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Health for the Millions. 2004 Jan; 30(4-5):28-29.Availability of essential drugs has been one of the major components of the Alma Ata Charter. Dr. Halfden Mahler, former Director General, WHO had called increasing pharmaceuticalisation of health care and the increasing power of the drug corporators and the drug exporting countries as neo colonialism. He set up the Drug Action Program in WHO that reported to him directly. The model essential drug list was brought out and the guidelines for National Drug Policy were drawn. (excerpt)
Perspectives in Health. 2003; 8(2):3-7.This year marks the 25th anniversary of the first International Conference on Primary Health Care in Alma- Ata, Kazakhstan, an event of major historical significance. Convened by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Alma-Ata drew representatives from 134 countries, 67 international organizations and many non-governmental organizations. China, unfortunately, was notably absent. By the end of the three-day event, nearly all of the world's countries had signed on to an ambitious commitment. The meeting itself, the final Declaration of Alma-Ata and its Recommendations mobilized countries worldwide to embark on a process of slow but steady progress toward the social and political goal of "Health for All." Since then, Alma-Ata and primary health care have become inseparable terms. A quarter century later, it is useful to look back on the event and its historical context – particularly on the theme of "Health for All" in its original sense. For one who was a direct witness to these events, it is clear that the concept has been repeatedly misinterpreted and distorted. It has fallen victim to oversimplification and voguishly facile interpretations, as well as to our mental and behavioral conditioning to an obsolete world model that continues to confuse the concepts of health and integral care with curative medical treatment focused almost entirely on disease. (author's)
The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
International Workshop on Youth Participation in Population, Environment, Development at Colombo, 28th Nov. 83 to 2nd Dec. 83.
Maribo, Denmark, WAY, . 120 p.The objectives of the International Youth Workshop on Population and Development were to provide a forum to the leaders of national youth councils and socio-political youth organizations. These leaders were brought together to review national and local youth activities and their plans and action programs for the future. The outlook for these discussions was local, regional, and global. In addition the Workshop aimed at providing interaction among the youth organizations of the developing and the developed countries. These proceedings include an inaugural address by Gemini Atukorata, Minister of Youth Affairs, Government of Sri Lanka and presentations focusing on the following: youth and development; the key role of youth in production and reproduction -- important factors of development; 60% of the aid goes back to the giving country in several ways; adolescent fertility as a major concern; social development for the poor with particular reference to the well-being of children and women; commitment for the cause is the key to attract funds; and observance of the International Youth Year under the themes of participation, development, and peace. The 11th workshop session dealt with follow-up and the future direction of the World Assembly of Youth (WAY). The following points emerged in this most important session: WAY should emphasize "Youth Participation in Development" as the major program; WAY's population programs should not be limited to just information, education, and communication, and youth groups should be encouraged to become service delivery agents for contraceptives wherever possible; environment awareness should become an integral part of population and development programs; youth in the service of children, health for all, and drug abuse should be the new areas of operation for WAY; and programs of youth working in the service of disabled, especially disabled young people, and youth and crime prevention programs also found favor with the participants. Recommendations and action programs are outlined. Proceedings include a summary of WAY activities and resolutions.
WORLD HEALTH FORUM. 1997; 18(2):107-15.In 1996, the World Health Organization (WHO) identified the following issues for consideration as it designed its new strategy to achieve "health for all" in the 21st century: the determinants of health, health patterns in the future, intersectoral action, essential public health functions, partnerships in health, human resources for health, and the role of the WHO. Because ethical considerations play a vital role in developing the strategy, the WHO sought the input of the Council for International Organizations of Medical Sciences in this regard. As understanding of the role and nature of medical ethics has deepened in the past decades, new ethical questions are continually being raised by changing patterns of disease and health care and by technological advances. The new health-for-all strategy must, therefore, give prominence to the consideration of equity, utility, equality, and human rights. In order to attain justice, the equilibrium between equity and equality should be maintained. Cultural diversity will also inform notions of equity. The principles of primary health care contained in the WHO's Alma-Ata Declaration also need to be strengthened to place proper emphasis on the need for information systems, decision-making mechanisms, and support systems. The most important activities the WHO is applying to its effort to renew its "health for all" strategy are 1) clarifying the concepts; 2) strengthening links to related fields; 3) working in partnership with countries, regions, and organizations; and 4) promoting the dissemination of information and ideas. The WHO's renewed strategy must bring clarity, practicality, and effectiveness to global health activities while fostering an understanding of the moral issues that contribute to human well-being.
BMJ. British Medical Journal. 1995 Oct 7; 311(7010):891-2.Over the past 30 years a wide range of developing countries have successfully developed a model of primary health care promoted by the World Health Organization (WHO). It differs fundamentally from the primary care system in the United Kingdom, which relies more on technical and curative care than the community-oriented approach. In the 1950s and 1960s many developing countries faced a daunting task. A different model of care emerged, which recognized that the health of populations was determined by factors other than medical care and that these factors could be controlled by communities themselves, through collaboration with agriculture, water sanitation, and education in a spirit of self reliance. By the 1970s WHO had formulated this model and declared at Alma Ata that Health for All was achievable through primary health care by 2000. The West's reaction to this model was to support it in developing countries by giving aid but to reject it for the West's own countries. The medical model was powerful, and its proponents argued that populations would become healthier with more doctors and hospitals. The West's second reaction was political. Socialist countries such as China, Cuba, and Tanzania had fully adopted primary health care and the concepts of community participation. Such reforms resulted in dramatic improvements in health status in many countries. After the introduction of barefoot doctors, for example, in China mortality among children under five fell from more than 175 per 1000 live births to under 49. With the end of the Cold War, the receding threat of socialist expansionism, British and other Western governments are now discovering the wider determinants of health and the strength of community involvement. Some of the WHO's initiatives that have been so successful in developing countries, such as Health for All, use of health targets, and community empowerment, are now being pursued in Britain.
IPPF OPEN FILE. 1994 Jun; 1.The 1994 Human Development Report from the United Nations Development Program (UNDP) proposes a 20-20 Human Development Compact based on shared responsibilities between poor and rich nations, whereby poor and rich nations would help unmet basic human development needs such as primary education, primary health care, safe drinking water, and family planning over the next 10 years. This would require an additional US $30 to US $40 billion annually. Developing countries would commit 20% of their budgets to human priority concerns instead of the current 10% by reducing military expenditure, selling off unprofitable public enterprises and abandoning wasteful prestige projects. Donor countries would increase foreign aid from the current average of 7% to 20%. The report will propose a new concept of human security at the World Summit for Social Development to be held in March 1995, calling widespread human insecurity a universal problem. On average, poor nations have 19 soldiers for every one doctor. Global military spending has been declining since 1987 at the rate of 3.6% a year, resulting in a cumulative peace dividend of US $935 billion from 1987 to 1994. But this money has not been expended on unmet human needs. India ordered fighter planes at a cost that could have provided basic education to the 15 million Indian girls now out of school. Nigeria bought tanks from the UK at a cost that could have immunized all 2 million unimmunized children while also providing family planning to nearly 17 million couples. UNDP proposes a phasing out of all military assistance, military bases, and subsidies to arms exporters over a 3-year period. It also recommends the major restructuring of existing aid funds, and proposes a serious study on new institutions for global governance in the next century.
WORLD HEALTH FORUM. 1993; 14(4):333-44.WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.
WORLD HEALTH FORUM. 1992; 13(2-3):232-6.In 1989, the city of Rennes, France created its healthy city committee consisting of people from different sectors to strengthen health and the environment and to encourage public participation. It organized existing activities and integrated the health dimension into municipal decisions at all levels to create joint healthy city projects. For example, over 18 months, the Brittany Youth Information Center, the city of Rennes, the National School of Public Health, representatives of about 60 groups, teenagers, and private citizens organized and implemented an adolescent health week in November 1990. The intersectoral and participative approach of preparation resulted in new working relationships contributing to health for all. Some other healthy city projects included noise abatement actions, family gardens, a health information and documentation center, creation of a sexually transmitted disease/AIDS group, and roof safety campaigns. Organizers of all projects considered the health criteria including quality of the environment, support for the disabled, safety, and access to health care. Rennes became part of national and regional networks in France consisting of 30 cities. It also joined the WHO-European network and the French-speaking network where cities shared information via meetings and symposia. WHO emphasized a different health promotion topic each year such as community participation and equity. Issues discussed at the 1990 symposium in Stockholm were clean cities campaigns, nonpolluting urban transportation, the social and cultural environment, and unique urban problems of eastern European countries. The French-speaking network involved French-speaking areas and countries in Canada, Europe, and Africa. Sharing problems of cities in the developed countries could allow developing countries to avoid some of the same problems. The healthy cities approach cannot be just the responsibility of municipal authorities but also requires the backing of national governments and international groups.
MEDICAL JOURNAL OF AUSTRALIA. 1990 Dec 3-17; 153(11-12):635-7.While most infant-related health problems in the Third World can be attributed to commonplace diseases, the lack of resources necessary to implement Western styles of medicine suggests the need for new strategies -- those that rely less on technology and more on grass roots efforts. Most illnesses in the developing world are the result of the top 5-10 diseases. Of the 4 million deaths from pneumonia each year, 97% take place in the Third World. Measles causes the yearly deaths of 1.6 million. Many of these diseases have been eradicated in the West; the others can be easily treated. But in the 3rd World, health problems are compounded by the fact that attention is often sought late, as well as the lack of doctors and nurses. Most of those with Western-style medical training rarely practice in rural or urban slum areas. One strategy to meet these difficulties is to train personnel on how to diagnose and treat these 5-10 common diseases without them having to go through Western-style training -- reminiscent of the famous "barefoot doctors" of China. These local health workers can more easily meet the health needs of isolated areas, since they can be trained to carry out immunization, and teach nutrition and family planning. Furthermore, this strategy does not rely on high technology, following instead the scheme laid out by acronym GOBI -- Growth monitoring. Oral rehydration therapy, Breast feeding, and Immunization. Developed nations can help in this effort by supporting WHO, UNICEF and other international organizations, as well as sending personnel to work in 3rd World countries. While individual 3rd World nations must confront these problems, worldwide social, political, and economic changes will be necessary.
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.
WORLD HEALTH. 1988 Aug-Sep; 10-5.The 1978 International Conference on Primary Health Care (PHC) in Alma-Ata, USSR, sponsored by the World Health Organization (WHO) and by UNICEF, culminated in the Declaration of Alma-Ata. This Declaration, signed by representatives of 134 nations, pledged urgent action for the development of PHC and toward the goal of "Health for All by the Year 2000." Among the most important principles of PHC are these 5: 1) that care should be accessible to all, especially those in greatest need; 2) that health services should promote popular understanding of health issues, and should emphasize preventive as well as curative measures; 3) that health services should be adapted to local economic and cultural circumstances, and be effective; 4) that local communities should be actively involved in the process of defining health problems and developing solutions; and 5) that health development programs should involve cooperation among all the community and national development efforts that have an impact on health. Even before the Declaration 10 years ago, the concepts underlying PHC had been taking root around the world. Progress toward the ideals of PHC has been made. Immunizations rates increased from 5% in 1970 to 40% in 1980. Only 34 countries had under-5 mortality rates of 178/1000 or more in 1985. 1/2 the number of 25 years earlier. However, PHC has in general achieved much better coverage in the developed countries than in the developing ones. The increase in world poverty -- to 1 billion people in absolute poverty today -- is a major setback for PHC. A major cause of health problems in the 3rd World is the too-rapid growth of unwieldy cities. Another common problem is that the training of medical professionals has not prepared them for leadership roles in community-oriented, preventive health programs. The ideals of PHC have been widely accepted throughout the world, and progress has been made, but much remains to be done.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
WORLD HEALTH FORUM. 1988; 9(2):185-99.This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.
HEALTH POLICY AND PLANNING. 1986 Mar; 1(1):37-47.This economic analysis assesses the probable costs of implementing various activities of the World Health Organization's (WHO's) global strategy of "health for all by the year 2000" and the likelihood that developing countries will be able to afford these costs, either on their own or with the assistance of developed countries. If this policy is to be transformed into concrete results, there must be a plan complete with budgetary requirements, planned activities, and expected results specified in adequate detail. The overall costs of the activities proposed by the global strategy would amount to approximately 5% of the gross national product of most developing countries, with water supplies and primary health care comprising the most expensive activities. Although there is a good match between estimated resource requirements and planned activities, the desired outcomes are often unlikely to result from the activities proposed. At present, all 25 industrial market and nonmarket industrial developed countries have already achieved the outcome goals of the global strategy; however, these countries account for only 25% of the world's population. Of the 63 middle-income countries, 54 have already achieved a gross national product per capita of over US$500, but only 22 have an infant mortality rate better than 50/1000. Very few low-income countries are close to reaching their targets for income, infant mortality, life expectancy, or literacy. On the basis of current trends, 25-33% of countries are considered unlikely to achieve the outcome goals by the year 2000. In general, it appears that expenditure targets are too low to cover the needed health services activities. Further research on the costs of health promoting activities such as immunization and primary health care should be given high priority.
The potential of national household survey programmes for monitoring and evaluating primary health care in developing countries. L'apport potentiel des enquetes nationales sur les menages a la surveillance et a l'evaluation des soins de sante primaires dans les pays en developpement.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(1):38-64.National programs of household sample surveys, such as those being encouraged through the National Household Survey Capability Program (NHSCP), are a principal source of information on primary health care in developing countries. Being representative of the total population, the major population subgroups and geographic subdivisions, they permit calculation of health status and utilization of health services. Household surveys have an important role to play in monitoring and evaluating primary health care since they sample directly the intended beneficiaries, and so can be used to judge the extent to which programs are meeting expected goals. Caution is necessary, however, since methodological problems have been experienced for many evaluation surveys. National surveys are especially appropriate for measuring many indicators of progress towards national goals within a broad socioeconomic perspective. Future directions in making the optimum use of household surveys for health program purposes are indicated. The NHSCP is a major undertaking of the UN system including WHO to collaborate with developing countries to establish a continuing flow of integrated statistics on a recurrent basis to support the national development process and information priorities. It brings together the principal users and producers of data to plan and conduct surveys which respond to national needs and priorities. The NHSCP encourages countries to employ a permanent national field organization for data collection. Areas of discussion are: the potential for monitoring and evaluation, the household survey as a source of health indicators, the demand for household surveys of health, followed by a summary of the health and health-related topics covered by 6 national health and nutrition surveys conducted in several developing countries. The special themes of infant and child mortality, morbidity and nutritional surveillance are also considered. The experience of many developed countries has been very positive with the use of nonmedically organized health surveys. Although the sample survey can be used in many settings to obtain population-based data, it must be carefully designed and implemented according to scientific procedures in order for the results to be validly extrapolated to the population or subgroups of primary concern.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
Who Chronicle. 1984; 38(4):155-60.The voice of the World Health Organization's (WHO) internal world is reassuring and tells of widespread political will to attain the goal of health for all, yet another voice says that if the policies adopted in WHO are slowly trickling into national health systems, the process of infiltration is much too slow and may still be far from completion by 2000. A number of developed countries are taking the challenge of health for all very seriously both within their own boundaries and in their dealings with less developed countries, but too many of them did not even take the trouble to report on the results of their monitoring of the health for all strategy. Some claimed off the record that it would have been too complicated in view of the size and complexity of their health system; others that they were not really in need of a strategy since their health service was so comprehensive. If the developed countries shy away from the responsibilities they accepted, why should more be expected of the developing countries. At Alam Alta there was enthusiastic support for action from all countries, no matter what their level of development. Most difficult to assess is the extent to which people themselves are taking the goal of health for all seriously. If the social aspects of the strategy are difficult to monitor, one would expect that the financial aspects should be clearer. This is not the case. Few countries, including the most economically developed, were able to assess the amount and flow of resources for health for all. In particular, they were unable to distinguish between the allocation of funds for the continuation of old policies and for the promotion of new ones. WHO has embarked on a new General Program of Work -- the 7th in the history of the organization. The program aims at making member nations more self-reliant than ever in the fields of health. The major task is to build up solid health infrastructures that are capable of delivering the most needed programs to the most people on the basis of equality of access for all. Unfortunately, only the sounds of the 7th program have made themselves heard, not the substance. Among the organization's successes can be included many of WHO's publications, particularly the "Health for All" series, but these publications are being used much too sparingly. New managerial arrangements have been introduced to help countries make the best use of everything WHO has to offer, yet all moves too slowly.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
An introduction to the primary health care approach in developing countries. A review with selected annotated references.
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.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.
Report of the Technical Work Group on the Participation of Organizations Related to Women in Primary Health Care Activities, 26-28 April, 1983, Washington, D.C., Volume I. Final report.
Washington, D.C., Pan American Health Organization, 1983. 30 p.Women from Colombia, Honduras, and Peru met with Pan American Health Organization (PAHO) advisors April 26-28, 1983, to discuss how women's organizations can participate more effectively in primary health care. Specific objectives of the meeting were to define the current and potential roles of women as promoters and beneficiaries of primary care; to define ways women's groups can collaborate with ministries of health in the planning, implementation, and evaluation of primary health care services; and to determine how PAHO can facilitate such collaboration. The obstacles to women's fuller utilization of primary health care were noted. These barriers include a lack of information on health problems and availability of services, cultural beliefs, real or perceived negative attitudes of health care providers, and the fragmentation of services. Other areas of discussion concerned the need to raise women's awareness of their responsibilities and rights as individuals, employment of women in key positions within the Ministry of Health, enhancement of women's influence on the health care system, and the lack of interagency coordination. As a hypothetical exercise, conference participants from each country drafted proposals for specific primary health care projects involving women. The Honduran and Peruvian projects, based on real experiences, concerned local construction of latrines and cancer screening, respectively. The Colombian project was aimed at sex and self-awareness education for teenage girls. Recommendations emerging from the meeting focused on 4 broad areas: 1) increasing awareness and concern for women's health issues among health personnel and policy makers, 2) establishing improved communication and coordination between the Ministry of Health and women's groups, 3) improving women's health care to more effectively meet women's needs, and 4) increasing the influence of women's groups on health activities. Specific tasks outlined for PAHO include the development and dissemination of educational materials, funding of research on women's health, technical assistance, definition of specific areas of primary health care (e.g., oral rehydration, breastfeeding, family planning, and immunization) in which women's groups are especially qualified to work effectively, and the promotion of communication about and coordination of health activities between the Ministry of Health and nongovernmental women's organizations.
New York, New York, IPPF, .  p.This Annual Report 1983 of the Western Hemisphere Region International Planned Parenthood Federation (IPPF) presents a selection of activities of all 43 associations. The annual meeting of the Western Hemisphere Regional Council offered a striking contrast to the 1st meeting in 1953. In 1983, the total regional enterprise contained some 3500 paid employees and even larger number of active volunteers. It involved large numbers of cooperating physicians, the direct participation of universities, hospitals, and other community institutions, and had the support of thousands of community distributors. These were people operating a total of 2044 clinics and 11,894 community distribution posts. Their messages went out through press, raido, and television and reached 3/4 of the Hemisphere's population. The comparison of the 2 meetings 30 years apart testifies to the successes realized by the associations in the Western Hemisphere. Their accomplishments serve to reveal the full measure of the task they set for themselves. This was to demonstrate that family planning is the strongest single correlate of family health. It was to establish family planning as a human right and to show that the practice of family planning helps to develop attitudes of mind in which people reassert control over their lives. Yet the full task calls for constantly new approaches in which success has not yet been won. This report comments on a number of these, of which the following are a partial list: the integration of family planning with other development strategies, including broad-scale community development; the addition to family planning of other elements of primary health care; the incorporation into family planning programs of a direct attack on infant mortality through vaccinations, oral rehydration therapy, and the promotion of breastfeeding; a renewed emphasis on the advancement of women; and the elaboration of fresh approaches to national leadership. Success is always partial, yet it can lead to the mistaken idea that the ultimate answers have been found. The family planning associations in Latin America and the Caribbean have had to pay a price for their achievements -- in complacencies on the part of international donors and official sectors that have come to see the Region's population problems as essentially "solved." On the other hand, the regional network is firmly established and subject to a constant review that seeks to improve service delivery. The trend toward program integration directs the associations toward new and challenging activities.