Professor of Primary Healthcare Research at the Graduate Entry Medical School (GEMS), University of Limerick.
Community participation in primary healthcare is enshrined in international policies since the 1970s and has been re-emphasised since then, most recently in the 2018 WHO Astana Declaration. The concept of community participation comes from a social justice perspective. It emphasises that the participation of communities and groups who experience poverty and social exclusion is essential to the development of primary health care services in order to shape these services and make them relevant to those with the greatest need. This is important if we are to address the well-documented Inverse Care Law.
However, in practice, there is a clear pattern of exclusion whereby so-called “hard to reach” groups are not adequately involved in primary healthcare decision-making. This is the case for refugees and migrants who arrive to settle and integrate in host countries in Europe. The recent WHO Strategy and Action Plan for Refugee and Migrant Health (2016) is a call for action for multiple stakeholders, including those in primary care and public health, to disrupt this pattern of exclusion and improve the health of refugees and migrants.
Drawing on the rich tradition of participatory health research is valuable as a way forward because it can provide important concepts, tools and techniques to address this problem. There are innovative examples of successful structures and interactions in family practice settings from North America and around Europe. These have re-imagined participatory spaces and have brought together diverse stakeholders from a variety of backgrounds with differential power and social status. They can provide guidance about how to involve refugees and migrants in research and practice development to realise community participation in primary healthcare, for all.
Anne MacFarlane is Professor of Primary Healthcare Research at the Graduate Entry Medical School (GEMS), University of Limerick. She is the first social scientist to hold a Chair in academic primary care in Ireland. She has 20 years' experience of using qualitative research methods with a portfolio of completed health services research projects and educational research projects. Anne has been successful in securing research income of over €10 million euro for primary healthcare research and development projects.
Anne graduated with a B.A. (psychology and sociology) from University College Cork in 1992. She completed her M.A. (1995) and PhD (1998) in the Department of Health Promotion, NUI Galway. She worked as a Research Fellow in University College London (2000-2002) before returning to NUI Galway where she held positions as a HRB Health Services Research Fellow and Lecturer in Primary Care in the Department of General Practice (2002-2011).
At University of Limerick, Anne has established an inter-disciplinary Public and Patient Involvement (PPI) research group at GEMS with members from general practice, speech and language therapy, physiotherapy, sociology, psychology and biostatistics. The group are leaders in PPI in research, specifically participatory health research with socially excluded communities. Anne has specialist expertise in migrant health working with key academic, community and policy stakeholders in Ireland and abroad. The PPI Research Unit has been designated as a World Health Organisation Collaborating Centre for Migrant’s Involvement in Health Research.