TY - JOUR T1 - Three-way partnerships fuel primary health care success JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-001579 VL - 4 IS - Suppl 8 SP - e001579 AU - Abdul Ghaffar AU - Soumya Swaminathan AU - Anuradha Gupta AU - Stefan Swartling Peterson AU - David Bishai Y1 - 2019/08/01 UR - http://gh.bmj.com/content/4/Suppl_8/e001579.abstract N2 - In the summer of 1970, Drs Raj and Mabelle Arole finished their graduate public health studies in the USA and arrived in rural Maharashtra, India, searching for a community where they could make a difference. They had a primary health care (PHC) blueprint for community health improvement in rural India that had everything anyone could ask for. They envisioned a small hospital surrounded by subcentres, teams of nurses and paramedical workers, sanitation work, integration of prevention and cure and community participation. A community meeting with villagers in a potential site seemed like a textbook beginning. They described their first such meeting in Osmanabad district.1 The village leader had ordered 40 village heads to the meeting. None of them spoke; they nodded assent to all of the leader’s suggestions. Dr Arole suggested that they should hear from the villagers. The host found the suggestion perplexing, saying ‘I just have to give the order and the people will follow’.If they had merely been interested in building a medical clinic to provide primary medical care, then an alliance with a powerful local politician would have been supremely attractive. That power would have helped to secure facilities and patronage that propel success in organising medical care. However, the Aroles dreamed of much more than just delivering primary care, and they clung to their vision. They moved to a neighbouring district and persisted in building the community partnerships that became the foundation of their half century of success in Jamkhed.2 The slow path to create those partnerships started with building trust by listening and being willing to adapt their original blueprint. As it turned out, the highest priority of the people of Jamkhed was just to secure better access to medical care, and so the doctors focused on clinical services first, even … ER -