Paper short abstract:

Alma Ata inspired community healthcare was implemented in Guinea-Bissau from 1978 to 2012. Examination exposed how changes in global health policies impacted on its execution. Aid dependency led Guinea-Bissau to align revitalized policy with global trends, but failed to consider local realities.

Paper long abstract:

This paper examines the implementation of community-based primary health care in Guinea-Bissau, inspired by the Alma Ata Declaration in 1978. It is based on 20 months of ethnographic fieldwork in 2009-2012.

In 1977, a community health program was initiated in Guinea-Bissau with assistance of donors. Village health units were constructed and staffed with volunteer community health workers (CHWs) and traditional birth attendants (TBAs). In the 1990s, villagers appreciated community health care and its implementation was considered successful. Due to a range of circumstances, including shifts in donors' priorities, aid shock, and a military uprising in 1998, the first decade of the 21st century resulted in degradation of community health care. In 2010, the Ministry of Health elaborated a new community health policy in collaboration with donors that emphasized professionalization of CHWs whilst excluding TBAs. The Ministry of Health was to lead implementation, but due to military coup in 2012, it was bypassed by donors with NGOs taking on a prominent role.

This paper argues that the health policy of Guinea-Bissau has been influenced by swift changes in global health policies and priorities. Due to its aid dependency, the country realigned its new policy with global trends hoping to improve its indicators for the Millennium Development Goals. However, the policy did not take local realities into consideration, leading to discontent among villagers who were not consulted. This study shows that despite the appeal of volunteer work and community participation, community health care is neither cheap nor easy to implement.