초판발행 2021.06.04

“Oh, that you would bless me and enlarge my territory! Let your hand be with me, and keep me from harm so that I will be free from pain. And God granted his request (1 Chronicles 4:10)”.

I am honored to introduce the health book series “Primary Health Care: Tikapur Nepal Meets Ganghwa Republic of Korea!” to the international health care community, and I thank Professor Chun-Bae Kim for his willingness to assist in a rendering process for the advancement of primary health care in Volta, Ghana. The Korean version has already been selected as the 2020 Sejong Book (Outstanding Award of This Year) in the science & technology genre by the Publication Industry Promotion Agency of Korea, the Ministry of Culture, Sports and Tourism.

Access to health care has long been considered a human right in our world. This was formally declared to be the case in 1946 when the heads of various states wrote the constitution of the World Health Organization (WHO). In 2018, global and governmental health societies met to endorse a new declaration on primary health care in Astana, Kazakhstan. While the 1978 Alma-Ata declaration focused on building primary healthcare systems, particularly in countries with underdeveloped systems, the new declaration adopted a wider scope.

The commitment of the Astana declaration is “to make bold political choices for health across all sectors”, “to build sustainable primary health care”, and “to empower individuals and communities”. It reemphasizes the importance of primary health care in terms of addressing current health challenges, renewing political commitments to primary health care, and achieving universal health coverage. However, more than 70 years after the WHO’s declaration, the global community has not yet achieved this goal. Altogether, we believe that research and knowledge must be shared to improve the efficiency and innovation of primary health care and ensure its sustainability.

As you know well, Korea was in very poor shape due to the Korean War in the 1950s before experiencing the joy of liberation. However, with international cooperation and foreign aid from many developed countries including the United Nations, Korea achieved the miracle on the Han River and has since become an OECD member country. Until the 1970s, the regional healthcare system in Korea was naturally very weak in the journey of its economic and social development, and the health status of local residents was left unattended.

However, the Korean healthcare community has successfully carried out regional health projects in vulnerable areas in accordance with the spirit of primary health care, with assistance from the WHO as well as from various developed countries and international non-governmental organizations (INGOs). For example, health project teams in the Ganghwa area organized and operated a regional healthcare delivery system to overcome the difficult reality at that time, and they continuously published their project performance and research results to Korean and international academia. There was also an international development project in Nepal's Tikapur region, which was implemented in the 2010s to provide official development assistance (ODA) from Korea and which is delivered by next-generation health experts.

In order to share these valuable experiences and cases of primary health care in the international community, we are publishing an English version of this health book series. After collecting more than 2,200 articles and reports on community health projects in Korea and Nepal, we deviated from the preparation of the original book—the Korean version, which was written by a qualitative systematic review—by including a process of checking the copyrights of all the figures and tables cited in the text of this book. The copyright holders of some materials were separately paid usage fees for quotations (marked with the ‘permission’), while other materials were publicly available (creative commons attribution non-commercial license or 4.0 license); for these, the sources were identified at the bottom of each of the individual tables or figures. It may be difficult to find a copyright holder for each of the various materials in this book, so if you contact me, I will obtain permission to publish it again. I deeply appreciate the efforts of the researchers and institutions who prepared the numerous articles and reports that allow for the creation of evidence-based books such as this one and the corresponding citations.

This work is part of the Health and Medical Education Competency Enhancement Project of the University of Health & Allied Science (UHAS) in Ghana, which is facilitated by the Ministry of Education and supported by the National Research Foundation (NRF) of Korea. The goal of this project is to make the UHAS experience a new leap forward as a health-specialized higher education institution in Ghana while strengthening the capabilities of community health education at UHAS's medical school, nursing school, and iv Foreword health school. The aim is to help UHAS cultivate differentiated health professionals in the community health sector who can then help improve the health standards in other regions of Ghana and other countries in Africa. Over the last four years, since 2017, Yonsei University has been running a project supporting UHAS so that it can serve as the best public health college in terms of community health and contribute to the health improvement of the residents of Volta, Ghana. Therefore, we are preparing to provide a practical reference textbook that can provide information on building, changing, and implementing primary health care’s strategies so that professors and students can appropriately apply them in the field of community health in each stage of economic growth.

Further, we hope that this evidence-based book will help establish realistic, affordable, and effective regional healthcare delivery systems that are tailored to the economic and cultural level of each community to aid developing communities that still lack access to essential services for primary health care. In the midst of the public health crisis of the COVID-19 pandemic, we also hope that all countries can apply the philosophy and principles of primary health care to suit their health care systems and smoothly overcome their specific challenges.

Once again, I sincerely appreciate Dr. Chun-Bae Kim for inviting and helping me with this tedious and difficult work process. I would like to express my gratitude to not only Sangwon Jung, Dae Won Jung, Soobin Kim, Eun Kyung Lim, and Jonghyeok Kim from the Harvesters’ Mission International School in Philippines, but also to Young-Joo Lee, Hyun-Joo Lee, and Dr. Jung Ran Choi from Yonsei University Wonju College of Medicine, Hyo Jung Sea from Yonsei University Graduate School PhD course student for their invaluable assistance in helping translate and edit this book. I also appreciate the meticulous professional proofreading by Julia W. of HARRISCO-Encorrection. In addition, I would like to thank the researchers who made efforts to publish this book while participating in the Health and Medical Education Competency Enhancement Project of University of Health & Allied Science (UHAS) in Ghana, as well as the National Research Foundation of Korea (NRF) who supported the production of this book. Finally, I would like to thank Jong-Man Ahn as CEO and Grace Choi as editor of Parkyoung Press for their guidance throughout this publishing process.

March 31, 2021

Professor So Yoon Kim, Yonsei University College of Medicine

Chun-Bae Kim (kimcb@yonsei.ac.kr), MD, MPH, MEP, PhD, is a Professor of the Department of Preventive Medicine, Yonsei University Wonju College of Medicine in Korea. He participated in the Ganghwa Community 

Demonstration Health Project as a director of Ganghwa Community Health Institute from 1994 to 1995, and in the Project for Health Services Improvement in Tikapur, Nepal (HIT project) as a project coordinator from 2011 to 2015. Since 2012, he has taken a lead role in implementing the Hongcheon County Hypertension and Diabetes Registration and Education Center initiative which has brought together community medicine and primary health care. Till now, he has published more than 140 articles (including Korean and International Journals), focusing on issues such as global health, community medicine, systematic review, and health policy evaluation, etc. 

So-Yoon Kim (syoonkim@yuhs.ac), MD, MPH, PhD, is a Professor of Division of Medical Law and Ethics, Department of Humanities and Social Medicine, Yonsei University College of Medicine in Korea. Now, she is working as a director of the Asian Institute for Bioethics and Health Law (WHO Collaborating Center for Health Law & Bioethics) and Division of International Health Science, Graduate School of Public Health, Yonsei University. Also, she is serving as editor-in-chief of the Journal of Global Health Science (JGHS) in the Korean Society of Global Health. 

Foreword iii

Recommendation of English Version v

Preface viii

Recommendation of Korean Version x

About the Joint Translation Authors xii

Co-author Members of Korean Version xiii

Abbreviations xiv

Part 1 Going into

Chapter 01 Introduction: For Searching the Meaning of International Development 

and Community Health in Ganghwa and Tikapur Community Health Projects 3

1.1 International Development in Korea: Following the Footsteps 3

1.2 Link between Community Health Projects in Tikapur Nepal and Ganghwa Republic of Korea 10

1.3 Composition of this Book 12

Part 2 The Link between International Development and Primary Health Care

Chapter 02 Past, Present, and Future of International Development 17

2.1 International Development 17

2.2 Health as an International Development Agenda 21

Chapter 03 Past, Present and Future of Primary Health Care: 

From Alma-Ata Declaration to Astana Declaration 25

3.1 Primary Health Care: Declaration of Alma-Ata 25

3.2 Approach to Primary Health Care and Regional Health Care System in the Global Society 27

3.3 Approach to Primary Health Care in Korea 28

3.4 UN Millennium Development Goals and Sustainable Development Goals 31

3.5 30th Anniversary for Alma-Ata Declaration and Revision on Primary Health Care 32

3.6 Primary Health Care: Astana Declaration 2018 38

3.7 What Can Be Learned from the Alma-Ata Primary Health Care Movement? 40

Chapter 04 Link between International Development and Primary Health Care: 

Case Study on Community Health Projects in Korea and Nepal 45

4.1 International Development Aid to Korea: Toward Primary Health Care 45

4.2 International Development Aid to Nepal: Forward Primary Health Care 66

4.3 The Characteristics of Community Health (Demonstration) Project in Korea and Nepal: 

Similarities and Differences 75

Part 3 The Link of International and Regional Development

Chapter 05 Establishment and Performance of Health Care Infra-structure in Ganghwa and Tikapur 83

5.1 Selection of Regions for International Comparison in the Primary Health Care Level 83

5.2 Approaches for Performance Evaluation of Community Health Project 85

5.3 Frame on the Content Analysis Study of Community Health Project 85

5.4 Implementation Progress of Community Health Pilot Project 85

5.5 Content Analysis of the Pilot Projects in terms of Structure 102

5.6 Content Analysis of the Pilot Projects in terms of Process 107

5.7 Content Analysis of the Pilot Projects in terms of Performance 115

5.8 Lessons and Policy Implication from HIT Project for ODA Support and Project Management 

by Comparing the Pilot Projects 119

Chapter 06 Strategies for Strengthening the Health Care System to Expand Primary Health Care 135

6.1 A Conceptual Approach to Analysis in accordance with the Strategy 

for Health (Care) Systems Strengthening 135

6.2 Strategy and Performance of HSS in terms of Health Workforce 135

6.3 Strategy and Performance of HSS in terms of Financing 139

6.4 Strategy and Performance of HSS in terms of Health Service Delivery 143

6.5 Strategy and Performance of HSS in terms of Health Management Information System 144

Chapter 07 Key Health Program for Achieving Primary Health Care and MDGs: 

Maternal and Child Health Care 157

7.1 Maternal and Child Health Program in Ganghwa, Korea 157

7.2 Maternal and Child Health Program in Tikapur, Nepal 162

7.3 Evaluation and Lessons of Maternal and Child Health Programs in Ganghwa and Tikapur 167

Chapter 08 Control of Communicable Diseases according to the Periodic (Economic) 

and Geographical Characteristics of Project Areas 175

8.1 Tuberculosis Control Program in Ganghwa, Korea 175

8.2 Resurgence of Malaria by Geographical Characteristics in Ganghwa, Korea 179

8.3 Malaria Control Program in Tikapur, Kailali District, Nepal 189

8.4 HIV/AIDS Epidemic by Geographical Characteristics in Kailali Distric, Nepal 195

Chapter 09 Management of Chronic Diseases and Evaluation of Mortality Level 

by the Establishment of Kangwha Cohort 203

9.1 Cancer Control Programs by Establishment of Kangwha Cancer Cohort 203

9.2 Establishment of Kangwha Blood Pressure Cohort 

for Chronic Disease (Hypertension) Management Program 219

9.3 Establishment of Kangwha Cohort for Reduction of Preventable Early Death 236

Part 4 Leaving

Chapter 10 Implications for International Health and Regional Development in Ganghwa and Tikapur 

Community Health Projects 259

10.1 What Does the Comparison Case of Ganghwa and Tikapur Mean to the Development 

and Evaluation of the Model for International Health Projects in Korea? 259

10.2 What Implication Does the Case of Ganghwa and Tikapur as Community Health Projects Have 

for Regional Development? 261

10.3 Summing-up and Policy Implication for Primary Health Care 263

Annex

Annex 1 UN Millennium Development Goals and Sustainable Development Goals 268

Annex 2 List of Reports and Research Articles by Region on the Primary Health Care 

related Pilot Health Projects in Korea 273

Annex 3 List of Research Articles by Region on the Primary Health Care 

related Pilot Health Projects in Nepal 289

Annex 4-1 (Research) Team of Ganghwa Community Health Project in Korea 299

Annex 4-2 (Operation) Team of HIT Project in Nepal 300

Annex 5 Qualitative Systematic Review of Research Articles (Other Sections) 

for the Ganghwa Community Health Project 302

Annex 6 Qualitative Systematic Review of Research on Kailali District, 

the Site for the HIT Project in Nepal 308

Index 311