case study in the Pakistani context provides evidence of the persistentuddifficulties and shortcomings of official government basic health care in Pakistan,udparticularly for rural poor people, showing that the field is open for other providers of healthudcare, such as NGOs. The thesis goes on to discuss strengths and weaknesses of NGOs inudgeneral, and particularly as health care providers. In investigating characteristics of theudNGO sector in Pakistan, the study pays special attention to the discrete health care systemudfor Afghan refugees created in the early 1980s, including its introduction of CommunityudHealth Workers.udIn order to assess the impact of the NGO on people’s health, the study uses data fromudmother/child health and family planning programmes (as far as available) demonstrating thatudthis NGO is a more effective provider than the other two agencies i.e. the Government ofudPakistan and the Afghan Refugee Health Programme. Placing the NGO in this context alsoudshows that it has a better understanding of the underlying “pillars” and has made moreuddetermined and effective efforts to implement them, especially in regard to communityudinvolvement.udIt is unusual for a project initially refugee-oriented to have matured sufficiently to be makinguda contribution, as a matter of formal policy, to basic welfare in the host country, itself auddeveloping country. The study concludes that the significant factors in its success areudcontinuity of leadership; boundaries of population, geography and administration;uddependable income and material resources; rigorous supervision; support, but not takeover,udby experienced consultants; capacity to use learning to adapt and move on; and sensitivity toudlocal cultural norms. All these have enabled the project to survive and develop as anudindigenous autonomous organisation beyond the twenty years covered by the case study.udFPHC is still operational in 2004.