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  1. 1
    Peer Reviewed

    Medicalization and its discontents.

    Goodman MJ; Goodman LE

    Social Science and Medicine. 1987; 25(6):733-40.

    In 1978 leaders from 134 governments and 67 UN bodies proclaimed their union of purpose to bring Health For All by 2000. They described health in terms of access to primary health care, not the freedom of disease. The plan they developed was designed to bring all health care providers together, be they medical doctors (MDs) from Western medical schools herbalists, shamans or barefoot doctors. The plan was to create a system of referrals where people would initially turn to their traditional healers for help and then be moved along the system as the complexity of the condition exceeded the ability of attending healer. However, the system failed because of 3 major factors: political resistance, professional and economic inertia, and chauvinism and emulousness called the Jazz Factor. Instead of acting like a funnel to move people along the system from the less advanced to the more advanced healers, it acted like a filter. The political resistance is clearly seen when a careful examination of the AIDS virus is made. Many African nations refused to acknowledge that AIDS was even in their countries. Thailand was so fearful of losing tourism dollars that it covered up the fact that many of their prostitutes are infected. US servicemen are tested and discharged if they are found to be infected. In many US states people's rights to privacy hamper the control of the spread of AIDS. The sexual revolution is founded on liberal principles of freedom. The result is the right of individuals to spread the disease if they so choose. Economics plays its role when we see the linking of profit motive and the public interest in the health care area. The Jazz Factor refers to the practice of considering prestige over practicality. Oral rehydration therapy is an excellent example of this. Today dehydration caused by diarrhea is the single biggest cause of death among children. Yet the cure is so simple, so easy, and so inexpensive that it is within the reach of almost every family on earth. 1 reason given for this fact that there is no profit to be made from ORT. Today health care professionals still prescribe US$400 million worth of antidiarrheal drugs.
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  2. 2

    An introduction to the primary health care approach in developing countries. A review with selected annotated references.

    Walt G; Vaughan P

    London, London School of Hygiene and Tropical Medicine, Ross Institute of Tropical Hygiene, 1981 Jul. 61 p. (Ross Institute of Tropical Hygiene Publication No. 13)

    This introduction to the primary health care (PHC) approach in developing countries is for those who want to examine health in the broader context, particularly with reference to the many development issues involved. The included annotated references were selected primarily from material published since 1975 with a view toward illustrating the many facets of health and development that the PHC approach encompasses. Some annotations are not directly related to health but are included because they address questions that affect health policy. An introductory section reviews the following: changing theories about health and development, concerns about poverty and population growth, attacking the medical care model, community involvement, and the implications of implementing PHC (political and economic implications and planning and management problems). The current emphasis on health as an aspect of development can be seen partly as a reaction against the neglect of health, and other social dimensions of welfare, in the literature on development produced in the 1950s and 1960s as a guide to economic and social policy in the newly independent countries of the 3rd world. Recent criticisms of earlier development theories emphasize the politics of inequality and particularly the way in which urban elites were consuming health service resources at the expense of the majority rural populations and the concept of health as part of an integrated package that would help conquer underdevelopment. A fairly general consensus still exists that fertility must be controlled if poor countries are to develop. While the pattern of thinking about health was moving from medical care to health services and from disease care to health care what was not being discussed from within was the concept of community development in its own health care. That came from another source, during the 1970s, especially from reports of experiences in China and their idea of the Chinese barefoot doctor. In sum, the sources of ideas that led to the primary health care approach were changing theories of development, concern about population growth, disenchantment with a technological approach to diseases and medical services which failed to sufficiently consider social, economic, and political aspects of life, and reported success of community participation in health. The basic components of a primary health care service are: education about diseases, health problems, and their control; safe water and basic sanitation; maternal and child care, including family planning; immunization against major infectious diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.
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  3. 3

    Auxiliaries in primary health care: an annotated bibliography.

    Elliott K ed

    London, Intermediate Technologies Publications, 1979. 126 p.

    This bibliography was compiled by the Appropriate Health Resources and Technologies Action Group Limited, an organization which functions as a clearing house for information on alternative forms of health care and which is also an official collaborating center of WHO. The bibliography provides references on the use of auxiliary health personnel in the delivery of primary health care services. There are 357 references and each one includes an abstract. The bibliography is divided into 2 sections. The 1st section contains references to 144 articles, books, and manuals which can serve as tools in education and training auxiliary health personnel. The documents provide information ranging from techniques to control houseflies and recipes for low cost weaning foods to techniques for disease diagnosis and methods for developing effective communication between health personnel and the community. The second section is entitled "Auxiliaries and Community Health and Development" and contains references to 213 documents. Most of these documents describe specific programs in which auxiliary health personnel participate or discuss the potential of using auxiliary health personnel to promote development programs. Names and addresses of a variety of organizations, universities, and agencies concerned with the training and utilization of nonprofessional health personnel are listed by country.
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  4. 4

    Local responses to global problems: a key to meeting basic human needs.


    Washington, D.C., Worldwatch Institute, February 1978. (Worldwatch Paper No. 17) 64 p

    According to a World Bank estimate, large scale international efforts to improve social and economic conditions in developing countries would cost 47.1 billion dollars between 1980-2000. Since rich countries have not been disposed in the past to contribute heavily toward solving these problems, it is unlikely that they will commit themselves to this type of financial help in the future. Collective, self-help efforts on the local level may offer a feasible alternative for aleviating global problems of inadequate housing, food shortages, insufficient medical care, and energy shortages. Small scale efforts which enlist community involvement in the initiation, planning, and carrying out of projects are frequently more effective in creating uplift than are larger efforts controlled by individuals outside the community. Attempts to provide better housing for the poor through building large public housing complexes are costly and tend to create non-livable conditions for many of the poor; self-help efforts such as homesteading and rehabilitation, on the other hand, have been more successful. In developing areas massive national programs to relocate squatters have failed. Efforts to help squatters improve the dwellings they presently inhabit may be a more fruitful approach. The recent emphasis on garden plots for urban dwellers and small labor intensive family farms along with marketing cooperatives in the rural areas may reduce malnutrition and protect the poor from inflationary food prices. At the present time 1/5 of the world's population is still without medical care and many others have inadequate health care. The mobilization of individuals for self care, especially in regard to disease prevention, and the decentralization of health services through the establishment of neighborhood health centers, family planning clinics, and systems utilizing barefoot doctors can help overcome present health deficiencies. The energy problem can be partially solved by individual efforts to conserve resources. Many individuals and communities are developing local solar, wind, and water sources and are thus reducing reliance on the highly centralized energy industries.
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  5. 5

    Background on traditional midwives.

    Rogers EM; Solomon DS

    In: Rogers, E.M. and Solomon, D.S. Traditional midwives as family planning communicators in Asia. Honolulu, Hawaii, East-West Communication Institute, (1975). (East-West Communication Institute Case Study No. 1) p. 9-64

    Several topics are presented to provide an understanding of the child delivery and related services of traditional midwives and their potential for family planning communication. The chapter contains an argument for the importance of traditional medicine and health systems in introducing scientific health and family planning ideas; a work-picture of characteristics of midwives; background or research and programs in each country of study; and a discussion of barefoot doctors in China. The rise of the dais in India; the downfall of the dais in Pakistan; the dukuns in Indonesia; kampong bidans in Malaysia; hilots in the Philippines; the Cebu City study of mananabangs; moh tam yae in Thailand; and parteras in Mexico are specifically discussed.
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  6. 6

    Primary health care--the Chinese experience: report of an inter-regional seminar.

    World Health Organization [WHO]

    Geneva, World Health Organization, 1983. 105 p.

    The Inter-regional Seminar on Primary Health Care was held to examine the Chinese system of health care and to consider the lessons that other countries can draw from this unique experience. 4 specific areas were examined: China's 3-level (county, commune, and brigade) health care network, involvement of the people, health manpower development, and financing of rural health care. In China, health is seen as the goal of all sectors, not simply the health sector alone. The organizational structures of the brigades and communes, designed primarily for production, are utilized for health campaigns and other social development projects. The Patriotic Health Campaigns, which emphasize disease prevention and general health promotion, have mobilized people on a large scale and achieved outstanding results in the field of parasitic diseases and vector control. Health manpower development initially placed emphasis on meeting the basic needs of the community, notably through the introduction of new categories such as the barefoot doctor. With the achievement of basic coverage, there was a shift to the upgrading of both the status and professional competence of each personnel category. The degree of decentralization is such that over 80% of health expenditure occurs within the 3-level network system, and 65% at the commune level or below. 4 factors were identified as having contributed to the high level of primary health care in China: 1) political commitment to the task of changing the quality of life of all people, especially the rural population; 2) reorganization of China's social and economic structure, including its decentralization, and the integration of the health sector with all aspects of social and economic development; 3) concerted action in many sectors (e.g., income distribution, family planning, mass education) aimed at improvement of health status; 4) participation of the people in the provision of health services, management of the system, and mass campaigns; and 5) use of appropriate technology. The Chinese experience shows that health for all can be achieved despite limited resources and a low per capita income.
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