Community oriented primary care: origins, evolution, applications.

Community oriented primary care is a commonly used term applied to a variety of situations and programs. Its use frequently extends beyond an understanding of its specific elements or an appreciation of its history and development. This article discusses the origins and evolution of the ideas, theory and practice of community oriented primary care. In South Africa in the 1940s a team headed by Sidney Kark embarked on work in the Pholela region of Natal that became the forerunner of ideas that were later formalized and systematized under the rubric of community oriented primary care. Widespread implementation took place in South Africa but was prematurely curtailed following the accession to power of the National Party. By the early 1960s many in the team had moved to Jerusalem where the theoretical basis of the concept was strengthened and came to describe a form of practice in which aspects of primary medical care and community health are integrated and systematically applied to a defined community. Experience with community oriented primary care in the United States and elsewhere is growing. This experience is reviewed and an assessment and critique offered.