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Foundational Doctrines and Principles Shaping OHRA’s Approach to Expanding Primary Health Care in Underserved Areas

Below is a complete, structured, authoritative list of all core doctrines, principles, pillars, and frameworks associated with the Extension of Primary Health Care (PHC) in underserved communities or countries.


This integrates WHO frameworks, Alma-Ata (1978), Astana (2018), UHC doctrine, Community Health Systems doctrine, Social Determinants of Health, and Health Equity Principles.

I. FOUNDATIONAL DOCTRINES OF PRIMARY HEALTH CARE (GLOBAL)

1. The Alma-Ata Doctrine (1978)

This is the original, foundational doctrine of PHC. It established:

  • Health as a fundamental human right

  • Governments’ responsibility to ensure accessible health care

  • PHC as the first level of contact with the health system

  • Community participation as a requirement

  • Emphasis on prevention, promotion, and basic curative care

  • Priority to vulnerable and underserved populations

Core Alma-Ata components:

  1. Health education

  2. Nutrition support

  3. Safe water and sanitation

  4. Maternal and child health

  5. Immunization

  6. Prevention & control of endemic diseases

  7. Treatment of common diseases

  8. Essential drugs

2. The Astana Doctrine (2018) / PHC for Universal Health Coverage (UHC)

A modern reaffirmation of PHC with three pillars:

  1. Primary Care Services

  2. Multisectoral Policy & Action

  3. Empowered people & communities

Key Astana principles:

  • Quality & safety standards

  • Person-centered care

  • Financial protection & UHC

  • Strengthened health systems

  • Use of digital health technologies

  • Resilient community health workforce

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II. HEALTH SYSTEM DOCTRINES FOR EXTENDING PHC TO UNDERSERVED AREAS

3. The Universal Health Coverage Doctrine (UHC)

The PHC extension framework for global health equity:

  • Access to essential health services for everyone

  • No financial hardship

  • Equity-driven coverage expansion

  • Prioritization of poor, rural, marginalized populations

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5. Health Equity Doctrine

Frequently called the Equity-First PHC Doctrine.

Principles:

  • Allocate more resources to areas with highest need

  • Use of equity-based targets, indicators, and budgets

  • Removal of structural barriers: cost, culture, geography, discrimination

  • Prioritizing Indigenous groups, refugees, the disabled, minorities

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4. Community Health Systems Strengthening Doctrine

(Used by WHO, UNICEF, USAID, Global Fund)

Guiding principles:

  • Community Health Workers (CHWs) as a formalized workforce

  • Task-shifting / task-sharing to extend services

  • Community-based surveillance

  • Integrated community case management (iCCM)

  • Home-based care

  • Community participation in governance

  • Door-to-door service extension

  • Local health committees as core structures

6. Social Determinants of Health Doctrine (SDOH)

PHC extension must address:

  • Poverty, unemployment, hunger, education

  • Gender inequality

  • Water, sanitation, housing

  • Environmental health

  • Transport and geography

  • Social protection systems

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PHC extension integrates health + social services for underserved areas.

III. HEALTH DELIVERY DOCTRINES SPECIFIC TO EXPANDING PHC ACCESS

7. Community-Based PHC Delivery Doctrine

Focus:

  • Bringing services out of clinics and into communities

  • Outreach clinics

  • Health posts, mobile teams, and community medicine boxes

  • Home visits

  • Village health committees

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9. Task-Shifting Doctrine (WHO Task Shifting Guidelines)

Redistribution of tasks from doctors to:

  • Nurses

  • Midwives

  • Community health workers

  • Pharmacy technicians

  • Lay counselors

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Goal: Expand PHC coverage where professionals are scarce.​​

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8. Mobile Health & Outreach Doctrine

Used by MSF, UNICEF, WHO in rural/remote areas.

Includes:

  • Mobile clinics

  • Mobile maternal care

  • Mobile immunization units

  • Emergency outreach

  • Seasonal outreach for nomadic populations

  • Integrated outreach health days

10. Public Health Promotion Doctrine

Core principles:

  • Behavior change communication (BCC)

  • Community awareness on hygiene, nutrition, MCH

  • School health programs

  • Village health education

  • Risk communication

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IV. GOVERNANCE & POLICY DOCTRINES FOR PHC EXTENSION

11. Integrated Service Delivery Doctrine

Integration avoids fragmentation.
Combine:

  • HIV, TB, Malaria services

  • Maternal and child health

  • Nutrition and WASH

  • NCD prevention

  • Mental health

  • Reproductive health

PHC extension must deliver one-stop, multi-service packages.

12. Decentralization & Local Health Governance Doctrine

Principles:

  • Transfer authority to local districts

  • Community health committees

  • Local budgeting and planning

  • Training local leaders

  • Accountability & transparency mechanisms

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13. Essential Medicines Doctrine

From WHO Essential Medicines List.

Ensures:

  • Availability of essential drugs at all PHC levels

  • Community drug supply management

  • Affordable pricing

  • Standard treatment guidelines

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V. HEALTH WORKFORCE DOCTRINES FOR UNDERSERVED AREAS

14. Rural Health Workforce Doctrine

Includes:

  • Incentives for rural posting

  • Rural training tracks

  • Local recruitment and retention

  • Community-based medical training

  • Supportive supervision

  • Continuous professional development

15. Human Resources for Health (HRH) Crisis Doctrine

Used in post-conflict or fragile countries.

Focus areas:

  • Emergency training of mid-level workers

  • CHW scale-up

  • Simplified training packages

  • Partnerships with NGOs and faith-based organizations

VI. TECHNOLOGY AND INNOVATION DOCTRINES

16. Digital Health for PHC Doctrine

WHO Global Digital Health Strategy framework.

Components:

  • Telemedicine

  • mHealth for appointments, health education

  • Electronic health records

  • Remote consultations

  • Digital decision-support tools for CHWs

  • Community data dashboards

17. Health Information Systems Doctrine

Core principles:

  • Collect, analyze, use local data

  • Community surveillance

  • Monitoring underserved populations

  • Data-driven intervention

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VII. EMERGENCY, HUMANITARIAN, AND RESILIENCE DOCTRINES

18. Humanitarian PHC Doctrine

Used by UN, MSF, Sphere Standards.

Principles:

  • Rapid access to essential services in crises

  • Minimum service standards

  • Adapted mobile PHC packages

  • Community outreach in displacement settings

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19. Epidemic Preparedness & Community Resilience Doctrine

Key components:

  • Community surveillance

  • Local rapid response teams

  • Risk communication

  • Vaccination campaigns

  • Infection prevention & control (IPC) in communities

VIII. CROSS-CUTTING GLOBAL DOCTRINES

20. Gender Equity & Women’s Health Doctrine

PHC extension prioritizes:

  • Maternal health

  • Respectful maternity care

  • Girls’ education

  • Reproductive rights

  • Gender-based violence services

21. Child Survival & Development Doctrine

UNICEF’s PHC extension framework:

  • Immunization

  • Nutrition

  • iCCM

  • Newborn care

  • Early childhood development

22. Faith-Based and Cultural Competence Doctrine

Important for underserved traditional communities:

  • Cultural respect

  • Engagement of religious leaders

  • Spiritual and psychosocial support

  • Community trust-building

IX. FINANCING DOCTRINES FOR PHC EXTENSION

23. Essential Health Package (EHP) Doctrine

  • Low-cost, high-impact PHC interventions

  • Standardized national packages

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Examples:
BPHS, EPHS, BPEHS used in Africa and Asia.

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24. Donor Alignment Doctrine

Following:

  • GFATM

  • Gavi

  • USAID’s NPI

  • World Bank

  • WHO PHC compacts

Principles:

  • Harmonization

  • Country ownership

  • Sustainability

  • Results-based financing

SUMMARY: 24 TOTAL DOCTRINES

  1. Alma-Ata Doctrine

  2. Astana Doctrine

  3. Universal Health Coverage (UHC) Doctrine

  4. Community Health Systems Strengthening Doctrine

  5. Health Equity Doctrine

  6. Social Determinants of Health Doctrine

  7. Community-Based Delivery Doctrine

  8. Mobile Health & Outreach Doctrine

  9. Task-Shifting Doctrine

  10. Public Health Promotion Doctrine

  11. Integrated Service Delivery Doctrine

  12. Decentralization Doctrine

  13. Essential Medicines Doctrine

  14. Rural Workforce Doctrine

  15. HRH Crisis Doctrine

  16. Digital Health Doctrine

  17. Health Information Systems Doctrine

  18. Humanitarian PHC Doctrine

  19. Epidemic Preparedness Doctrine

  20. Gender Equity Doctrine

  21. Child Survival Doctrine

  22. Faith-Based Health Doctrine

  23. Essential Health Package Doctrine

  24. Donor Alignment Doctrine

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