Axioms of Community Health

Axioms are statements or Ideas believed to be true by people. These axioms were derived from the early engagement of Community Health Cell with the community health movement in India in the first two years of the study reflection action experiment began in January 1984.

 

A mimeographed report entitled "Community Health: the search for an alternative process" was first circulated in 1987 in which these 10 axioms derived from the movement were enumerated. In 2011, during the celebration of 20 years of SOCHARA as a society (1991-2011) this reflective report popularly known by then as the red report was re-printed as “Community Health in search of Alternative Processes”. The Axioms listed below are taken from this new publication.

Axiom 1. Rights and responsibilities

Community Health is a process of enabling people, to exercise collectively their responsibility, to their own health and to demand health as their right.

Axiom 2. Autonomy over health

The Community Health Approach involves the increasing of the individual, family and community autonomy over health and over the organizations, the means, the opportunities, the knowledge and the supportive structures that make health possible.

Axiom 3. Integration of health and development activities

The community health approach includes

  • An attempt to integrate health with development activities including education, agricultural extension and income generation programmes.
  • An attempt to orient existing medical programmes towards preventive, promotive and rehabilitative actions.
  • A search for and experimentation with low-cost, effective, appropriate technology in health care, health communications and recording systems.
  • A recognition and involvement of local, indigenous, health resources like traditional healers, folk-medicine practitioners, traditional birth attendants (dais), non allopathic systems of medicine, herbal medicines and time-tested home remedies.
  • An initiation of greater community organisation through farmers, youth and women's clubs.
  • An increasing involvement and participation of the community, through formal and informal organisations and health committees, in decision making for health action including planning, financing, organising and evaluation of health actions;
  • A quest for generating greater community support in health action through cooperatives, health insurance and other schemes as well as tapping locally available labour, human skills and material resources.
  • An organisation of informal and non-formal demystifying and conscienting programmes of education for health.

Axiom 4. Building decentralized democracy at community and team level

The community health approach

  • Essentially a democratic, decentralized participatory, people-building and people empowering activity.
  • Recognises that this new value system must pervade the interaction between the community and the 'health action' initiators as well as within the team of 'health action' initiators themselves.
  • Enhances the 'community health' approach. It is "therefore, necessary for 'health action' initiating teams to evolve a greater democratic, non-hierarchical, participatory, team-building and 'team empowering' ethos in their own relationships as individuals and members of a team.

Axiom 5. Building equity and empowering community beyond social conflicts

The community health approach recognises that in the present inequitous and stratified social system there is no 'community' in the real sense of the word and hence community health action will invariably mean, the increasing organisation, involvement and participation of the large sections of the community, who do not participate adequately in decision making at present i.e. the poor, the under-privileged, the marginalizedsuch attempts will invariably be opposed by 'status quo' forces and all those who draw greater advantage from the present situation.

Axiom 6. Promoting and enhancing the sense of community

The community health approach recognises that the large majority, the poor and the disadvantaged are not themselves 'one community' even though they are linked by their poverty and social situation, since they have internalised various social, cultural religious and political differences that divide society at large.

Axiom 7. Confronting the biomedical model with new attitudes skills and approaches

The community health approach recognises that the present over medicalised health care system is characterised by certain features viz:

  • Hierarchical team functioning and non participatory decision making.
  • Water-tight division of responsibilities with over-emphasis on the role of doctors.
  • Quest for specialisation and compartmentalization of professional activities.
  • A pre-occupation with the understanding of human illness in terms of an organ centredness and at intracellular, molecular levels, forgetting the whole 'being' in the process.
  • A clear distinction between 'providers' of the service and the 'users' of the service.
  • An over-emphasis of the 'physical' dimension of health and a disregard for the psychological, social, cultural, spiritual, ecological and political dimensions.
  • Over-professionalisation which controls the spread of technical knowledge and skills to members of the health team and to the people at large.
  • Providing orientation of services and actions rather than the 'enabling' orientation.
  • An over-emphasis on drugs and technology leading to a complete disregard for non-drug therapy and skills.

Axiom 8. Confronting the existing super structure of medical / health care to be more people and community oriented

The community health approach evolves action from the community outwards and upwards confronting the various components of the existing superstructure of health services which includes:

  • Primary health centres, dispensaries, hospitals, teaching and research institutions.
  • Medical, nursing, paramedical and public health teams and professional training centres and associations.
  • Health programmes and health institutions under government or nongovernmental voluntary agency auspices.

Axiom 9. A new vision of health and health care and not a professional package of illness

The Community Health Approach is therefore not just a speciality, a new professional discipline, a new 'technological fix' or a new package of actions. It is predominantly a new vision of 'health' and 'health care', a new attitude of mind, a new' value orientation' in health action and a new perspective for the future linked to a new vision of society. It must therefore, pervade existing health care systems, institutions, research efforts, training programmes, professional ethics and health planning exercises.

Axiom 10. An effort to build a system in which Health For All can become a reality

Community Health Action is closely intertwined with efforts to build an alternative socio-political-economic-cultural system in which health can become a reality for all people.

The 'community health approach' therefore recognises that the components of actions are means and not ends, and will therefore be flexible enough to reorient, reprioritize, disband or change towards more relevant actions and directions as they evolve in the interactions at the community level.