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Indian Pediatrics. 1983 Apr; 20(4):235-42.This article discusses implementation of the Alma Ata Declaration on primary health care in developing countries, particularly in India. Tasks are outlined in the areas of health indicators, training of health personnel, allocation of resources, integration of traditional health workers, drug policy, and health delivery strategies. The success of the primary health care strategy hinges on the support of the rest of the health system and of other social and economic sectors. Each country will have to specify its own health goals and priorities within the context of overall development policies, particular circumstances, social and economic structures, and political and administrative mechanisms. The training of health personnel, which is an essential part of primary health care, should be geared to the health needs of the community rather than patterned after the health services in developed countries. In particular, greater use should be made of community health workers. Traditional practitioners represent another potential reservoir of personnel for primary health care, and their integration into the modern system of medicine should be organized. The Government of India has adopted a strategy aimed at integrating promotive, preventive, and curative aspects of health care through a decentralized approach that involves the community in planning, providing, and maintaining the health services. 580,000 community health volunteers, as well as 1 traditional birth attendant for each village, are scheduled to be trained. A subcenter with 1 male and 1 female multipurpose worker is planned for every 5000 population; a subsidiary health center staffed by a doctor, 2 health assistants, and 2 multipurpose workers is proposed for every 25,000 population; and a primary health center is proposed for every 50,000 population, with 1 in every 4 centers to be upgraded to a rural hospital. The Integrated Child Development Services (ICDS) program delivers maternal and child health services at the village level. The number of ICDS projects is proposed to be increased to cover 913 of the 5011 community blocks and 87 urban slum areas by 1985.
[Unpublished] 1978. Paper presented at National Workshop on Innovative Projects in Family Planning and Rural Institutions in Bangladesh, Dacca, Bangladesh, Feb. 1-4, 1978. 21 p.The author describes the establishment of a rural health service in Companigonj thana in Bangladesh done jointly by the government and international relief agencies. Provision was made for integrated health services including family planning, child health services, maternal health services, nutrition programs, and both curative and preventive medicine. Field workers, mostly female, were trained to provide medical services not requiring a doctor's presence. The author finds a marked increase in attendance at the health service over a period of years. The government should intensify its participation in the health service component for the program to have a chance of taking hold. Tables to illustrate the experience of the program in money expended; numbers of patients; cost per patient; clinic attendance by age, sex; hospital deliveries; new family planning acceptors; contraceptive usage; mortality and birth rate and causes of death by age; and antenatal follow up.
World Health Forum. 1983; 4(2):157-61.In developing countries, the delivery of basic health care services is often hampered by communications problems. A pilot project in Guyana, involving 2-way radio in 9 medex (medical extension) locations, was funded by USAID (United States Aid for International Development). A training manual was prepared, and a training workshop provided the medex workers with practical experience in using the radios. The 2-way radios have facilitated arrangements for the transport of goods, hastened arrangements for leave, and shortened delays in correspondence and other administrative matters. Communication links enable rural health workers to treat patients with the advice of a doctor and allow doctors to monitor patient progress. Remote medex workers report that regular radio contacts with their colleagues have lessened their sense of isolation, boosted their morale, and helped build their confidence. 1 important element of the project was the training given to the field workers in proper use of the radio and in basic maintenance. Another key to the success of the system appears to be the strength and professionalism of the medex organization itself. Satellite systems may eventually prove to be the most cost effective means of providing rural telephone and broadcasting services and may also be designed to include dedicated medical communications networks at very little additional cost.
World Development. 1982; 10(7):573-84.Current efforts at involving communities in health activities are analyzed from a number of perspectives. Participation may be mainly aimed at easing resource constraints, through involvement in the implementation of health activities. Examples are the construction of health infrastructure, or the enlistment of community health workers--though in Latin America strong medical resistance to delegation has severely restricted their tasks. Participation in decision making has been even more limited, with the exception of some small scale NGO (nongovernmental organizations) sponsorship projects with conservative or progressive orientations also differ in degree of participation. The structure of the community, and the sociopolitical context in which it exists, are examined for the different constraints and opportunities they present to community participation for health. (author's modified)