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  1. 1

    Toward 2000: the quest for universal health in the Americas.

    Acuna HR

    Washington, D.C, Pan American Health Organization, 1983. x, 145 p. (Scientific Publication No. 435)

    This document, prepared by the Pan American Health Organization (PAHO), reviews health in the Americas in the period 1905-47, provides a more detailed assessment of progress in the health sector during the 1970s, and then outlines prospects for the period 1980-2000 in terms of meeting the goal of health for all by the year 2000. The main feature of this goal is its comprehensiveness. Health is no longer viewed as a matter of disease, but as a social outcome of national development. Attainment of this goal demands far-reaching socioeconomic changes, as well as revision of the concepts underlying national health systems. It seems likely that the coming period in Latin America and the Caribbean will be characterized by intense urban concentration and rapid industrialization, with a trend toward increasing heterogeneity. If current development trends continue, the gap in living standards between urban and rural areas will widen due to sharp differences in productivity. Regionally based development planning could raise living standards and reduce inequalities. In the type of development expected, the role of social services is essential. It will be necessary to determine whether the objective is to provide the poor with access to services that are to be available to all or to provide special services for target groups. The primary health care strategy must be applicable to the entire population, not just a limited program to meet the minimal needs of the extreme poor. Pressing issues regarding health services in the next 2 decades include how to extend their coverage, increase and strengthen their operating capacity, improve their planning and evaluation, increase their efficiency, and improve their information systems. Governments and ministries must be part of effective infrastructures in which finance, intersectoral linkages, community participation, and intercountry and hemispheric cooperation have adequate roles. One of PAHO's key activities must be systematic monitoring and evaluation of strategies and plans of action for attaining health for all.
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  2. 2

    Demographic trends and their development implications.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)

    This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
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  3. 3

    The NGO Group on Primary Health Care.

    World Health. 1985 Mar; 8-10.

    The emerging pattern of cooperation between nongovernment organizations (NGOs) and between NGOs and governments in the provision of primary health care (PHC) services was noted, factors which impede the cooperative provision of PHC services were identified, and some principles for guiding the cooperative delivery of PHC services were delineated. NGOs initiated the delivery of organized health services in several developing countries, and NGOs are currently responsible for the provision a large proportion of the health services in many countries. In 1978 the estimated development contribution of NGOs was about US$700 million. In comparision, the development contribution was US$1200 million for the World Bank, US$600 million for other development banks, and US$500 million for UN agencies. The expertise acquired by the NGOs in the development of innovative health programs throught the years should be utilized by governments to formulate effective health policies and programs. Cooperation between NGOs and between NGOs and governments is increasing both at the national and international level. 30 countries now have national bodies which coordinate the activities of NGOs operating in their country. Many of these national bodies are forging cooperative links with government agencies. An example of international cooperation is the NGO Group on PHC established in 1976. This group, comprised of several international NGOs based in Europe is currently coolaborating with the World Health Organization, the UN Chindren's Fund and the governments of Botswana, Lesotho, Zambia, Zimbabwe, and Swaziland for the purpose of promoting the development of PHC services in these 5 countries. Factors which impede the cooperative provision of PHC services include 1) the tendency of both governments and NGOs to use scarce resources to develop sophisticated medical services rather than to develop basic services for the general population, 2) the use of superior employment benefits by NGOs to attract trained personnel away from government programs, 3) the failure of many NGOs to develop programs in accordance with national policies and priorities, 4) the failure of many NGO projects to promote community participation and self-reliance, 5) the duplication of services by NGOs and governments, 6) competition between NGOs and between NGOs and government agencies, and 7) the failure on the part of some NGOs to adequately evaluate and monitor their projects. Principles which should guide the cooperative provision of PHC services are 1) health care should be developed in accordance with a nation's socioeconomic development goals; 2) NGOs and government agencies should provide coordinated and expanded services rather than competitive services; 3) NGO activities should be an integral part of each nation's health care system, and a referral network between all programs in the system should be established; 4) both national and external resources should be allocated in such a way as to promote harmony between the various programs in the system; 5) training programs should stress the acquisition of practical skills and 6) NGOs should focus more attention on monitoring and evaluating their programs in order to improve their ability to participate in the formualtion of health policies and programs.
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  4. 4

    Partners in health.

    Mutalik GS

    World Health. 1985 Mar; 5-7.

    Attainment of health for all by the year 2000 will require increased cooperation between governments, the World Health Organization (WHO), and voluntary health organizations. Voluntary organizations function at many levels. Some are strictly local, some operate nationwide, and others function at the international level. They have developed innovative health programs throughout the world and have developed expertise in confronting and solving a wide range of health problems. Collaboration between WHO, voluntary organizations, and member states was initiated in 1948 at the 1st World Health Assembly. In 1978 in the Declaration of Alma-Ata, WHO, voluntary organizations, and member states jointly identified the components and goals of primary health care, and in 1979, at the 32nd World Health Assembly they jointly launched the health for all by 2000 movement. The technical discussions scheduled for May 1985, in conjunction with the World Health Assembly will provide an opportunity for promoting further cooperation. At this meeting a number of issues must be resolved if an effective partnership is to emerge. Governments must declare their willingness to share the responsibility of providing health services for their populations and to share resources with the voluntary organizations. Voluntary organizations must declare their willingness to develop programs which are in accordance with the planning goals and priorities of the member states. Both must decide how closely they are willing to work together. Efforts must also be directed toward creating a structural framework for collaboration which will allow the voluntary organizations to participate in the nation's health development without stifling the organizations' albilities to formulate innovative programs and to make flexible responses to local conditions. The ability of governments and organizations to work cooperatively is being demonstrated in countries around the world. For example, in 1 Asian country, a voluntary organization is using its knowledge of local conditions to promote community acceptance of the government's malaria control program. In Africa, a joint effort to implement primary health care is being undertaken by several international voluntary organizations, the governments of 6 countries, and WHO. The degree to which cooperative bonds such as these are forged during the next few years will determine whether the world's goals for the year 2000 will be met.
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  5. 5

    Basic community services through primary health care: a training approach, 2nd ed., rev.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; UNICEF. East Asia and Pakistan Regional Office

    Bangkok, Thailand, ESCAP, 1984 Apr. 175 p. (ESCAP Programme on Health and Development Technical Paper No. 65/BCS 12; ST/ESCAP/291)

    The recognition of the necessity of involving the community in development efforts has been a turning point in the evolution of development thinking in recent years. Since 1978, the UNICEF Regional Office for East Asia and Pakistan and ESCAP have been conducting a series of training seminars where local development, basic services and primary health care are discussed as part of village reality. This volume reviews this experience, generalizing it to enhance adaptation. The seminars are a learning by doing and experience-sharing process. Group discussion and reflection on relevant issues are focused on. The seminars are oriented to community life as a whole, considering primary heatlh care as an entry point for coummunity development which involves generation of services within the community, supplemented by delivery of services from other institutional levels. This report describes the overall framework, including the organization of the 1983 seminar and the training approach, and the syllabus and evaluates the seminars. The goal of the seminar is the promotion of basic community health care in the countries of the region to improve the quality of life of the poor. Each participant discusses his/her work experience. Basic needs, basic services and primary health care are examined and a field-study phase at village-level is organized. Planning capabilities are developed by a phase of planning for basic and community services and primary health care. A module on national development, basic needs approach and production-oriented development is introduced. Finally, each participant prepares a draft project proposal for training for his/her own country situation. The evaluation of a program includes both its delivery system component and its eventual impact. The seminars used questionnaires, special group discussions and interviewing of the participants. The aim was to scrutinize the relevance and potential for modification of knowledge, attitudes and practice (KAP) rather that the actual impact actual impact achieved. Behavioral change should be evaluated on at least 2 levels: the individual and the collective. The structure, clustering and frequency of response to a given question in an evaluation questionnaire and the average level of awareness about a particular issue are 2 important measures to analyze. Seminar participants were mainly middle level personnel, but included some junior and senior officials from ministries of health, interior or home affairs and agriculture; training institutes; rural development institutes; planning commissions and universities.
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  6. 6

    Primary health care bibliography and resource directory.

    Montague J; Montague S; Cebula D; Favin M

    Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)

    This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
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