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BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1999; 77(5):436-8.This is a retrospective report on the importance of Kark and Cassel's 1952 paper on community-oriented primary care (COPC). In 1978, WHO and UNICEF endorsed COPC. However, the ideas girding and framing this approach had first been given full expression in practice some four decades earlier. In Depression-Era South Africa, Sidney Kark, a leader of the National Department of Health, converted the emergent discipline of social medicine into a unique form of comprehensive practice and established the Pholela Health Center, which was the explicit model for COPC. COPC as founded and practiced by Kark was a community, family and personal practice; it also was a multidisciplinary and team practice. Furthermore, the innovations of COPC entailed monitoring, evaluation, and research. Evaluation is the essence of Kark and Kassel's paper, which offers a convincing demonstration of the effects of COPC. Its key findings include the following: 1) that there was a decline in the incidence of syphilis in the area served by the health center; 2) that diet and nutrition improved; and 3) that the crude mortality rate as well as the infant mortality rate--the standard marker--declined in Pholela. In the succeeding decades, OPC had an international legacy (through WHO and H. Jack Geiger's influence in the US Office of Economic Opportunity), which came full circle in the 1980s, when a young generation of South Africans began to search their history for models for their health care programs at the dawn of the post-Apartheid Era.
DEVELOPMENT DIALOGUE. 1989; (2):5-38.The story of IBFAN, the International Baby Food Action Network, from its beginning with 6 members in 1979, to its status of 140 groups worldwide in 1989 is told by its founder, Annelies Allain. IBFAN celebrated its 10th anniversary in October 1989 with a week-long Forum of 350 organizers from 67 countries. IBFAN is a single-tissue grass-roots organization, almost entirely women: the issue is that bottle-feeding kills babies. It has mounted a successful campaign ending in passage of the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes in 1981. With this success, the political power of the "third system," of people, as opposed to government and transnational corporations, was recognized. The most important fundamental activity of IBFAN is to amass information to make its point that million of babies, primarily in developing countries, have died from consuming powdered formula instead of breast milk. IBFAN also set out to show that milk companies have influenced medical school training, health care providers, UN and WHO policies, and governments of developing countries through advertising and tax income. IBFAN's methods are boycott, corporate marketing analysis, shareholder, resolutions, and numerous strategies invented by local activists. The baby food industry responded by forming the International Council of Infant Food Industries, headed by a former WHO Assistant Director General, and applied for registration as an official NGO with the WHO. Again in 1987 they formed the Infant Food Manufacturers Associations, headed by a former WHO staff member, and gained WHO NGO status, claiming to advance infant nutrition and adhere to the WHO Code. Ibfan's current emphasis is on combatting free infant formula given out at maternity hospitals, the most effective way to block successful lactation, is developed as well as developing countries. An effort to monitor this activity will mark the 10th anniversary of the Code in 1991.