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PubMed1984

General practitioners: allies or enemies of primary health care.

In this paper the thesis is advanced that the general practitioners can either be a powerful ally or a major roadblock in the development of primary health care in the spirit of the Alma-Ata Declaration. The role they will play depends on their interpretation of, and attitudes towards, the concept. In the first part of the paper, four common interpretations of primary health care (primary health care as a set of activities; as a level of care; as a strategy; and as a philosophy) are described. The second part identifies common misconceptions - traps into which the general practitioners may fall when taking their stand on primary health care. In the third part, a blueprint for transforming the current systems of primary medical care systems into primary health care systems is outlined. The final section suggests some concrete actions to be taken by the general practitioners in implementing this blueprint.

Attitude of Health Personnel↗
PubMed1992

Hospitals as health centres.

As a signatory to the Alma-Ata Declaration in 1978, the Government of India is committed to taking steps to provide 'Health for All' to its citizens by 2000 AD. We have agreed to adopt the primary health care approach, for achieving the goal of HFA. In this context, it is very essential to redefine the role of hospital. It will not be possible to achieve the goal-HFA unless, hospitals start functioning as health centres. This paper discusses in details how a hospital can function as health centre.

Community-Institutional Relations↗
PubMed1991

Medical education and primary health care in Nigeria: the Sokoto University experience.

Despite the acknowledgement and adoption of the Alma-Ata declaration by majority of the countries of the world as a strategy for achieving Health For All, medical educational systems often remain as ivory towers from the health service system. This traditional system of medical education does not adequately prepare doctors in developing countries for their expected leadership role in meeting the health needs for their communities through primary health care. In Nigeria, primary health care forms the basis for an official health policy aimed at meeting the health care needs of the entire population particularly those in the rural areas. This article, while highlighting the need for integration of medical education and the primary health care services, also examines the structural relationships between the two components at the Sokoto University in Nigeria, a West African country with one of the oldest medical educational system in the area.

Community Medicine↗
PubMed1991

[Primary health care in developing countries].

The Alma-Ata declaration and global strategy of Health for All by the year 2000 have given political and practical momentum to the delivery of primary health care in developing countries. WHO has provided leadership for this process, with support from other UN agencies and international donor organizations. Primary health care is based on the concept of a District Health System which provides comprehensive services. Community participation and intersectoral collaboration are the cornerstones of primary health care. Using Malawi, Uganda, India and Indonesia as examples, the article explores experiences of health problems and of health care delivery to underprivileged populations in African and Asian countries.

Delivery of Health Care↗
PubMed1996

Renewal of the health-for-all strategy.

It will soon be 20 years since the much-publicized Alma-Ata Declaration calling for health for all through primary health care. This article aims to stimulate debate on the successes and failures of past efforts, on the values that should guide policy-making in national and international health work, and on approaches to promoting equity and solidarity in future health strategies.

Forecasting↗
PubMed1990

A call for systematic action for changing medical education: reaction of working partners.

How far has medical education been reshaped to meet society's new realities and expectations? More than 40 years have passed since the establishment of the World Health Organization. More than 20 years of the WHO's active work has gone into the educational development of health professionals. And it is now more than 10 years since the Declaration of Alma-Ata, which urged Member States to reorient their health systems so as to provide for more equitable and appropriate services to every citizen on our planet. But the question remains: have there been any significant changes in medical education that reflect these events?

Education, Medical↗
PubMed1991

[Survey on international health related education in the schools of public health nurses in Japan].

A nation-wide survey of directors of 60 schools for public health nurse education in Japan was made from April and May of 1990 regarding international health related education for the 1990 academic year. The survey questionnaire utilized 3 questions, and a column for free answers. An effective response rate of 76.7% from a total of 46 schools was obtained: 4 year colleges-4; 3 year junior colleges-4; and 37 schools with a 1 year course. Among them 27 schools (67.9%) responded that related courses was available in their curriculum. Except for 2 key-words (WHO, Alma-Ata Declaration-PHC) which are found in all schools, quarantineable diseases were taught in 34 schools, international exchange and cooperation in 23, JICA (Japan International Cooperation Agency) in 10, NGO in 10, health care for the Japanese in foreign countries in 6. Free answers were provided by 22 schools. From these results, the need for a changing role of the public health nurses in the internationalizing of Japan's society and for future curriculum development is seen.

Curriculum↗
PubMedDate not supplied

Physical assessment of people with AIDS.

Since the Declaration of Alma-Ata in 1978, primary health care (PHC) has been acknowledged as the most effective means of achieving "health for all". Promotion of the PHC model provides nurses with an excellent opportunity for professional growth and development. The PHC role of nurse practitioner is gradually emerging within the Australian health care system and if nurses are to fulfil this role adequately they need to equip themselves with additional skills. The art of performing competent physical assessment of clients is one such skill. As the concept of the AIDS nurse practitioner is being developed locally and overseas, this paper focuses on the physical assessment of people with AIDS. While the constellation of physical signs and symptoms they experience are all too familiar to those who work in the area, they are often unusual for those who do not.

AIDS Dementia Complex↗
PubMed1989

[Education concerning health, water and sanitation in the control of schistosomiasis].

Education concerning prevailing health problems and the methods of preventing and controlling them is the first of the eight essential components of health care stated in the Declaration of Alma-Ata 1978. As regards schistosomiasis, the current strategy of control is based on the reduction of morbidity within the context of primary health care. In this perspective, it follows that in any control programme health education must have a central place in its operations. This health education, a multidisciplinary science so far neglected by health programmes of developing countries, now has new approaches that health workers must take into account. In the case of schistosomiasis, the target of health education must be the control of transmission (human-water contacts), sanitation (urinary and faecal contamination) and chemotherapy, all this with the voluntary and conscious participation of the community. There are no standard health education programmes which are applicable everywhere; they must be developed locally with the communities concerned so that the health technologies proposed will be appropriate, applicable, and compatible with their socio-cultural situation and their resources.

Animals↗
PubMed1989

The first forty years: a personal view.

Discussed below are some of the great public health issues and trends of the period that has elapsed since the foundation of the World Health Organization. They were dominated by the new Malthusian nightmare, the tussle with malaria, the eradication of smallpox, the improved control of some other serious infections, the struggles for family planning, breast-feeding, immunization, and clean water, among other things, and above all, perhaps, by the decline of the doctor and the rise of the planner and manager. More recently there have been the policy changes affecting international health which came from the Declaration of Alma-Ata, and the emergence of primary health care.

Family Planning Services↗
PubMedDate not supplied

The relevance of transcultural nursing to international nursing.

Does transcultural nursing as taught in United States' nursing education programmes adequately prepare US nurses for experiences in international health as they assist with the implementation of changes in another country's health care delivery system? That's the question posed by Lydia DeSantis, who is concerned that US nurses need a broader perspective of health care and culture in order to effect changes needed at the national level of policy and decisionmaking to meet the challenges of the Declaration of Alma-Ata. Her concerns about the focus of transcultural nursing are also relevant to INR's international readers, as it offers another perspective on how to persuade policymakers in their countries to reassess and initiate the health programmes needed to attain WHO's HFA goal.

Cross-Cultural Comparison↗
PubMed1981

[Physician's role in primary health care].

This article puts forward a series of considerations on primary health care and on how the physician should be trained to perform services for the patient, the family and the community at large in the framework of such care. The author notes that, as a result of the Declaration of Alma-Ata, primary health care imposes new responsibilities on the physician, who is now called upon to provide ongoing, comprehensive services with an approach that sees not only the physical, but also the psychological and social conditions that affect the state of health. In primary care the physician also has to be trained to minister to the individual both in sickness and in health and to inform the community of what it needs to know in the area of health education, in addition to taking his traditional preventive and curative measures. In other words, the physician must wear the hats of the clinician, organizer, supervisor and teacher, and his training must be designed to enable him to acquire the knowledge, abilities and skills that he needs to play all these roles satisfactorily. The writer expresses the hope that health conditions will improve, particularly in the developing countries, if every individual, every community, and every health team, the physician included, accepts the responsibilities that devolve upon each of them in primary health care.

Health Education↗
PubMed1997

Selected ethical issues in planned social change and primary health care.

This paper discusses two interrelated concepts: (1) the ethics of planned social change and (2) primary health care. It takes the World Health Organization's definition of primary health care as a point of departure to examine four identified potential areas where ethical dilemmas may occur. In addition, questions are raised about nursing education, as well as about the class and status differences between nurses and patients and communities. It takes the position that our first task is to encourage more discussion and examination of ethical issues in the planned social change of primary health care.

Developing Countries↗
PubMed1987

Bridging the gap: the village health worker as the cornerstone of the primary health care model.

The Alma-Ata Conference in 1978 reiterated the goal of 'Health for All by the Year 2000' and declared primary health care (PHC) the vehicle through which this lofty goal was to be achieved. National governments were recognized as responsible agents for developing and implementing PHC plans. The emphasis on community-oriented delivery of care places great importance on the village health worker (VHW), the individual who serves as the 'interface' between the formal health care system and the community. Despite the acknowledged importance of the VHW role, the question of whether the PHC model, with the VHW as the cornerstone can be effectively implemented without a "fundamental shift of wealth and power" (Sidel) continues to be asked. This paper examines the evolution and current status of the VHW role in Costa Rica, Nicaragua and Columbia, three Latin American nations which have adopted the PHC model. The authors discuss the evolution of the PHC model in each country with particular reference to the occurrence or non-occurrence of fundamental changes in the society. The conclude that the primary determiner of successful implementation of PHC is a national commitment to PHC including recognition of the importance of community participation which is best achieved through reliance on the village health worker.

Colombia↗
PubMed1990

Crash of the immunization program: consequences of a totalitarian approach.

India's Universal Immunization Program, which was to cover a population of more than 90 million pregnant mothers and 83 million infants living in more than 575,000 villages during 1986-90, has failed dismally. The coverage has been less than one-fifth of the requirement in more than half of the population. The situation in most third world countries, which have even weaker political clout and weaker health service infrastructures, is even more catastrophic. From a purely public health standpoint, the disaster was inevitable. No efforts were made even to define the problem of the six immunizable diseases; there was no question of understanding their natural history; the efficacy of the vaccines used was not well-known; the cold chain, which is meant to retain the potency of the vaccines at the time of inoculation, frequently broke down; there was confusion about the dosage; and even where the program is most successful, ecological conditions will erode much of the benefits from immunization. That such a technocentric program was imposed on the peoples of the third world by their governments was bad enough; even more frightening is that these countries were persuaded to follow the line developed in affluent countries by influential agencies such as UNICEF, WHO, the World Bank, the Rockefeller Foundation, and Rotary International. This is an awe-inspiring manifestation of the power of the affluent countries to impose their will on the weak and helpless peoples of the world. It is a bitter irony that UNICEF and WHO, which sponsored the famous global conference at Alma-Ata, should have lent their weight to a program that is the very antithesis of the Declaration. To embark on such a venture, the exponents had to ignore weighty scientific evidence that raised serious doubts about the program. They had to stoop to suppression of information, disinformation, and distortion of information. What is even worse, efforts will be made to erase this experience from memory, and similar efforts will again be made to launch such ill-conceived programs in the name of the welfare of the oppressed peoples of the world. Scholars who have concern for the oppressed must remain vigilant.

Female↗