Visualising Primary Health Care: World Health Organization Representations of Community Health Workers, 1970-89

Alexander Medcalf*, João Nunes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


For the World Health Organization (WHO), the 1978 Alma-Ata Declaration marked a move away from the disease-specific and technologically-focused programmes of the 1950s and 1960s towards a reimagined strategy to provide 'Health for All by the Year 2000'. This new approach was centred on primary health care, a vision based on acceptable methods and appropriate technologies, devised in collaboration with communities and dependent on their full participation. Since 1948, the WHO had used mass communications strategies to publicise its initiatives and shape public attitudes, and the policy shift in the 1970s required a new visual strategy. In this context, community health workers (CHWs) played a central role as key visual identifiers of Health for All. This article examines a period of picturing and public information work on the part of the WHO regarding CHWs. It sets out to understand how the visual politics of the WHO changed to accommodate PHC as a new priority programme from the 1970s onwards. The argument tracks attempts to define CHWs and examines the techniques employed by the WHO during the 1970s and early 1980s to promote the concept to different audiences around the world. It then moves to explore how the process was evaluated, as well as the difficulties in procuring fresh imagery. Finally, the article traces these representations through the 1980s, when community approaches came under sustained pressure from external and internal factors and imagery took on the supplementary role of defending the concept.

Original languageEnglish
Pages (from-to)401-424
Number of pages24
JournalMedical History
Issue number4
Early online date7 Sept 2018
Publication statusPublished - Oct 2018

Bibliographical note

© The Author(s) 2018. Published by Cambridge University Press.
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.


  • Community health workers
  • Global health
  • Photography
  • Primary health care
  • Public information
  • World Health Organization

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