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PubMed1982

Rural health development in Ethiopia. Problems of utilization of traditional healers.

In Ethiopia, a pluralistic complex of multiple and simultaneous medical care utilization has constituted the Ethiopian variant of medical pluralism in East Africa, where through a process of acculturation, Cushitic, Arabic and Amharic medical traditions co-exist with cosmopolitan medicine. On request of the central government, joint medical-sociological and anthropological research between in Universities of Addis Ababa and Leiden was conducted in the Eastern Highlands with the main objective to formulate recommendations for the improvement and extension of the health care facilities in the rural areas. The situational analysis revealed relatively low utilization rates of the "official' health services by the local population. Consequently a desire was expressed to undertake health services development research, particularly centered upon the functioning of the various medical systems and sub-systems in Hararghe. In order to assess the overall pattern of illness behaviour special consideration was given to the question "when, and to what extent do people use the available medical systems?". After the completion of the subsequent subjective and objective health surveys the concept of "distance reduction' between provider and consumer of health care was introduced in order to increase the utilization of the formal health services, taking into account the problems related to geographical, economic and socio-cultural distance. In this paper, a description will be given of the existing alternative health care resources. In addition, the positive contribution which the concept of medical pluralism could provide to rural health planning will be examined within the context of the research project. This will include a discussion of the problems encountered in connection with the utilization of traditional healers and the possibilities for their incorporation into a future syncretic type of national health care delivery system.

Attitude to Health↗

PubMed1997

Health human resource development in rural China.

China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas.

China↗

PubMed1987

The Saradidi, Kenya, rural health development programme.

A primary health care community development programme was initiated in 1979 by people living in Saradidi, Kenya. The community was involved in planning, organization, setting of priorities and objectives, implementation, evaluation and benefits. This paper describes the developmental process that occurred including how the programme began, how it was organized and what it attempted to accomplish.

Community Health Services↗

PubMed1998

Agency-Community Partnership in Landcare: Lessons for State-Sponsored Citizen Resource Management

/ With over 2500 Australian Landcare groups, 65,000 volunteer members, and considerable evidence of program impact, Landcare is an important example of state-sponsored rural development in a developed nation. The agency-community partnership is a fundamental element of Landcare and getting the partnership right is vital to long-term program success. After reviewing the emergence of Landcare in the state of Victoria, the author reports research from a 1995 survey of Victorian Landcare groups. Survey information highlighted the extent of agency-group contact, the important roles agency staff played in many Landcare groups, and the positive impact of agency contact and government funding upon group activity. Large majorities of groups reported they were satisfied with their relationship with agency staff. However, a majority of groups reported money or materials provided to manage land and water degradation was inadequate. Recently proposed changes to the Landcare program will provide government funding of work on private property and may address this concern. A majority of groups also reported support for leadership and management training was inadequate and respondents emphasized the need to revise program guidelines that limit funding for group coordinators. This information highlighted the importance of articulating a practical model of community participation in Australia and adopting a systematic approach to providing agency support for Landcare groups. Reflecting upon the Landcare experience, the author suggests some of the key elements of a practical model of state-sponsored citizen resource management contributing to rural development.KEY WORDS: Landcare; Australia; Community participation; Rural development; Citizen resource management; Sustainable agriculture

Journal Article↗

PubMed1987

Community leadership and participation in the Saradidi, Kenya, rural health development programme.

Community participation and leadership in initiating and implementing a health development programme in Saradidi, Kenya were examined. Organization of the area into villages had to be sensitive to existing community organizational structures such as geography, religion, kinship and administrative boundaries. The lowest level government leaders did not always have the support of the community. Some groups such as women and those who were not wealthy were not always included in leadership positions; these people, however, were often most aware of certain village problems. In Saradidi, women's groups were important for community development; they supported the volunteer community health workers and carried out many village health activities. Many village health committees did not function effectively. Village health workers were supported principally by the programme centre. Village income-generating activities were not very successful. Group involvement in income raising ventures proved to be inefficient; many ended up as income draining activities. Village group income projects must be well selected relative to the skills and resources available and the ability of the product to be marketed; only exceptional ones should be encouraged. Those based at the programme's centre were more successful perhaps because of a greater investment in skills, money and marketing. Age was an important factor in accepted leadership roles in Saradidi; most effective leaders were more than 45 years of age. Village health helpers volunteered a significant proportion of their time despite poor support by village health committees and no financial remuneration. The central project structure and the training they received compensated for the lack of guidance by village health committees.

Community Health Services↗

PubMed1987

The Saradidi, Kenya, rural health development programme: retrospective demographic analysis.

A census was done in Saradidi, Kenya from 1980 to 1982 as part of a community-based health development programme. The population was 42,755 (excluding 39 persons of unknown age or sex); 17.1% were less than five years old, 46.9% were below age 15, 4.7% were age 65 years or older and 19.7% were women in the reproductive years (age 15 to 44 years). The sex ratio was 86 males per 100 females due principally to migration of adult males for work. The mean number of persons per household was 4.0 and the mean village population was 764. The singulate mean age of marriage for men was 27.0 years and for women 19.9 years; 0.8% of adult men had never married. Only 0.1% of women by age 50 had never been married. Men were significantly more likely than women to be married to more than one spouse, divorce and separation was higher among men, and by age 50 about one-third of women were widows. Men had more years of formal education than women and young people of both sexes more than older people; 73.1% of men and 96.1% of women 60 years and more had never attended school. Infant mortality rates estimated indirectly ranged between 139 and 155 by area. A strong association was found between increasing education of the mother and decreased reported mortality of children. The total fertility of 6.2 was high but lower than the national average possibly because of the high rates of polygamy and primary infertility and the long periods of amenorrhoea and breast feeding which occurred after delivery. This area continues to have one of the highest levels of infant and child mortality in Kenya as well as relatively high fertility and a population with a very young age structure. This implies a continued very rapid rate of population growth which will make more difficult in the future the problems of delivering effective health services and overcoming poverty. A vigorous programme directed toward improving health is indicated which must include family planning.

Community Health Services↗

PubMed1986