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In: Tradition and transition: NGOs respond to AIDS in Africa, edited by Mary Anne Mercer, Sally J. Scott. Baltimore, Maryland, Johns Hopkins School of Public Health, Institute for International Programs, 1991 Jun. 15-22.Many people at risk of HIV infection are changing their behavior drastically when they are referred for HIV testing, as a result of more access to information. Featured as a theme for World AIDS Day, women are particularly vulnerable, since they have less power than men to influence their interpersonal relationships. Women with HIV/AIDS often are asked to make the unrealistic decision to avoid childbearing, but the status of a women in Africa depends on her reproductive ability. The traditional role of women as caregivers both as professional health workers, or in home care, is critical in HIV/AIDS disease. Preservation of the health of the 5-14 age group, who is uninfected, is a priority. Adolescents must be specially targeted in preventive counseling on the consequences of early sexual activity such as teenage pregnancies and sexually transmitted diseases. Sex education in the schools should start at a much earlier age. Studies in Zimbabwe show that women are being infected 5-10 years earlier than men, and there are even cases in 15, 16, and 17 year old women. Most HIV-infected people are afraid of being ostracized or fired from jobs. Women have lost their jobs when their HIV status became known, although the Minister of Health has issued a directive that HIV infection is not a valid reason for discharging an employee. Women are especially vulnerable because they may be rejected by their families and their partners, while having small children who also may be infected. Empowerment of women is needed so that destructive relationships do not continue only because of economic dependence. Ministries of Health, Labor, and Social Welfare need to develop strategies with NGOs to cope with demand to find resources for increasing numbers of desperate people. Community-based care is ideal, and positive trends are emerging to combat the destructive effects of AIDS that divide families leaving the most vulnerable uncared for.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (746):1-89.A World Health Organization (WHO) Study Group on Community-based Education of Health Personnel met during November 1985 to clarify the meaning of the term community-based education, to determine its implications, to suggest how to put it into practice, and to recommend ways of fostering it. This report of the meeting defines terms and covers the following: the rationale of community-based education (a historical account, underlying principles, 6 reasons in support of community-based education, the organization of community-based educational programs, major problems and constraints, and quantitative and qualitative considerations); and the principles and issues (educational principles and issues, coordination between the health and educational systems, the intersectoral approach, community involvement, the health team, the competency-based learning approach, problem-based learning, performance assessment, and recapitulation of the action to be taken in implementing a community-based educational program). Recommendations to the WHO are included along with recommendations on how to start a community-based educational program and on how to foster an understanding of the concept of community-based education. An educational program, or curriculum, can be termed community-based if, for its entire duration, it consists of an appropriate number of learning activities in a balanced variety of educational settings, i.e., in both the community and a diversity of health care services at all levels. Participation in community-based educational activities gives the students a sense of social responsibility, enables the students to relate theoretical knowledge to practical training and makes them better prepared for life and their future integration into the working environment, helps to break down barriers between trained professionals and the lay public and to establish closer communication between educational institutions and the communities they serve, helps to keep the educational process current, helps students to acquire competency in areas relevant to community health needs, and is a powerful means of improving the quality of the community health services. A clear organizational design is needed to create a community-based educational program.
Social Science and Medicine. 1985; 21(1):41-53.This paper explores the emergence of an international fad aiding and monitoring community participation efforts and projects its future outcome based on lessons from previous experiences in other than the health sector. The analysis suggests that the promotion of community participation was based in all cases on 2 false assumptions. 1) The value system of the peasantry and of the poor urban dwellers had been misunderstood by academicians and experts, particularly by US social scientists, who believed that the traditional values of the poor were the main obstacle for social development and for health improvement. However, the precolumbian forms of organization that traditional societies had been able to maintain throughout the centuries were not only compatible with development but had many of the characteristics of modernity: the tequio guelagetza minga and even the cargo system stress collective work, cooperation, communal land ownership and egalitarianism. 2) Another misjudgement was the claim that the peasantry was disorganized and incapable of effective collective action. In Latin America historical facts do not support this contention. A few examples from more recent history show the responsiveness and organizational capabilities of rural populations. The Peasant Leagues in Northeastern Brazil under the leadership of Juliao is perhaps 1 of the best known example. The question is thus raised as to why international and foreign assistance continues to pressure and finance programs for community organization and/or participation. It is suggested that the experience in Latin America (except perhaps Cuba and Nicaragua) indicates that community participation has produced additional exploitation of the poor by extracting free labor, that it has contributed to the cultural deprivation of the poor, and has contributed to political violence by the ousting and suppression of leaders and the destruction of grassroots organizations. Information presented on community participation in health programs in Latin America illustrates that they have followed closely the ideology and steps of community participation in other sectors. A country by country examination indicates that health participation programs in Latin America in spite of promotional efforts by international agencies, have not succeeded. The real international motivation for participation programs was the need to legitimeize political systems compatible with US political values. Through symbolic participation, international agencies had in mind the legitimation of low quality care for the poor, also known as primary health care and the generation of much needed support from the masses for the liberal democracies and authoritatrian regimes of the region. Primary health care delivery can be successful without community participation, in contradiction to what international agencies and governments maintain.