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[Unpublished] 1984. Presented at the WFPHA (World Federation of Public Health Associations) iv International Congress, "Quest for Community Health; Experiences in Primary Care", Tel Aviv, February 19-24, 1984. 6 p.Discussion focuses on a key aspect of primary health care (PHC) programs -- the training of personnel and includes a review of the current concept of primary care, linking it to the training of community health workers. The World Health Organization (WHO) in its early days had a highly technical orientation. WHO and international agencies generally viewed their role as conveyors of information from 1 country (usually developed) to another (usually less developed). Not until the 1970s were questions asked that concerned all rather than a specific developing country. Most important were questions about coverage of the populations of these countries with wome minimal health service. The rediscovery of China had a difinite impact on the posing of a new type of question. China seemed to demonstrate that a very poor country could achieve virtually universal coverage of its huge population with essential PHC services -- given a high level of political commiment. In 1973 new leadership was elected to WHO and a new look was taken at the WHO constitution. A sequence of insights culminated in the World Health Assembly resolution of 1976 which called on all countries to take action to mak PHC available to their entire population and thenthe dramatic follow-up of this by the Alma Ata Conference on Primary Health Care in 1978. The new strategy was essentially to encourage the concept of the "barefoot doctor." The idea of paramedical or subprofessional health personnel was not new, and these middle medical personnel had quite extensive education, although not university graduates. The challenge was to start with village dwellers, who might be barely literate, but who knew the people and were trusted by them. They should be trained in the local area for 6 weeks to 6 months. The training should provide the trainee with a certain number of practical skills. These individuals are most widely known as community health workers (CHWs). With such limited training, the performance and effectiveness of CHWs depended on their motivation, relationships with the community they serve, the ability to learn from experience, and support by an organized framework in a health system. The organized framework is very important and includes proper supervision, continuing education, available consultation and referral, and some type of compensation. Hundreds of CHW training programs have been developed throughout the world and in the 1980s are undergoing a period of assessment.
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.
Contact. 1983 Oct; (75):1-16.Investigates health planners' assumptions about community particiation in health care. Primary health care aims to make essential health care accessible to all individuals in the community in an acceptable and affordable way and with their full participation. It is the strategy propagated by the World Health Organization to provide health for everyone by the year 2000. Community participation is seen as the key to primary health care and has raised many assumptions and expectations among health planners. Community people are seen as a vast untapped resource which can help to reduce the cost of health care by providing additional manpower. It is also expected that community people want to participate in their own health care because they wish to serve their community and to have a part in decisions which affect them. In the early 1970's, programs were developed out of church-related efforts. They pioneered many of the ideas which became principles of primary health care. The church-related programs were nongovernmental and therefore flexible. They had the same goal of letting the community take responsibility for their own health care; program planners were primarily medical people trained in Western medicine. The planners were concerned with the plight of the poor. However, the programs tended to reflect planners' hopes for, rather than the community's understanding of, the community health problem. The author concludes that the assumptions that planners make about their programs need to be critically analyzed. Investigations need to be made into community perceptions and expectations of their role in health programs. Studies need to be undertaken to identify the potentials and problems of community participation and the record of established community health care programs needs to be examined.
[Geneva, Switzerland], WHO, 1982. 17 p. (HRG/CRU.1/Rev.1/Mtg.1)In 1979, a WHO team collaborated with national personnel in The Gambia in developing a comprehensive primary health care (PHC) plan of action for the period 1980/81 - 1985/86. In his address to the legislature in August, 1980, the president declared that the plan involved the active participation of local communities and emphasized programs for health promotion and disease prevention. This monograph reports on a meeting of the Gambian Ministries of Economic Planning and Industrial Development and of Health, Labor and Social Welfare in June 1982. Improvements in rural health are a basic need. In order to provide PHC, it was fully realized that a strong supportive infrastructure was essential. The village sensitization program was considered as vital for success. Not 1 village has rejected PHC or its responsibilities. The training program for community health nurses, village health workers and traditional birth attendants was proceeding according to plan for the various levels. Recognizaing that an efficient drug supply was essential, concomitant action had been taken to reorganize the central store. Another essential element without which success could not be achieved related to provision of transport and facilities for their maintenance, so that communications could be assured with rural areas. The need for a radio network to link 6 staions and 26 sub-stations was stresses. The list of participants and the agenda are attached as are the requirements for external support for the planned provision of PHC which were considered by the participants of the meeting.