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The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.