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NUOVI ANNALI D IGIENE E MICROBIOLOGIA. 1987 Sep-Dec; 38(5-6):471-6.Community medicine (CM) addressing the global problems of human health has been intensifying in concert with primary health care (PHC) in developing countries, especially since the 1977 session of the WHO launched a program called "Heath for all by 2000" whose central component was PHC. An international conference in Alma Ata in 1978 on PHC stressed essential health care for all communities supported by practical methods that were scientifically valid and socially acceptable, assistance that was accessible to all members of the community. The objectives of PHC were: promotion of proper nutrition, safe water supplies, basic hygiene, maternal-child hygiene, vaccination against major infectious diseases, prevention and control of endemic local diseases, health education, and proper treatment of common diseases and injuries. A PHC post on the village level of Cm would have 1 community health worker (CHW) and 1 traditional birth assistant (TBA) providing health care for 500-1500 people. On the district level, a PHC unit would have 2 CHWs and 2 TBAs for 10,000 people. On the regional level, a PHC center would have 1 physician, 2 attendant nurses, 2 obstetricians, 1 technician, 1 pharmacist, and 1 administrator. Finally, on the national level, hospitals would take care of health needs. The lack of properly trained staff and resources poses the biggest problem in the organizational structure of Cm, but this could be overcome by collaborating with rural medicine and traditional medicine.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
Social Science and Medicine. 1987; 25(6):615-20.It is expected that community involvement in health policy be not only cost-effective but also the best way of providing comprehensive solutions to public health problems. Over 50 years of experience in India show that public enthusiasm does tend to wane after a short period of time, but efforts continue to be made. Governmental and other organizations and UN agencies have been active in promoting the concept of community involvement. The best that can be expected is that people will come forward voluntarily to participate in public health programs formulated by governments and other agencies. Generally, however, public cooperation has to be sought and participation motivated. There is little support for coercive measures. Community participation is often hampered by a wide range of factors including: difficult terrain; inegalitarian social structure; the tendency to depend on others to look after one's needs; and the absence of an understanding of healthful conditions and practices. Also, bureaucrats and medical professionals often consider community involvement an interference. Nevertheless individuals and organizations are everywhere engaged in experiments in such involvement, and certain Indian projects have provided valuable insights which may be of use in other developing countries.