An alternative strategy in community health care: community-oriented primary health care

Isr J Med Sci. 1983 Aug;19(8):707-13.


The need for alternative strategies in providing personal health services in the community is discussed in relation to Israel, which has a widespread network of community-based curative clinics and preventive family health centers. Community-oriented primary health care (C-OPHC) is the major alternative strategy, which has been developed and evaluated by the Hadassah Teaching and Research Health Center in Kiryat Hayovel, a neighborhood of Jerusalem. The case for adapting this C-OPHC approach throughout the country is presented in a review of existing primary health care services.

PIP: Community-oriented primary health care (COPHC), which coordinates individual clinical care and community medicine, requires a change in both orientation and skills. Although Israel has a network of over 2000 community-based curative clinics and preventive family health centers, they are not necessarily community-oriented facilities. The increasing age of Israel's population and the prevalence of chronic diseases in younger age groups indicate a need for integration of health and personal social services in the community. This strategy has been implemented at the Jerusalem Kiryat Hayovel Teaching and Research Health Center. 1 of its programs aimed to reduce the gap in intelligence and development quotients between infants of poorly educated mothers and those with more educated mothers. All children in the community served by the health center's maternal and child health service were involved. Other interventions at this center have focused on family formation and reproduction, infant and child health, control of cardiovascular diseases, and surveillance of acute infectious illness. Among the important features of COPHC are the following: 1) definition of the population; 2) defined community health programs; 3) use of epidemiologic and clinical skills as complementary functions; 4) accessibility; 5) involvement of the community in the promotion of its health; 6) coordination of activities, including the integration of different types of health care, specialties, services, and instritutions; and 7) a comprehensive approach to health care. In countries such as Israel, the community medicine orientation can be integrated into existing primary care practice. The Israel experience demonstrates several encouraging trends. 1st, the scope of preventive maternal and child health centers has been widened to family health centers, which now include care of the aged, chronically ill, and mentally ill. 2nd, community programs focused on the prevention and control of risk factors for cardiovascular diseases have been implemented. 3rd, the need for an appropriately trained staff has been recognized. All 4 medical schools in Israel have facilties for students to participate in community-based primary care. Research and controlled trials on the development of community health care and its effectiveness and suitability in the different communities of the country are needed.

MeSH terms

  • Child
  • Community Health Services / organization & administration*
  • Community Health Services / trends
  • Female
  • Health Promotion / organization & administration
  • Humans
  • Insurance, Health / organization & administration
  • Israel
  • Maternal-Child Health Centers / organization & administration
  • Preventive Health Services / organization & administration
  • Primary Health Care / organization & administration*
  • Primary Health Care / trends