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Indian Journal of Community Medicine. 2010 Apr; 35(2):326-330.Background: The World Health Report, 2008, contains a global review of primary health care on the 30th anniversary of the Declaration of Alma-Ata. The period covered by the study reported on here corresponds with that of the Report, allowing for a comparison of achievements and challenges in one primary health care centre vis-a-vis the WHO standards. Materials and Methods: This study uses qualitative and quantitative data from a rural primary care facility in Western Maharashtra, collected over three decades. It analyzes the four groups of reforms defined by WHO in the context of the achievements and challenges of the study facility. Results: According to the WHO Report, health systems in developing countries have not responded adequately to peoples needs. However, our in-depth observations revealed substantial progress in several areas, including in family planning, safe deliveries, immunization and health promotion. Satisfaction with services in the study area was high. Conclusion: Adequate primary health care is possible, even when all recommended WHO reforms are not fully in place.
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
Washington, D.C., World Bank, 1999 Dec. viii, 113 p. (World Bank Discussion Paper No. 411; Europe and Central Asia Gender and Development Series)This collection of papers was selected from the proceedings of the World Bank conference held on June 7-8, 1999 in Washington District of Colombia. The conference entitled, "Making the Transition Work for Women in Europe and Central Asia," underlined the importance of gender as a factor influencing change during the shift from a command to a market economy. Women, who were invited to the conference, from Europe spoke directly to the World Bank about their problems and to make suggestions for action. In addition, scholars from the US and Britain were also invited to express their views on the gender dimension of transition. It was pointed out that the transition is taking place without the input of women, who are consequently suffering from the change. The participants also agreed the changes also caused men to engage in domestic violence, thus causing additional problems for women. The feminization of poverty and trafficking in women were also identified as new problems that demand to be addressed. In view of these problems, the participants advised that reforms were necessary but should proceed with caution.
A charade of concern: the abandonment of Colombia's forcibly displaced. [Falsa inquietud: el abandono de los colombianos desplazados por la fuerza]
New York, New York, Women's Commission for Refugee Women and Children, 1999 May. 24 p.The armed conflict in Colombia has forced more than 1.5 million Colombian citizens to flee their homes and communities. Caught in a nightmare of violent conflict with no prospects for reconstructing their former lives, hundreds of thousands of mostly rural peasants have found no option but to join the ranks of the internally displaced. It is noted that despite the extraordinary dimensions of the displacement phenomenon, the issue has remained a silent crisis. During November 29-December 10, 1998, the Women's Commission for Refugee Women and Children sent a delegation to Colombia to assess the conditions of women, children and adolescents uprooted by war and violence. The objectives of the delegation were to: 1) report on the scale of the displacement crisis; 2) determine to what extent the specific needs of women and children were being addressed by the government and international humanitarian relief; and 3) raise awareness among policymakers and among donor agencies of the status, rights and needs of women and children. Overall, the delegation found evidence of a seriously deprived displaced population which receives alarmingly low levels of humanitarian support and only minimal recognition of their plight from national and international agencies and governments. Thus, this paper also provides recommendations for ameliorating this crisis.
Policy aspects of community participation in maternal and child health and family planning programmes.
Geneva, Switzerland, World Health Organization, 1989. , 56 p. (WHO/MCH/89.14)The International Conference on Primary Health Care (PHC) organized by WHO and UNICEF in Alma Ata in 1978 pointed to involving the public in health care services including planning, implementation, and evaluation. These projects, experience in other areas of community participation (CP) as well as a meeting that was organized by WHO and the UN Fund for Population Activities (UNFPA) in Zimbabwe in October 1986 are detailed. The rationale for CP is to improve health service delivery and to enable health service users to have more control. Emphasis is placed on women in communities as the key participants in maternal and child health/family planning (MCH/FP) programs to increase their status. Women are the beneficiaries of MCH/FP services with traditional responsibility for the health of their families. They make up the majority of nurses, modern and traditional midwives, and paramedical workers within the formal system. In traditional communities women become community health workers (CHWs) and village development workers. WHO has supported research to assess the health impact of community participation in health services. UNICEF has focused on a more integrated approach where community participation is promoted through community development activities. UNFPA has supported projects in which traditional birth attendants or village health workers are trained to improve their skills in MCH/FP. Some policy issues for CP implementation in MCH/FP programs include: decentralization of the health care systems; health care information and education; training; resources for CP in MCH/FP activities; implementing MCH/FP activities in the community (antenatal care, delivery care, child care, and FP care); promoting multi sectoral collaboration; and evaluating and monitoring community participation. Some international research projects initiated are the PRICOR operations research project on the implementation of the PHC (supported by USAID), and ESCAP's cross-cultural research project about constraints on community participation in national FP programs (supported by UNFPA). Governments are urged to hold workshops for policymakers, train district and local officials in managerial skills, develop guidelines for medical preventive health training curricula, and develop management information systems.
POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
INDOCHINA ISSUES. 1988 Jan; (78):1-7.A campaign promoting "1 or at most 2 children" was launched officially in 1982 in Vietnam, a country which ranked 12th most populous in the world in 1987, with the 7th largest annual growth rate. Although major municipalities have registered less than 1.7% annual growth rates, in rural areas, particularly in the southern provinces, the growth rate ranges from 2.3-3.4%; 80% of the population resides in such locales. In April 1986, the Hanoi City People's Committee issued regulations designed to encourage the practice of birth control. Cash awards were offered to couples with only 1 child and payments for sterilization after the birth of a 2nd child. The birth of a 3rd child triggers higher maternity clinic charges, and an escalating scale of birth registration fees has been introduced to discourage failure to practice family planning. The most significant statistic to emerge from the birth control program is the gradual increase in the number of family planning acceptors over the past 5 years, slightly over 1 million couples estimated in 1981 to 4.5 million acceptors estimated for 1987. Between 1981-87 there was more than a doubling of acceptors for sterilization and IUD insertion. The IUD is used by 75% of couples practicing birth control, followed in popularity by the condom. Agencies in a UN triumvirate with special population concerns in Vietnam include the UN Fund for Population Activities (UNFPA), the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO). In the 3 years preceding 1987, several new UNICEF-supported public information projects were implemented, including the creation of an extensive maternal and child care network. This network was used to train cadres from the Women's Union as family planning motivators. In mid-1986, an experimental and innovative pilot project on "family life" or "parenting information" was initiated by UNICEF, UNFPA, and the Vietnamese Committee for the Protection of Mothers and the Newborn (CPMN). The desired growth rate of 1.1% by 2000 will have to rely on a variety of current program innovations. Surveys now being conducted in various regions of Vietnam reveal attitudinal problems in promoting smaller families. A survey of the members of 300 farming cooperatives in various areas of Vietnam in 1986 found that 60% of those questioned believed that the more children they had the better it would be for their family economy. Cooperative Vietnamese and UN efforts, particularly the innovative surveys and field research, represent valuable approaches, but considerable need remains for improvement in birth control knowledge and application and in the means to reduce child morbidity and mortality rates.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
International Journal of Gynaecology and Obstetrics. 1985 Sep; 23(4):247-8.The WHO is certain that the health of mothers and babies can be improved by giving traditional birth attendants (TBAs) special training and support to enable them to carry out their activities with greater safety. This is probably one of the most cost effective approaches to reducing maternal and infant mortality and morbidity. Some workers, however, stress that this approach is inappropriate to the real needs of the impoverished majority. They believe that the real causes of mortality are socioeconomic deprivation, top managerial incompetence and mass illiteracy. In addition to TBA training the WHO suggests strengthening the referral and support system and improvement and wide spread use of appropriate technologies. TBAs have been most successful when trained for a special skill, such as reducing neonatal tetanus. This supplement shows some of the achievements and problems that still exist. The material is presented to gain better understanding of obstetricians and support for simplified maternity care for mothers and babies in rural areas. Obstetricians can influence decision makers who allocate funds for health care to achieve a more equal distribution of resources. The articles are presented as part of a broader program of collaboration between the WHO and the International Federation of Obstetrics and Gynecology (FIGO) in their common objective of improving the health of women and children based on the principles and programs for primary health care. The 2 organizations have joined to form a WHO/FIGO Task Force for the Promotion of Maternal and Child Health (MCH), including Family Planning (FP), and Primary Health Care. The activities of the Task Force are: to put into effect the specific recommendations of the Joint WHO/FIGO workshop; to promote and support the MCH/FP elements of PHC at the national levels; and to promote the transfer, adaptation and further development of appropriate technologies for pregnancy, perinatal and family planning care.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 11-7. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)In developing countries systems of "bare-foot doctor" health care are being used. The goal is to provide a health service that is within the reach of each individual and family in the community, is acceptable to participants, that entails their full participation at a cost suitable to the individual and the nation. As opposed to hospital oriented Western medicine, there is usually a health officer from the local community, trained and provided with a dispensary, who returns to the home community. 2 projects in progress which were having negative results, 1 in Zaire and 1 in Senegal, were evaluated. The principles which redirected the programs are discussed. Problems such as mobile centers versus fixed sites for health centers, single aim projects and self-administration of the centers are explored. The acceptance of responsibility by the local public by using funding and resources of its own was judged to run the least risk of failing in the long term. In Senegal a new law on administrative reform was passed which allowed district health committees dealing with about 100,000 people to be set up. With a system of self-financing, more than 500,000 people were treated in 3 years. The fees were modest and 65% of the income from fees was used to keep drug supplies up to date. 3 dangers were identified and overcome: risk of embezzlement by district treasurers, overconsumption of drugs, and stocking excessively expensive products. The basic conditions necessary to provide an efficient network of health services in a rural environment (Zaire) and an urban environment (Senegal) are joint financing of activities through contractual financial participation, local administration, improved medical personnel, standardized medical procedure, and continuous supervision in collaboration with non-professional health workers.
Washington, D.C., U.S. Dept. of Health, Education, and Welfare, Office of International Health, 1978 Aug. 288 p. (Contract No. TAB/Nutrition/OIH RSSA 782-77-0138-KS)The most rapidly growing category of health assistance is the development of low cost health delivery systems which integrate health services, family planning, and nutrition interventions. It has been shown that the perception of improved child survival due to better health and nutrition is a precondition to the acceptance of family planning on the part of the rural poor in developing countries. In 1977, 27% of AID health funds went to integrated low cost health delivery systems and in 1979 the figure was 43% with Africa receiving the largest proportion (1/3) of the funds. This volume summarizes 39 AID projects based on information contained in AID Project Identification Documents and Project Papers. 2/3 of the projects summarized target the population of a region or subregion in the country rather than the population as a whole; the assumption here is that if the value of low cost rural health delivery can be demonstrated in a part of a country it will be extended to other regions.
Washington, D.C., U.S. International Development Cooperation Agency, 1981 Jan. 59 p.This strategy statement prepared by the USAID field mission includes a brief description of the political background of aid to Honduras and an analysis of the country's economic situation including an examination of the extent and causes of poverty among different population subgroups, an overview of the economy and assessment of its ability to absorb aid, a discussion of development planning as reflected in the 5-year plan and "Immediate Action Plan" drafted in late 1980; an assessment of progress to date in development efforts and of the Honduran govenment's commitment to development objectives; and a discussion of other donors. Favorable and unfavorable factors influencing achievement of development efforts are then identified, program strategy prior to and during the current planning period are discussed, and specific issues such as the role of the private sector, human rights, the role of women, and public sector management are examined. AID's sectoral objectives and courses of action in agriculture and rural development, population, health and nutrition, education, urban and regional development, and energy are outlined, with problems, current activities, and strategy for 1983-87 identified for each sector. Efforts to improve regional cooperation and AID program efficiency are described. Proposed assistance levels and staff levels are discussed. A series of tables containing data on public sector operations, central government budget expenditures, balance of payments, and key economic indicators are included as appendices.
New York, UNFPA, 1978 Jun. 53 p. (Report No 3)The present report presents the findings of the Mission which visited Afghanistan from October 3-16, 1977 for the purpose of assessing the country's needs for population assistance. Report focus is on the following: the national setting (geographical, cultural, and administrative features; salient demographic, social, and economic characteristics of the population; and economic development and national planning); basic population data; population dynamics and policy formulation; implementing population policies (family health and family planning and education, communication, and information); and external assistance (multilateral and bilateral). The final section presents the recommendations of the Mission in detail. For the past 25 years Afghanistan has been working to inject new life into its economy. Per capita income, as estimated for 1975, was $U.S. 150, a relatively low figure and heavily skewed in favor of a very small proportion of the population. The country is still predominantly rural (85%) and agricultural (75%). In the absence of reliable data, population figures must be accepted tentatively. According to the 7-year plan, the population in 1975 was 16.7 million and the rate of growth around 2.5% per annum. The crude birth rate is near 50/1000 and the crude death rate possibly 25/1000. The Mission endorses the priority given by the government to the population census and recommends continued support on the part of the United Nations Fund for Population Activities (UNFPA) to help the Central Statistical Office in the present effort and in building up capacity for future work. The Mission recommends that efforts be concentrated on the reduction of infant, child, and maternal mortality levels and that assistance be continued to the family health services and to programs of population education. Emphasis should be on services to men and women in rural areas. The Mission also recommends a training program for traditional birth attendants.
Impact of population assistance to an African country: Department of State, Agency for International Development. Report to the Congress by the Comptroller General of the United States
U.S. General Accounting Office. Comptroller General, Washington, D.C., United States, 1977. (ID-77-3) v, 65 p.Add to my documents.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
Primary health care and traditional medicine: considering the background of changing health concepts in Africa.
Social Science and Medicine. 1979 Sep; 13B(3):175-82.The stress placed on utilizing traditional medical practitioners in fulfilling the basic health needs for citizens of developing countries and the reasons behind the recent enthusiastic endorsement by international agencies and national governments of the primary health care strategy were examined in reference to Africa. In attempting to provide low cost alternative health care systems in Africa, considerable attention was given to developing schemes for integrating traditional medical practitioners into the health care system. Despite these efforts, little integration has occurred. The development of a collaborative form of integration between these two types of medical systems, except in such areas as the utilization of traditional birth attendants, is impossible. In the treatment and diagnosis of disease Western medicine demands the acceptance of the scientific etiology of disease, and this view clashes with traditional conceptions of disease etiology. Under these conditions the only type of integration that can occur is a structural one in which traditional medicine is placed in a subordinate position to Western medicine. Currently, this problem is reflected by the fact that most programs stress the recruitment of young men and women from rural areas for training programs in which only Western oriented medical concepts are taught. Despite the fact that the need to improve the health status of rural populations has been recognized for a long time, concerted efforts to deal with the problem have only recently been undertaken. These recent efforts are economically motivated. The economic value of rural populations as a source for fulfilling the labor needs of urban residents and as a market for the consumer goods produced by urban dwellers has only recently been realized. In order to preserve this labor and market resource, the health and well-being of rural dwellers must now be promoted. Furthermore, the initial emphasis on community involvement in health related decision making has all but disappeared. The seriousness of the committment of agencies and governments to promote community development must, therefore, be questioned.
World Health. 1982 Jun; 28-9.The Lao People's Democratic Republic, a country faced with the problem of ensuring an outlet to the sea, suffers from all the undesirable economic and social consequences which being a landlocked country entails. Foreign products which Laos needs will be bought at a high cost in time and in scarce foreign exchange, but without foreign exchange the country is unable to obtain what it needs for economic and social development. The local manufacture of many items that are important for the country's growth remains limited because its dependence on supplies from abroad has always retarded technical development. At this time the national economy is advancing too slowly in relation to its capacity and to domestic demand. A factor seriously affecting the capacity for development has been the protracted war in which Laos has been embroiled by its geographical position. Health services, particularly in rural areas, reflect this situation as do all the other essential services. Defective communication networks have contributed to the weakness of the health sector. For many years the country has been receiving assistance from the World Health Organization (WHO) tailored to its needs, but the insecurity created by the war has precluded penetration into the most remote and poorest areas. Currently, the low rate of graduation from secondary schools limits the recruitment of people to be trained for the many vacant posts in the health services. WHO has the technical capacity for helping Laos to speed up its health development process, but it must first overcome the most important hurdle by introducing a more efficient system of management and creating among the staff the necessary confidence and decision making ability that are required. WHO is now helping Laos to deal with the priority problems that have been identified, i.e., the most common and most serious diseases. Malaria has been brought under control in 2 of 13 provinces. A drinking water supply project is being financed, and an immunization campaign against the common diseases of childhood has been initiated. Health education is another problem area. In rural areas WHO is primarily concerned with a project for developing primary health care so that improved health services can be made available in the most remote regions.
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)
Geneva, World Health Organization, 1983. 105 p.The Inter-regional Seminar on Primary Health Care was held to examine the Chinese system of health care and to consider the lessons that other countries can draw from this unique experience. 4 specific areas were examined: China's 3-level (county, commune, and brigade) health care network, involvement of the people, health manpower development, and financing of rural health care. In China, health is seen as the goal of all sectors, not simply the health sector alone. The organizational structures of the brigades and communes, designed primarily for production, are utilized for health campaigns and other social development projects. The Patriotic Health Campaigns, which emphasize disease prevention and general health promotion, have mobilized people on a large scale and achieved outstanding results in the field of parasitic diseases and vector control. Health manpower development initially placed emphasis on meeting the basic needs of the community, notably through the introduction of new categories such as the barefoot doctor. With the achievement of basic coverage, there was a shift to the upgrading of both the status and professional competence of each personnel category. The degree of decentralization is such that over 80% of health expenditure occurs within the 3-level network system, and 65% at the commune level or below. 4 factors were identified as having contributed to the high level of primary health care in China: 1) political commitment to the task of changing the quality of life of all people, especially the rural population; 2) reorganization of China's social and economic structure, including its decentralization, and the integration of the health sector with all aspects of social and economic development; 3) concerted action in many sectors (e.g., income distribution, family planning, mass education) aimed at improvement of health status; 4) participation of the people in the provision of health services, management of the system, and mass campaigns; and 5) use of appropriate technology. The Chinese experience shows that health for all can be achieved despite limited resources and a low per capita income.