[The Alma-Ata Declaration and the development of sanitary and epidemiologic services in Kazakhstan].
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Of late, governments of affluent countries have become more brazen in using United Nations organizations and other global commissions as tools to serve their political and economic interests. WHO and UNICEF have been used by these governments to impose technocentric and dependence-promoting programs on countries of the South. The report of the Commission on Health Research for Development is yet another effort in that direction. It advocates international cooperation in health research. It merely adds to the bulk of documents on international health research. It is ahistorical. It does not analyze why WHO and UNICEF and the governments of affluent countries imposed global programs on immunization and diarrheal and respiratory diseases without bothering to gather even the most elementary data about them. There is a method in the brashness. Worse still, it ignores the rich heritage of health research of the past half a century in countries such as India, Indonesia, and Thailand. It is yet another effort to obscure the message of self-reliance contained in the Alma-Ata Declaration on Primary Health Care.
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.
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.
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?
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.
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.
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.
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.