Health across barriers / Sylvia Moore

Health across barriers C ommunity self-help action in isolation can-not be sustained without support from outside the community. This is especially so in developing countries and in the poorest areas of developed countries. Consequently, the responsi- ~ bility for disease prevention and health ..c promotion rests not only with govern- U: ments and the international corn- ~ munity but with the individual. The complexities of local and re- gional administration make it difficult for small communities to gain access to civil servants. Especially so for those communities living in a world apart - physically, socially, and economically - from the capital city, and therefore unable to share in the main stream of modern life. At the same time, their own traditionally sustaining resources are rapidly on the wane. In order to put primary health care into effective practice, the district system can help close this gap by bringing health care within reach of the most isolated areas. District level administration recurs in modified forms in all national structures, and can therefore be a crucial link between governments and communities. The district system has the potential of tying government resources , national goals and policies to the specific needs and aspirations of the local communities. By creating two- way linkages, it has a crucial role to play in advocacy and in policy implementation. Not only can the district network link local communities to the national system; it can also link different activi- ties at all levels of the community, such as agriculture, nutrition, education, employment, human settlements and environmental care. Since other sectors than those directly related to health are involved, improvements in health call for an integrated approach to development. So the district net- work can simultaneously tackle such unhealthy factors as lack of clean water, bad sanitation, inadequate housing, lack of basic education, and inadequate incomes. It can promote improvements in agricultural tech- niques , nutrition , literacy and numeracy , s kills train ing and employment. And it can encourage 18 Sylvia Moore It has often been said that health is indivisible. For young and old (above, in Chandigarh, India) and for the Russian worker getting first aid in a Volgograd clinic, health services are a basic human right. l..eonid T oprover health programmes for different sectors of the communities such as children, youth, women and the elderly. Strengthening health systems through the district approach was expressly encouraged by a resolution of the 39th World Health Assembly in Geneva in 1986. And WHO's first interegional meeting on this subject, held in Harare, Zimbabwe, in August 1987, drew up a number of concrete recommendations which stressed com- munity involvement, intersectoral action, district leadership and mobil- isation of resources. The following year, a: meeting held at Riga in the Soviet Union to reaffirm the 1978 Declaration of Alma-Ata called for accelerated action to W ORLD HEALTH. May 1989 "Strengthen district health systems based on primary health care, as a key action point for focusing national poli- cies, resources and local concerns on the most pressing health needs and on under-served people." The Riga meeting was held at the mid-point in time between the historic Alma-Ata Conference in 1978 and the year 2000. The meeting was held by WHO to review progress and problems experienced in pursuing the goal of Health for all. It was held at Riga, USSR from 22 to 25 March 1988, and brought together experts from all WHO regions as well as representatives of UNICEF, UNDP and non-governmental organizations. The participants found that the Health for all concepts have made strong positive contributions to the health and well-being of people in all countries. At the same time, they noted that problems remained and ~ that increased action was needed to ~ ensure that primary health care ~ reached everybody. c:o A working woman in Bangladesh has no need for a baby-sitter. [Further information on these meet- ings can be obtained from the Division of Strengthening Health Services at WHO Headquarters, Geneva. Docu- ments include: report of the Inter- regional Meeting on Strengthening District Health Systems based on Pri- mary Health Care (Harare, Zimbabwe, 3-7 August 1987); the World of Health Radio Information Programmes of November and December 1987, entitled "Health across barriers through the district approach" (Part I and II respectively); post-conference information comprising transcriptions of recorded interviews, audio-cassettes of the conference, video documentary of the main events of the conference; report "Aima-Ata reaffirmed at Riga 1988".] • W ORLD HEALT H, M ay 1989 Youngsters enjoy a nourishing meal in India. Nutrition is one of the eight supporting pillars of primary health care. Recommendations of the Harare Conference: Ensure Sustainability Adopt National Policies Decentralise Redefine the Role and Functioning of Develop a District Planning Process Strengthen Community Involvement Promote Intersectoral Action Develop District Leadership Mobilize all Possible Resources Hospitals Use Health Systems Research Ensure Equity between Districts Encourage the Mobilization of International, Multilateral And Bilateral Resources Recommendations of the Riga Meeting: I. Maintaining Health for all as a permanent goal of all nations up to and beyond the year 2000. Intensifying social and political action for the future Agenda 2000. 11. · Renewing and strengthening strategies for Health for All. Ill. Intensifying social and political action for health. IV. Developing and mobilising leadership for Health for All. V. Empowering people. VI. Making intersectoral collaboration for Health for All. Accelerating Action for Health for All - Agenda 2000. VII. Strengthening district health systems based on primary health care. VIII. Planning, preparing and supporting health personnel for Health for All. IX. Ensuring the development and rational use of science and appropriate technology. X. Overcoming problems that continue to resist solution. Special priority initiative in support of the least developed countries by WHO and the international community. 19