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WHO's program of health for all by the year 2000: a macro-system for health policy making--a challenge to social science research.
Social Science and Medicine. Medical Psychology and Medical Sociology. 1980 Oct; 14A(5):381-6.The author reviews the history of the idea behind the Health for All by 2000 (HFA/2000) program of WHO and its subsequent progress, reactions to it, and outcomes. Primary health care was seen as instrumental in attaining the goal of HFA/2000, including health education, nutrition, sanitation, maternal and child health (including family planning), immunization, prevention and treatment of diseases, and provision of drugs; and access to effective health services is central to the goal. Support of 140 countries, the U. S., and the World Bank for HFA/2000 is cited, and the author argues that it is not a passing fad but an enduring concept which emerged from evolving ideas, approaches, and information concerning the nature of development, social justice, medical technology and personnel, primary health care, and political will. The role of WHO in establishing guidelines for member countries and in turn incorporating feedback into guidelines is described, and examples given of successful health programs. The possibility of introducing HFA in the U. N. as a bridge between disparate views of development strategy, because it could contribute to both economic productivity and social justice, is discussed. The author proposes that the HFA movement could benefit from social science research which would clarify the dynamics of health policy formation, the diffusion of ideas, social, ethical, and technical goals and strategies, and international development and cooperation.
Social Science and Medicine. Medical Psychology and Medical Sociology. 1980 Oct; 14A(5):391.The author states that most health care systems fall short of the goal of providing care to all people in need or at risk, as evidenced by high morbidity and mortality rates in disadvantaged areas where 80% of the world population lives. This failure is seen as the result of a highly technical and centrally located health care structure wherein personnel and resources are most scarce at the levels closest to the community. It is suggested that "health for all" requires the development of a purposeful health care system for delivery of primary health care, and that the basic unit of the system should be local health service systems geared to the local conditions, including health risks and health resources. Community participation, generated by communication and education, is seen as essential for the local system. Reorganization of current Western style, centralized health care facilities would be imperative, though national centers for health care development would serve in an organizational and training capacity. It is proposed that the most important factor in bringing about these changes in the health system is a strong political will, supported at both national and community levels.
In: Family planning within primary health care, edited by F. Curtis Swezy and Cynthia P. Green. Washington, D.C., National Council for International Health, 1987. 112-4.The World Bank's appreciation of the unique role of NGOs in working beyond the effective reach of government systems in reaching underserved populations and communities has come with its increasing involvement in social sector development. NGO understanding of the needs of communities, underserved populations, and special subgroups constitutes a strong basis for designing and implementing actions to promote social and behavioral change. NGOs can complement the skills available within governments to put their people-oriented policies into meaningful effect. This NGO support may be sine qua non for the success of such policies, and of the programs and projects the Bank supports in the social sectors. The Bank is still developing ways to encourage NGO participation in such programs and projects. Staff in the Population, Health and Nutrition Department of the Bank are directing much more effort now to working with NGOs in family health and population work, particularly in subSaharan Africa where the greatest current challenge exists. At the international level, in order to promote policy dialogue with an operational perspective between the Bank and the NGO community, a Bank/NGO committee has been established. Composed of NGO representatives from both donor and recipient countries and Bank staff, it meets regularly and has proven helpful in identifying mutual interests and common objectives in a number of important areas, including food security. The committee does not replace collaborative mechanisms at the country level, but it has been successful in inspiring both the Bank and NGPs to pursue collaboration more assiduously at the country and sectoral levels.
New policies and approaches of health education in primary health care in attaining the objectives of health for all/2000.
IN TOUCH 1991 Mar; 10(98):34-6.This overview of what the WHO Alma Ata Declaration is and how the objectives translate to policy in the structure of health education involves manpower development, professional level training, community involvement, mass media, and related research. Alma Ata identified health education as the first of 8 essential activities in primary health care (PHC). Policy failures in health education included the inability to live up to expectations, the targeting of programs to specific diseases, and to the inappropriate conceptualization of community participation as a process which can be centrally controlled. Other factors were the gap in understanding the relationship between socioeconomic development and health, weak national structure which provided inadequate demonstration of health education project results, the inability of health education to solve individual problems such as working conditions or environmental pollution, and the lack of multisectoral cooperation. In order to achieve the Alma Ata objectives health education must be an agent of social change. Primary health care (PHC) - health education, development of a patient's educational skills, needs to be incorporated into the formal curricula of medical and nursing programs, as well as informal training, planning, and practice among rural and agricultural developers, public health engineers, and educators. Health workers need training in use of appropriate technology and in bridging the gap between the community and existing health care systems. The mass media needs to emphasize basic health necessities, and the importance of health, and solutions to problems. Broad public participation including voluntary organizations is necessary to the multisectoral approach. Research needs to be disseminated to administrators.
IN TOUCH 1991 Mar; 10(98):3-11.In order to institute the Alma Ata Conference goals of health for all (HFA) and primary health care (PHC), the author has provided an overview of the tenets of basic management as it pertains to a health services system in Bangladesh. Central government structure is diagrammed. The internal operation is described as composed of administrative decisions; operational management; operational planning; organizing resources; motivating health personnel; appraising staff performance; coordinating; developing public relations; managing information systems; monitoring; conducting evaluations; identification and collection of data pertinent to evaluations; methods and techniques of data collection; reporting of background information; and objectives and methodology of evaluations, findings, and major achievements. Activity is evaluated based on relevance, progress, effectiveness, adequacy, efficiency, and impact. The author finds that Bangladesh's lack of any formal document on national health policy impedes the managerial process. Other inadequacies involve the lack of dissemination of the HFA country paper and unsuitable perceptions of the PHC approach; the deficiencies in the 5 year plans to address the main concerns of the PHC in the health care system such as community finances or inequitable resource allocation; the lack of preventive and integrated care in upazila health management; the lack of definition of responsibilities of institutions; the lack of motivated grass roots level workers who provide coordination with other sectors; the lack of micro or macro evaluations of quality of care; and management deficiencies. Supervision is incompetent. Linkage between formal and informal health sectors are missing. Skills are lacking in operational planning. Conceptualization of PHC is inadequate.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):403-16.In the context of the controversial conference at Alma Ata and the emergent plan of Health for All by the Year 2000 (HFA/2000), the role of academic institutions is discussed. At the risk of expanding the controversy over HFA/2000, institutional involvement facilitates the testing of principals against real world problems of health development. Views from both sides of the debate and controversy are considered with respect to the appropriateness of institutional involvement in HFA/2000. A consultative committee to the Director General of the World Health Organization (WHO) analyzing the successes and failures of primary health care development is 1st explored. Other views from technical discussions of WHO on the roles of universities in the strategy of HFA are then examined. Traditional and progressive arguments on the roles of university in society are reviewed, with an eye to how HFA fits in. The paper concludes that institutions capable of and willing to provide substantial, institution-wide commitment are appropriate candidates for involvement in HFA/2000. The Aga Khan University's commitment orientation and health services development is cited as an example of appropriate, positive institutional participation. The Network of Community-Oriented Educational Institutions for Health Sciences addressing problem-based teaching methods, community orientation, and partnerships with governmental health services is also exemplary. In closing, the paper queries the extent to which the movement will attract institutions around the world.