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Media Seminar on Health for All through Primary Health Care, Philippines and Republic of Korea, 18-23 April 1983 : report

December 31, 1983 World Health Organization

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(WP)ICP/INF/OOI

2 November 1983 ENGLISH ONLY

~IA SEMINAR ON HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE

Philippines and Republic of Korea 18-23 April 1983

Not for sale Printed and distributed by the

Regional Office for the Western Pacific of the World Health Organization Manila, Philippines November 1983

CONTENTS

1. 2" 3.

INTRODUCT ION

" "" "" " " """ " """ """ " "" "" " " "" ,. " "" "" "" "" "" """ " """ " """ "" "" "" "" " "" "" " " " "" "" "" "" "" "" "" "" "" " "",," "" "" ,,""" "" "" " " "" " " """ """""""""" "" """

1 1 2

THE OPENING CEREMONY THE SmINAR PROPER

3.1 3.2 4.

Plenary sessions ••••.•••.••••••.••••.•••••••••••••••• Field visits """""""""""""""""""""""""""""""",,"""""""" """"""""""",, .. ,,""""""""""""""""""""""""

2 4 5

TIlE CWSING CEREMONY

CONCLUS IONS

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ANNEX 1 ANNEX 2 -

AGENDA

"" " • "" " "" "" " " "" " "" " " ,. " "" "" "" " "" "" "" "" " "

OPENING SPEECH OF DR HIROSHI NAKAJIMA, WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC, AT THE MEDIA SEMINAR ON HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE, MANILA, 18 TO 23 APRIL 1983 .•••••.••••.•••••••••••••

ANNEX 3 -

LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISERS AND SECRETARIAT

"" " "" """ " " "

15 19 21/22

ANNEX 4(a) - FIELD VISITS to THE PROVINCE OF NUEVA EeIJA, PHILIPPINES ••••••••••••••••••••• ANNEX 4(b) - SCHEDULE (SEOUL) ANNEX 5 ANNEX 6 -

............................. HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE ... .•••••.•••••.•••••••••••••••••• .••...••..•.••••••.••••••

RESEARCH AND DEVELOPMENT PROJECTS IN PRIMARY HEALTH CARE IN WESTERN PACIFIC REGION 27 33 47

ANNEX

7(a) -

BRIEFING NOTES - FIELD VISITS to NUEVA ECIJA PROVINCE REPUBLIC OF KOREA

ANNEX 7(b) - PRIMARY HEALTH CARE IN THE • • • • • • • • • • • • • • •• • • • • • • • • • • • •

ANNEX 8 -

CLOSING SPEECH OF DR HIROSHI NAKAJDKA, WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC, SEOUL, 23 APRIL 1983 •••••••••••••••• SPEECH OF DR PHUNG CHUC PHONG, VIET NAN •••••••• HEALTH COUNTRY PAPER, FIJI

57 59

ANNEX 9 ANNEX 10 ANNEX 11 -

.................... •••••••••••••••••

DANG MOK PRIMARY HeALTH POST

INTRODUCTION

The Media Seminar on Health for All through Primary Health Care was held at the Conference Hall of the World Health Organization Regional Office for the Western Pacific, Manila, from 18 to 23 April 1983, and included field visits to Nueva Ecija, Philippines, and Seoul, Republic of Korea. The following were the objectives of the (1) seminar~

to strengthen press reporting in health in order to enlist and sustain political commitment and social support for primary heal th care; to identify and strengthen mechanisms for maintaining linkages between the mass media and sectors involved in primary health care. aimed~

(2)

specifically, the seminar (1)

to expose and orient mass media practitioners to the concept of primary heal th care through presentations, discussions and field visits;

(2) (3)

to convince them of the relevance of primary health care to national development; to provide them w~th the material and first-band knowledge and experience of primary health care to enable thea to write and report on the subject in the mass media; and to encourage more comprehensive and responsible reporting on primary health care and the goal of health for all by the mass media in the Region.

(4)

THE OPENING CEREMONY

Dr S.T. Han, Director of Programme Management of the WHO Regional Office for the Western Pacific, opened the seminar on behalf of Dr Hiroshi Nakajima, WHO Regional Director for the Western Pacific. In his opening speech, Dr Han stressed the importance of the support and cooperation of the mass media in the attainment of the goal of health for all. He noted that the seminar was well-timed. This year'. World Health Day, celebrated on 7 April, had focused on the theme, "Health for all - the countdown has begun", a reminder that only 17 years were left for WHO Member States to schieve the goal of health for all by the year 2000. Dr Han said that the media could help make people aware of their potentials to achieve a socially and economically productive life. Tbe media could reinforce the interest and the determination of policy makers and health administratots to translate the commitment of govern8ents to primary health care.

- 2 -

. He therefore sought the help of the media in spreading the concept of prLmary health care and the goal of health for all. Participants were aaked to provide feedbaCk on the promotional efforts of WHO. The full text of Dr Han's opening remarks is attached to this report as Annex 2.

THE SEMINAR PROPER

The seminar was attended by 19 participants from 14 countries or areas, who were mainly reporters and broadcasters of major mass media organizations in their country. There were, in addition, five temporary advisers, one consultant, one observer and three secretariat members. A list of participants is attached to this report as Annex 3. The seminar agenda included a two-day schedule for presentations and discussions on the following topics: Health for all through primary health care; Regional research and development projects on primary health care; World Health Organization perceptions on the role of media; World Health Organization programaes; and Media perceptions of primary health care coverage and stories. A two-day visit in relation to primary health care activities in Nueva Ecija, Philippines, and another two-day visit to Saemaul Undo~g, South Korea, were scheduled. The schedule of activities i. attached as Annex 4. Officers of the seminar were elected as follows: Mr Kyong Sik Kim, City Editor of The Korean Times, Chairman; Mr John Konainao, current affairs producer of the Solomon Islands Broadcasting Corporation, Vice-Chairman; and Me Yvonne Chua, feature writer of the Philippines Daily Express. Rapporteur. 3.1 Plenary sessions A plenary session immediately followed the opening ceremony. Participants were introduced to the goal of health for all by the year 2000 through primary health care by the Director. Health Protection and Promotion. WHO Regional Office for the Western Pacific. The Director of Health Protection and Promotion defined the meaning of health for all and primary health care and described the background events leading up to their adoption at the World Health Assembly. He concluded his paper by citing various conditions for attaining health for all by the year 2000. An outline of the paper is attached as Annex 5. The Chief. Human Resources Development. WHO Regional Office for the Western Pacific, summarizing the main points of the above paper said that primary health care was a revolutionary idea and must be made available to all. However, cost and intersectoral collaboration were crucial factors in the implementation of primary health care in communities. He referred to the importance of the mass media.

- 3 -

During the discussion that ensued, concern was expressed at the extent of WHO's role in countries where social and political processes might prove an obstacle in health delivery. The willingness of governments to turn over power to the people to enable them to determine their own priority health needs and problems was also questioned. The participants agreed that health news, including news about primary health care, would sell if packaged attractively. However, information disseminated by the mass media must go hand in hand with service. It was the consensus that the establishments concerned should provide as much information as possible, ensuring its accuracy and leave the mass media to present it the way the practitioners thought best. The duties and responsibilities of the media men were underscored. Participants also urged the health ministries to prepare and facilitate the use of news facilities by people in depressed areas. A paper entitled Regional research development projects in primary health care in the Western Pacific Region was presented by the Scientist, Primary Health Care. She identified three patterns of the primary health care developmental process in the Region as well as defining research and development in primary health care, and discussing its features, strategy, phasing, significance and impact. The status of implementation of research and development projects in primary health care in China, Malaysia, Papua New Guinea, Philippines, the Republic of Korea, Trust Territory of the Pacific Islands and Vanuatu were also described. The paper is attached to this report as Annex 6. Participants felt that this report on the different research and development projects was too general, and that it would be of greater interest to present specific cases. The Papua New Guinea experience was discussed more extensively, and participants questioned the use of DDT to control malaria in Papua New Guinea. The discussion showed that media involvement in ongoing research and development projects was favoured over media involvement after completion of the projects. A 45-minute film presentation on primary health care activities in Fiji showed how community involvement could be achieved, priority health problems and needs identified, appropriate technology developed, health manpower trained and retrained, and self-reliance attained. A roundtable discussion on the role of the media highlighted the second day of the seminar. The Director of Programme Management, WHO Regional Office for the Western Pacific, presented WHO's perceptions on the role of media. He said that the re-examination and reorientation of the world health system might also mean a corresponding review by media men of their role.

- 4 -

The Regional Adviser in Environmental Health, WHO Regional Office for the Western Pacific, presented a paper on WHO projects in the area of sanitation and safe water. WHO projects on maternal and child health and family health were presented by the Regional Adviser in Maternal and Child Health, while the Medical Officers, Expanded Programme on Immunization and Acute Respiratory Infections took turns discussing WHO activities in the control of communicable diseases. Host participants noted that the media supported WHO and other health agencies in the dissemination of the concept and activities of primary health care. Health news was given due attention by the media. However, it was acknowledged that the media was faced with tha usual constraints, namely, inability of agencies to provide sufficient information, space limitations, lack of understanding from editors, pressures from advertisers and other obstacles. The information provided by WHO on health and health system was usually utilized, but the relevance of the data given to respective countries was a problem. The Organization also tended to overuse jargon. In cases where English was not the primary language, WHO data suffered from the translation from English into other languages or dialects. The Director, Programme Management, concluded the session by stressing that WHO needed to improve its communication means. He took note of the need to provide relevant information and to write World Health reports in "collllllOn and understandable English". The presentation of WHO data also needed to be improved While it might be impossible to regionalize the World Health Organization magazine in the near future, the WHO Regional Office for the Western Pacific could start innovations on its regional newsletter, Health and Development. 3.2 Field visits

To provide opportunities to observe primary health care activities at the community level, field visits were made to two barangays (villages) in the province of Nueva Ecija. Philippines, and to two villages in the Republic of Korea. Through actual observation and dialogue with the community members, the participants gained insights into the health development activities initiated and sustained by them in partnership with the government and the private sectors. Among the community-based projects observed in the Philippines were herbal gardens, income-generating sctivities such as brick-making and duck-raising, the community health insurance scheme and community health monitoring. Field visits to Yongin and Ansungcommunities in the Republic of Korea yielded valuable information on community-based activities related to tha people's participation and involvement in environmental sanitation projects, particularly the provision of safe water supply. Briefing notes and other relevant information on these field visits are attachea to this report as Annex 7.

- 5 -

THE CLOSING CEREMONY

The closing session of the seminar was held at Kimpo Restaurant in Seoul, Republic of Korea, just before a dinner hosted by Mr Kyung Hwan Chun, Pres ident of South Korea' s Saemaul Undong Movement. The WHO Regional Programme Coordinator in Seoul closed the seminar on behalf of Dr Hiroshi Nakajima. WHO Regional Director for the Western Pacific. He told the participants that the· seminar would help them create greater awareness of the importance of planning and management for social development in their countries. The WHO Regional Programme Coordinator reviewed the recurring themes of. the seminar, ~ich included. (1) (2) the goal of health for all by the year 2000, and, the primary health care concept; the importance of community participation in relation to human resources and the utilization of many factors in various social science fields in addition to the pure health field; the generation of public motivation for the community health programme; the projection into future planning of the national health programme; the need for the support by the private sector in stimulating policy formulation for the health field.

(3) (4) (5)

In closing, he summed up the feeling of the seminar participants, that the seminar was just a beginning and that they would continue to work jointly to achieve the final goal of health for all.

CONCLUSIONS

The 19 participants in the seminar and the three temporary advisers from the media represented a broad media cross-section- from the more highly developed radio and television network of Australia, Hong Kong and New Zealand, the international press, highly organized government and public news organizations and newspapers to small, almost hometown, newspapers and radio stations. It was felt that discussions, for example, about the problems of television -- where the line between entertainment and news was extreaely tenuous -- might be interesting to print or radio journalists, but certainly not relevant in practical terms.

- 6 -

, On the other hand, the problems raised by those who come from places where radio was the best, if not, the only media that could reach the "underserved" sectors of their community, were just as interesting but had just as little direct relevance to those coming from highly complex and organized institutions. The participants noted that the first day's presentation adequately met the requirements of providing journalists with material and first-hand knowledge and experience of primary health care to enable them to write and report on the subject but felt that the open forum that followed the presentations and the discussions on the role of media on the second day highlighted the classic gap between the scientists and media professionals. It was all very well to say that scientists should try to see things from the point of view of journalists and that journalists should equip themselves better to be able to appreciate what the scientist was trying to do. The question was how? The presentation On research and development projects was a case in point. It wss an excellent technical report, but the journalists were more interested in what was done, with what results and why. From the participants' point of view, the presentation would have made a better news report if they were able to present the conclusions in terms of their effects on a person, society or country. Each will have to present these in terms of its own audience. It was in this respect that the World Health Organization might be able to help media professionals in the presentation of primary health care stories. Journalists on the other hand had the duty to respect both accuracy and truth and were therefore duty-bound to attempt to learn the subject they were to write about. This was precisely one of the objectives of seminars on primary health care. In the light of these discussions, there was a consensus that the World Health Organization might wish to consider the following sugge8tions~ (1) The World Health Organization should endeavour to encourage and support health care organizations of Member States in holding national media seminars in which the actual problems between hpalth and media practitioner could be discussed. In the holding of media seminars, World Health Organization 8hould~

(2)

(a) (b) (c)

hold seminars on only one medium; or schedule separate discussions for each mass media division print, radio and television; or divide seminar participants into print, radio or television with each group following s syllsbus geared to its medium.

- 7 -

(3)

The World Health Organization should endeavour to cooperate with and support internstional media training institutions Asia/pacific Institute of Broadcast Development (AIBD) and Press Foundation of Asia (PFA), for example, by: (a) (b) developing a syllabus for primary health care and its coverage for use by these institutions; and/or requesting these institutions to include primary health care in their syllabi of instruction.

In this regard, the following suggestions ar1s1ng from the First WHO/UNICEF Regional Workshop on the Promotion of Health Information were underscored: (1)

Mass media (press, radio, television) should train their reporters on health reporting and identify both local and foreign resources where this new expertise may be obtained. In this regard, the World Health Organization should seek the expertise of international organizations and institutions such as the University of the Philippines Institute of Mass Communication (UPIMC), Asian Institute for Broadcast Development (AIBD), Press Foundation of Asia (PFA), etc., which were already engaged in cOllllDunication. These organizations and institutions should be asked to draw up a course for the handling of health and health-related inforaation that might be used for national or international training seminars/workshOps. The World Health Organization should develop an information brochure specifically for media and personnel dealing with media, expounding the concept of primary health care and the specific requirements of media that would achieve the objectives of this concept.

(2)

(3)

(4)

Finally, the participants found primary health care, specifically the activities observed by them during the field visits to be very interesting. The difficulties seemed to derive not so .uch from primary health care's lack of news value, hut rather from the shortage of information available to the media. As a result of the discussions and field visits, the conclusions could be summed up as follows: (1)

To strengthen the regional information system, WHO magazines/newsletters should carry news items/stories that are relevant to the needs and situations in countries within the Region. Efforts should be directed toward the translation of technical information into a language that is simple and easily understood. The use of jargon snd acronyms should be avoided.

(2)

- 8 -

(3)

To enable journalists to write about primary heslth care accurately and intelligently, they should be acquainted with primary health care activities as early as possible in the planning and implementation of the strategy. Presentation of primary health concepts and activities by technical personnel should be more personalized and should effectively utilize real-life situations and experiences. Specific rather than general information should be presented. A glossary of technical words and terms which WHO frequently uses in its documents should be prepared and distributed extensively. The holding of regular dialogues among media personnel and medical/health professionals in small groups, preferably at the country level, could contribute immeasurably to more extensive and effective media support to primary health care. Participation of media representatives in technical discussions of WHO should be encouraged. A two-way feedback mechanism in the sp1r1t of cooperation and collaboration should be established between the media and the medical/health professionals. All concerned should keep an open mind, cognizant of common goals of achieving health for all by the year 2000.

(4)

(5) (6)

(7)

(8)

- 9 ANNEX 1

AGENDA

Monday, 18 April 0800 - 0830 0830 - 0900 Registration Opening ceremony Opening Remarks by Dr Hiroshi Nakajima Regional Director, WHO/WPRO Introduction of participants Election of: Chairman Vice-Chairman Rapporteur

0900 - 0930 0930 - 1000 1000 - 1100

Briefing, announcements, group photograph Coffee break Presentation - Health for All Through Primary Health Care by Dr A. Noordin, Director Health Protection and Promotion, WHO/WPRO

1100 - 1200 1200 - 1330 1330 - 1430

Open forum/Discussions Lunch break Presentation - Regional Research and Development Projects on Primary Health Care by Dr K.S. Lee, Scientist Primary Health Care, WHO/WPRO

1430 - 1500 1500 - 1530 1530 - 1600 1600 - 1800

Open forum/Discussion Coffee break Film showing Cocktails - WHO Lounge

- 10 Tuesday, 19 April 0800 - 1000 Roundtable discussion on the role of the press (Professional staff) Working paper: The Mass Media - Players or spectators? Coffee break Roundtable discussion (continued) Lunch break Plenary session

1000 - 1030 1030 - 1200 1200 - 1330 1330 - 1600 Wednesday, 20 April 0700 Thursday, 21 April 0600 1100 Friday, 22 April 0900 - 1700 1900 - 2100 Saturday, 23 April 0920 1100 - 1200

Leave for Nueva Ecija, Cabanatuan City

Leave Nueva Ecija for Manila International Airport Leave for Seoul, Republic of Korea

Field visit (Seoul schedule) Reception - Ministry of Culture and Public Information

Field visit Presentation of reports Closing ceremony Closing remarks Announcements

- 11 ANNEX 2

OPENING SPEECH OF DR HIROSHI NAKAJIMA, WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC AT THE MEDIA SEMINAR ON HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE Manila, 18 to 23 April 1983

Ladies, Gentlemen, Many people have mixed feelings about encounters with the mass media. We in the World Health Organization, however, welcome these occasions. This is because we are well aware that your support and cooperation will be necessary if we are to achieve our Objectives. It is my pleasure, therefore, to welcome you on behalf of Dr Hiroshi Nakajima to this Media Seminar on Health for All through Primary Health Care. This seminar could not have come at a better time. Only a few days ago we observed World Health Day. This annual event, which is really a celebration of the founding of WHO, always focuses on a theme of global significance. This year we focused our attention on the theme "Health for All - the Countdown has Begun". The theme is first of all a reminder that we have only 17 years left to achieve the goal which WHO Member States have set for themselves "Health for All by the Year 2000". More than this, however, it is a call for everyone - individuals, communities, laymen, experts, all sectors - to get involved in the promotion and maintenance of their own health and well-being. With this year's World Health Day celebration, we wanted to make people aware of their potentials; of what they themselves can do to achieve a socially and economically productive life for everybody. This is the reason why we consider the mass media important. For it is through your cooperation and support that we hope to get this message across to the people and their leaders. People want to be healthy. The problem is that many of them do not know what can and should be done. The mass media, it has been repeatedly acknowledged, is a major instrument in relaying to the people the kind of knowledge and information that will enable them to take the initiative or get actively involved in the promotion of their own health.

- 12 -

Annex 2 .At the sam~ time, although most governments in the Region are already commLtted to prLmary health care, the media can play an important role in reinforcing the interest and determination of policy makers and health administrators to translate this commitment into action. You can encourage them to strengthen their efforts to build a closer relationship with the people and get communities involved in primary health care. There have been times when health workers have despaired of ever getting the mass media interested in this idea of Health for All through Primary Health Care. Stories published in the medical sections of prestigious and popular journals tend to give the impression that the media are interested only in dramatic and sensational events. Advanced technology - organ transplants, gene-splicing, test-tube babies, and the like - is one kind of information that attracts precious media space, if not the headlines. Not that these are less important or that they don't deserve the space that they get. Like the antibiotics and wonder drugs of yesterday, they have the potential to contribute effectively to the control of tomorrow's public health problems. But the public health priorLtLes of the present are different. And they are the ones which deserve increased attention from the public and policy makers. This is particularly true in an area like the Western Pacific Region where in most places, the causes of ill-health are still diseases like diarrhoeas, malaria and respiratory infections which can be largely controlled through community-based interventions. But we would media, so far, LS fully acquaint it as the concept of like to believe that this omission on the part of the due more to the fact that we have not yet managed to with our goal of Health for All by the Year 2000 as well primary health care.

For the next few days, that is what we would like to talk to you about - our goal of Health for All and how we are trying to achieve it through primary health care. We asked the Ministries of Health in the Western Pacific to invite their leading media men to this seminar and we are happy to have your distinguished group with us. What we would like to do during the next few days, is to enlist your help in spreading the concept of primary health care and our goal of Health for All. This we intend to do not by asking you to do so but by showing you some of the exciting and innovative activities being undertaken by communities which have decided to take charge of their own health and well-being. We hope that the ingenuity, enthusiasm, dedication and determination demonstrated by these communities will persuade you that primary health care is after all, as you media men would put it, good copy. We are quite optimistic that you will find the story of how people are working to achieve health for all interesting enough to tell your audiences, whether or not you yourselves are committed to the same goal.

- 13/14 Annex 2

What we would like you to do in return, as working journalists is to provide feedback on the effort so far of WHO in promoting the ideal of health for all through primary health care. We would also like to learn from you in getting our message across. The seminar secretariat has tried to make the sessions as unstructured as possible in keeping with the media style. You are having only two days of formal discussions. The rest of the time you will spend in field visits to Nueva Ecija and Seoul. I wish to express my gratitude to the Seminar Consultant, Mr Benjamin Defensor, Training Consultant, Press Foundation of Asia, and the Temporary Advisers: Me Yvpnne Chua, Feature Writer, Daily Express, Manila; Mr Msrcus Gee, General Editor, As iaweek , Hong Kong; Hs Melinda de Jesus, Columnist, Bulletin Today, Manila; Dr Dong-Mo Rhie, Director, Division of Local Health Services, Ministry of Health and Social Affairs, Republic of Korea and Mrs Leonor Zamora, Health Adviser, Office of the Minister, Philippines Ministry of Health. I wish you all a highly successful and productive seminar. Thank you in advance for your understanding and cooperation.

•

Seated (from left): Mr H.S. Dhillon; Ms Melinda de Jesus; Ms Leonor Zamora; Mr Telkon Tikon; Ms Yvonne Chua; Mr Myong-Sik Kim:, Dr S.T". Han; Mr" John Konainao; Mr Benjamin Defensor; Mr Marcus Gee; Dr Dong-Mo Rhie and Ms Erlinda Bolido. Standing (from left): Mr Othman bin Shafie; Mr Seremaia Tuiteci; Mr Wang Yong Sun; Mr Eparama Turaga; Dr Phung Chuc Phong; Mr Patrick C.L. Poon; Mr J.A. Lynn; Ms Marietta G. Bernaje; Ms Socorro Peralta; Ms Nurilah bte. Abdul Samad; Ms D. Chisholm; Mr Barry J. Hailstone; Ms Robina Sokal; Mr J. Tuli; Dr Nobuhiro Maruchi and Mr Ho-Hyong Hwang.

- 15 ANNEX 3 LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISERS AND SECRETARIAT 1. AUSTRALIA PARTICIPANTS

Mr Barry J. Hailstone Science and Medical Writer Advertiser Newspapers Adelaide Mr Wang Yong Sun Correspondent Xinhua News Agency Mr Seremaia Tuiteci Senior Information Assistant Department of Info~tion Ministry of Health, Suva Mr Eparama Turaga Senior Reporter Newspapers of Fiji, Ltd. Suva

CHINA

FIJI

HONG KONG

Mr J .A. Lynn Chief Editor ATV News and Public Affairs Kowloon Mr Patrick C.L. Poon News Editor Sing Tao Jih Pao North Point

JAPAN

Dr Nobuhiro Maruchi Chairman of Public Information Associate Professor Department of Health Administration School of Health Services Faculty of Medicine University of Tokyo Tokyo Ms Nurilah bte. Abdul Samad Broadcasting Assistant Radio & Television Malaysia (RIM) Angkasapuri Kuala Lumpur Mr Othman bin Shafie Journalist BERNAMA (National News Agency) Kuala Lumpur

MALAYSIA

- 16 Annex 3

NEW ZEALAND

Ms D. Chisholm Medical Reporter Auckland Star New Zealand Newspapers Auckland

PAPUA NEW GUINEA

Mr Peter Manau Head of Drama and Features National Broadcasting Commission Boroko Mr Asora Paul Senior Reporter PNG Post Courier - National Newspaper Port Moresby

PHILIPPINES

Ms Marietta G. Bernaje Chief, Information Division Ministry of Health Manila Ms Socorro Peral ta Chief of Production Ministry of Health Manila

REPUBLIC OF KOREA

Mr Ho-Hyong Hwang Reporter, K B S Youngdeungpo-Gu Seoul Mr Myong-Sik Kim City Editor, The Korea Times Chongno-ku, Seoul

SAMOA

Mr Ulafala Aiavao Broadcast Officer Department of Broadcasting Apia Mr John Konainao Journalist Current Affairs Producer Solomon Islands Broadcasting Corporation Honiara

SOLOMON ISLANDS

TRUST TERRITORY OF THE PACIFIC ISLANDS

Mr Telkon Tikon Republic of the Marshall Islands Majuro

- 17 Annex 3 VIET NAM Dr Phung Chuc Phong Editor in Chief "HEALTH" Journal Ministry of Health Hanoi

CONSULTANT

Mr Benjamin Defensor Training Consultant Press Foundation of Asia Manila 3.

TEMPORARY ADVISERS

Ms Yvonne Chua

Feature Writer Daily Express Manila Mr Marcus Gee General Editor Asiaweek Hong Kong Ms Melinda de Jesus

Columnist Bulletin Today Manila Dr Dong-Mo Rhie Director Division of Local Health Services Ministry of Health and Social Affairs Seoul

Mrs Leonor Zamora Health Adviser Office of the Minister Ministry of Health Manila 4.

OBSERVER

Mrs.Robina Sokal Director United Nations Information Centre Manila

- 18 -

Annex 3

SECRETARIAT

Ms Erlinda Bolido (Operational Officer)

Consultant Public Information Office WHO Regional Office for the Western Pacific Manila Mr H.S. Dhillon (Co-Operational Officer) Chief, Human Resource Development WHO Regional Office for the Western Pacific Manila Mr J. Tuli Public Information Officer WHO Regional Office for South-East Asia New Delhi

•

- 19 ANNEX 4(a)

FIELD VISITS TO THE PROVINCE OF NUEVA ECIJA, PHILIPPINES (a) (b) Barangay San Carlos, Cabiao Barangay Panabingan, San Antonio 20-21 April 1983 Objectives and Schedule

Objectives (1) (2) To observe primary health care activities at the barangay level. To gain first-hand information and insights on the processes involved in community-based health development activities in rural barangays through dialogues with the community people. To identify/strengthen mechanisms for maintaining functional linkages between the mass media and sectors involved in primary health care.

(3)

Schedule Wednesday, 20 April

a.m. Place of assembly: 0700 0900 0900 - 0930 0930 0945 WHO, Regional Office for the Western Pacific

Leave for Cabiao, Nueva Ecija Arrive Cabiao, Nueva Ecija - Meet local officials/leaders - Orientation Leave for Barangay San Carlos Arrive Barangay San Carlos Meet local officials/leaders/community people Briefing on local health development activities Dialogue with community people

1130

Leave Barangay San Carlos

- 20 Annex 4(a)

1230 1230 - 1330 1330 - 1600 1600 1700 1700 - 1830 1830 - 1930 1930 - 2100

Arrive Barangay Panabingan, San Antonio - Meet local officials/leaders/community people - Lunch Visit community PRC projects - Dialogue with community people Leave Panabingan Arrive Village Inn, Cabanatuan, Nueva Ecija Free time Dinner Evening session

Venue Thursday, 21 April a.m.

Conference Room, Village Inn Reflections on field visit* Questions, clarifications, other concerns Sharing of impressions

0500 0600 1100

Breakfast at Village Inn Leave for Manila International Airport Arrive MIA (check-in)

1220 1700

ETD Flight KE - 622, Manila ETA Flight KE - 622, Seoul, Korea

*Some health workers and leaders from communities visited will be present to fill in gaps in information, etc.

- 21/22 ANNEX 4(b)

SCHEDULE (SEOUL)

Thursday, 21 April 0600 1100 1220 1700 Friday, 22 April 0900 1000 - 1100 1100 - 1130 1130 - 1530 1530 1630 - 1730 1730 1900 - 2100 - Leave for Yongin County, Kyunggi Province Field visit and briefing about the Saemaul Undong - Observation of simple piped water supply of Gongsedong - Tour Yongin Folk Village, Luncheon hosted by the Chief of Country, Yongin-Gun - Leave for Ansung - Visit the Director of the Dang Mok Ri PHC, observe and discuss the project - Leave for Seoul - Dinner hosted by the Director General of Korean Overseas International Service - Stay overnight at Koreana Hotel Saturday, 23 April 1030 1100 - 1120 1120 - 1200 1200 - 1300 1300 - 1320 - Leave for Saemsul Undong Headquarters - Courtesy call on the Secretary General of Saemaul Undong Headquarters - Slide presentation on SUHQ - Luncheon hosted by the Secretary General of SUHQ - Closing ceremony - Leave Nueva Ecija for Manila International Airport - Arrive Manila International Airport - Leave for Seoul, Republic of Korea - Arrive at Rimpo International Airport, Seoul - Check-in at Koreana Hotel, Seoul

- 23 -

ANNEX 5

HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE Highlights of Presentation by Dr R.A. Noordin Director, Health Protection and Promotion WHO/WPRO

A. 1.

Background events Pre-basic health services era Urban based Curative Discrete services Provider/recipient relationship (limited number of recipients) Use of medical workers

Basic health services era Based in rural areas - Curative and preventive - More integrated services Provider/recipient relationship, but increasing emphasis on community participation - Use of health workers At this time, the following were felt as areas for concern: - Tendency for more expensive technology - Increasing cost of medical care - Increase in population Uneven distribution of health care services in rural and selected urban areas - Less emphasis on economically depressed areas.

The following events were major strides in the adoption of primary health care as a key strategy for the achievement of Health for All: 1974 1975 1977 1978 1979 1980 1982 - UNICEF/WHO Joint Study - WHO Resolution of Primary Health Care WHO Resolution on Social Target by Year 2000 - Alma-Ata Conference on Primary Health Care - Global Strategy for Health for All by the Year 2000 - Regional Strategy for Health for All by the Year 2000 - Adoption of a common format for monitoring Health for All at Regional Meeting of WHO

- 24 -

.' " II II

Annex 5 B. Definition of Health for All - Health for All - a social goal - As a minimum, all people in all countries should at least attain a level of health that will permit them to lead socially and economically productive life. - Every individual should have access to primary health care - All levels of comprehensive health care - Target is dynamic C. Fundamental policies underlying health for all (1) (2) (3) (4) (5) (6) (7) (8) D. Health is a fundamental human right Equitable distribution of health resources to reduce inequalities People's right and duty to participate in health care Government's responsibility to people Country self-reliance in health matters Interrelationship of health development and social and economic development Fuller and better use of world's resources to promote health development Technical cooperation among countries

Main thrust of health for all strategy

Development of health system based on Primary Health Care, that delivers health programmes to the whole population, using appropriate technology, and which have a high degree of community involvement. E. Essential characteristics of health system (1) (2) (3) (4) (5) Covers total population Includes components of health and interrelated sectors Primary health care at first point of contact Other levels support primary health care Intermediate levels - more complex problems, more specialized care, logistic support

- 25 -

Annex 5

(6)

Central level - planning and management highly specialized staff, central expertise, central logistic and financial support.

Illustration:

What is pr1mary health care?

Primary health care is "essential health care, made universally accessible to individuals and families in the community, by means acceptable to them, through their full participation, and a cost that the community and country can afford. It forms an integral part of the country's health system of which it is the nucleus, and of the overall social and economic development of the country". G. Essential elements of primary health care H. Promotion of proper nutrition Adequate supply of safe water Maternal and child care, including family planning Immunization against major infectious diseases Prevention and control of locally endemic diseases Health education Appropriate treatment of common disease injuries

Differences between primary health care and basic health services (1)

Basic health services include: Medical care Communicable diseases control Environmental sanitation improvement Health education Simple laboratory services - Records

- 26 -

Annex 5

(2)

Differences between primary health care and basic health

serv~ces

Differences in approach - Provider/recipient ~n basic health services vs. partner relationship in primary health care - Emphasis in primary health care is placed on (a) (b) (c) community organization; intersectoral collaboration; and use of appropriate technology.

I I

The major challenge in primary health care is how to ensure community involvement. I. Some conditions for ettaining health for all by the year 2000 - Political commitment and economic support - Generation and mobilization of financial and material resources - Ministry of Health's leading role - Mobilization of professional opinion support - Provision of social control of health system by all sectors of the community - Health manpower - including types, orientation - Strengthening of managerial processes in formulating, implementing, monitoring and evaluating of strategy - Mass media support

- 27 -

ANNEX 6

RESEARCH AND DEVELOPMENT PROJECTS IN PRIMARY HEALTH CARE IN WESTERN PACIFIC REGION by Dr K.S. Lee

Several patterns of primary health care (PHC) developmental process may be observed in countries of the Western Pacific Region since the Alma-Ata Declaration in 1978. Most countries, except China, have gone through a promotional stage before entering either the phase of health manpower reorientation and training and/or the initiation of some research and development (R&D) type projects in PRC development. The island countries in the South Pacific seem to favour training activities as a preliminary to PHC field development while the larger countries seem to prefer R&D type activities before embarking on large scale training activities, prior to the implementation of PHC field development. Many countries, however, have now reached the implementation stage which is at different levels of development. Consequently the monitoring and evaluation of PHC development, whether on the R&D scale or on a nationwide scale, have become the main areas of concern at present. This trend is evidenced by the increasing demand of countries for WHO collaboration in the development and strengthening of managerial functions in support of primary health care at all levels with special emphasis on the intermediate level. Patterns of the PHC developmental process in the Western Pacific Region development.

Promotional stage Pattern 1. National workshop activities for PHC approach/concept National ~orkshop activities for PHC approach/concept

Implementation stage Training of VHA Retraining of health manpower Initiation of R&D type activities Training of manpower at large scale health system development

Monitoring/evaluation stage Initiation of R&D type project Health system development

Pattern 2.

R&D activities for refinement of health system development in rural/urban Refinement of health system development

Pattern 3.

No promotional activities Health system development

R&D activities Manpower training Strengthening of health system

- 28 Annex 6

What is meant by Research and Development? Research and development in primary health care implies the development and implementation of primary health care in a few selected communities to start with. The process starts with a community assessment with emphasis on the health and livelihood aspects, then moves into the ' organization of the community, and the planning and implementation of programmes jointly by the community and health staff. Adjustments are made as the process continues, and the experience is documented. Knowledge and information generated at the grassroot level are expected to contribute to policy formulation in the areas of health and manpower development. As experience is gained in one area, more communities are then included in the developmental process, following a radial and geometric growth, while the functional and content areas of primary health care are also expanded as the capacities of communities and the health system increase. Research and development is thus eventually integrated into the health system, and becomes a permanent mechanism for health system development based on primary health care. The following is the status of implementation of some R&D projects in primary health care in the Region to which WHO is extending collaboration: Philippines The Tac10ban R&D project was completed in early 1982 after a project life of five years with WHO collaboration funded by DANIDA. The experience gained from the Tacloban R&D has now provided the main thrust for health system development for the rural population. Research and development in the Philippines has just entered its second phase of development as it now explores urban problems. The Manila City Health Department has just launched an R&D project in urban PMC development. Papua New Guinea The Provincial Government of New Ireland has been undertaking an R&D project with WHO collaboration since 1980. After one and a half years of preliminary phase activities, it is now in the middle of the implementation phase. The project began in eight villages with a population of 1es8 than 1000. It has now expanded to about 50 villages with a population of over 10 000. The functional and content areas of primary health care have also been expanded to include such fields as malaria and water supply and sanitation together with the development of village development projects. Community participation and involvement is the main thrust in this project as partnership between the community and health system is an essential element in the PHC approach. The project is expected to be completed in 1985 by which time the provincial health system will have been developed based on the PMC approach. Another R&D project is now being implemented in Oro Province, in the coastal region.

I I I I

- 29 Annex 6

Republic of Korea An R&D project has just begun in Chollanamdo Province in collaboration with Chonnam National University, and the Provincial Government and with the administrative support of the Ministry of Health and Social Affairs. It is in the initial stage of development.

Trust Territory of the Pacific Islands

An R&D project was launched in 1982, in Ponape. Malaysia Sarawak State of Malaysia has started an R&D project in Lundu District this year. China An R&D project in Conghua County which is one of the WHO Collaborating Centres for Primary Health Care, is scheduled to start this year. Vanuatu An R&D project is in its preparatory stage, on Pentecost Island. What does an R&D project do and try to achieve? The following is a brief outline of the course development of an R&D project; together with its main features: 1. Purpose and objectives of the project The essential features of a PHC development project are as follows: (1) The project activities coordinate with the socioeconomic and health-related services to help people deal with the many-sided problems of living that affect health. (2) It stresses the importance of health promotion and development and of increasing the capability of people to live a healthy and quality life. (3) It encourages the responsibility and involvement of the individual and community in their own health care and protection. (4) It is an integral part of the national health care system, which in turn is integrated in the national development plan, consisting of measures and activities undertaken at the level of first contact in the community for essential health care.

- 30 Annex 6

(5) More specifically, the project is intended to explore and identify/determine the following areas: (aJ the multi-faceted problems of daily living of individuals and communities, and ways of solving these problems with special reference to health; the kinds of knowledge, attitudes and skills required by different categories of health workers in the promotive, preventive, curative and rehabilitative dimensions of health care as well as in the socioeconomic dimension;

(b)

the types of worker most suitable for the different tiers of services and their training;

ways and means of achieving community involvement; ways and means of developing a linkage between people in the community and the health system, and their respective areas of responsibility; an information system to monitor the health needs of people and the output of the PRC programme.

(f) 2.

Project strategy

The main strategy adopted for the project is a two-pronged approach: it is research and development in health and health care. While the actual primary health care is being implemented in the village, exploration and identification of the various forces operating in relation to health and health care will be simultaneously carried out. The research portion will generate essential information and hard data which will be fed back to the PRC operation to help design improved strategies for the continuous development of health and health care in a dynamic process of change. The development portion will progressively expand the content of primary health care as well as the coverage of population as the capabilities of the health system and the communities develop. The significance of the project lies in its benefit to the community in relation to health development and to the national and provincial health system in the area of policy and strategy setting, since it can be expected to generate valuable information required in policy setting and strategy designing so as to achieve the worldwide goal of health for all by the year 2000.

- 31 Annex 6

Phasing of the project and activities Programme phasing and procedures

The duration of a project is usually five years as it is intended to measure some of the impacts of the programme inputs, which takes time. It is usually divided into three different phases, as follows \ (a) Preliminary phase (12 months)

This period is the preparatory groundwork stage required for the implementation phase. A plan of work for the second phase including the implementation plan for the PHC development programme will be drawn up after a series of workshops and field trials in respect of the initial PHC development programme. All the initial preparations such as drafting of the project proposal, selection of project site, exploration of programme feasibility, establishment of relation with authorities concerned, etc. are carried out long before the preliminary phase starts. (b) Implementation phase (36 months)

This period is the action phase to undertake activities related to the development of the PRC programme based on the implementation plan developed during the preliminary phase. During this period, the interaction between the health needs and responses of the community and the health system will monitor constantly and programme adjustments will be made. The main body of the relevant data and information will be generated and accumulated in this period. The programme will be expected to operate on a full scale covering all the areas originally planned where the population can benefit from the project. (c) Evaluation and development phase (12 months)

The body of relevant data and information collected during the implementation phase will be analysed in this period. On the basis of the evaluation, a plan for the expansion of the PRC programme in new areas of the province will be worked out. On completion of the evaluation phase, the project area will be expected to be continuously operating as a part of the permanent system while the project staff will be phased out and move into new areas for the expansion of PHC development. Any external input will be gradually phased out at any point in time as the degree of self-reliance of the programme increases. It will be expected to become an integral part of community development linked to the health system.

- 32 Annex 6 , I

Significance and impact of tbe project

As was stated earlier, tbe main strategy adopted in a project is tbe R&D approacb. This approacb starts witb a study in a selected area, from wbicb tbe results are fed back continuously. Research and development means that we embark on PRC development according to the best perception of the situation by the local staff based on whatever data they have, a few preliminary studies, and their observations. In tbe course of the operation, and according to a given plan, important issues/problems are identified and studied. The results of the studies are evaluated and then fed back into the ongoing operation with a view to the latter's corresponding modification. In terms of geographical coverage, the expansion is gradual. The developmental approach may bring about many different forms of change in a positive direction as we have experienced in New Ireland Province of Papua New Guinea which has resulted in the following: Population and area coverage have grown steadily from less than the initial 1000 population in eight villages to approximately 10 000 in three years. The village potentials in terms of human and physical resources have been tapped and developed to a greater extent. The project has been an eye-opener to both health staff and viliagers so far as self-reliance and self-fulfillment are concerned.

The PRC developmental concept has had a multiplier effect and has spread allover the country. Many provinces have launcbed tbeir own PRC development projects as this project has provided a learning ground for various observers from other provinces.

- 33 -

ANNEX 7(a)

BRIEFING NOTES Field visits to Nueva Ecija Province

(a) (b)

Barangay San Carlos, Cabiao Barangay Panabingan, San Antonio

Barangay San Carlos, Cabiao The village of San Carlos was organized under a Spanish Decree. It lies in time between two important events in the history of the Barangay; when it was abandoned by its inhabitants during the incursions of the then infamous civilian guards of a ruthless town executive and its recognition as a Barangay in May 1982. The village is practically surrounded by water thus making it virtually an island; to the North, the Pampanga River and to the South, the Harabas Lake, popularly known as Nabao which when viewed from above, it appears like a giant horseshoe. Although it is one of the smallest barrios in the Municipality of Cabiao, inhabited by 862 industrious and sturdy people, the Barangay holds in itself the promise of unlimited economic prosperity, this promise achieving complete fulfillment once a well organized and wise exploitation of the agricultural resources, with emphasis on industrialization becomes the major programme. Even now, the present development of the Barangay compares favourably with that of other wealthy Barangays of the municipality. These are some of the facts; (1) One of the proposed BLISS housing projects of the Ministry of Human Settlement is located in a strategic three-hectare lot in the Barrio. The said property has already been paid for by the Provincial Government. The Farm System Development Corporation (FSDC) irrigation pump projects costing more than 1160 000 is nearing completion.

(2)

The rivers of the Barangay can be harnessed for commercial and industrial purposes. Fish ponds are numerous. All the surrounding waters are rich in fish especially the Harabas Lake which alone has 39 hectares of fishing grounds. Almost 90% of the inhabitants of the Barangay are farmers. Fishing is the secondary livelihood of the people. Every family backyard contains a poultry and swine project.

- 34 Annex 7(a)

Agriculture Agricultural products are in abundant quantity, sufficient to make the barrio more than merely self-supporting. During the wars, enough food could be had by all and the people did not suffer so much as the people of other barrios. The occurrence of typhoons and floods only temporarily paralizes the food supply, but never to the extent that San Carlos has to import foods from other barrios. When there is shortage of rice, there are good rich substitute root crops like sweet potatoes, cassava and various variety of gabi. Other products are corn, sorghum, tobacco, sinkamas, peanuts and vegetables like eggplants, tomatoes, sitao, bataw, patani, upo, kalabasa and almost all other vegetables found in other barrios. Facts and figures Population, number of houses, age and sex Male 27 75 97 104 93 56 27 22 11 distribution~

Age group Under 1 1 - 4 5 - 10 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 & above Total

Female 31 29 47 28 24 38 16 17 15 14 11

14 10 27 563

299

Leading causes of mortality - all ages per 100 000 population Cabiao, Nueva Ecija - 1982 Leading causes~

Rate Cardiac pathology Cerebrovascular accident PTB Pneumonia Cancer Malnutrition Prematurity Cor Pulmonale 143.60 80.62 55.42 50.38 32.75 27.71 22.67 5.03

- 35 -

Annex 7(a)

Leading causes of infant mortality, Cabiao, Nueva Ecija - 1982 Causes~

Rate Pneumonia Prematurity cardio respiratory arrest Congenital neart disease Bronchitis Malnutrition Neonatal sepsis Nephritis Measles Respiratory distress 10.10 6.49 5.77 5.77 1.44 0.72 0.72 0.72 0.72 0.72

Civic, social and political organizations (1) (Z) (3) (4) (5) (6) (7) (8) (9) (10) (11) (lZ) (13) Barangay Council Tanglaw ng Barangay Balikatan Barangay Pastoral Council Aniban ng Manggagawa sa Agrikultura Mother's club Kabataang Barangay Samanang Ikauunlad ng Kabataang Pilipino Irrigators Service Association Bagong Lipunan Community Association Barangay Inter-Organization Committee Katipunan ng Bagong Pilipina Agrarian Reform Beneficiaries Association

Barangay brigades (1) (Z) (3) (4) (5) Justice Brigade Tanod Brigade Volunteer Brigade Ladies Brigade Disaster Brigade

Batika sa Barangay The Batika sa Barangay has been establisned two years ago wnen five American Peace Corps Volunteers had a week-long sojourn in tne barrio. It has been organized to give tne people tne following services~ (1) (2) (3) Serves as temporary office for visiting physicians, nurses, midwives, and other officials and personnel of the government. Gives the people low-cost medicine and free services. Other services that the Barangay Council and BlOC recommend.

- 36 Annex 7(a)

Presently, the Botika sa Barangay operates a mini-grocery where cheap canned goods and other items like coffee, milk, sugar, margarine, catsup, etc. are sold. Tanglaw ng Barangay The organization is composed of selected responsible and disciplined citizens of the barrio. As an economic booster, the group has now five cows, 86 goats, ducks, as their ongoing projects. Cleanliness, sanitation and beautification Every family is required to maintain a well-fenced backyard and toilet facilities. The barrio has a potable drinking water. Although our campaign for a "water-pump-for-every-home" has not yet been fully realized, almost 70% of the entire inhabitants have water pitcher pumps for their drinking and laundry needs. Nutrition The main food of the inhabitants is rice and fish. This is supported by a variety of vegetables abundantly found in the area. While it is true that the people were ignorant about nutrition in the past, they are now catching up fast in the proper food habits - the selection of cheap but rich in food nutrients supply of food. This is possible because of the continuous follow-ups being conducted by various organizations and leaders in the community. Barangay Panabingan, San Antonio A. Historical background

The village dwellers recount with mixed emotions how in the early 50s their families of about 200 returned to re-establish their lives in this small rural community. From light materials of cogon, bamboo and buri leaves which abound in the place, they built their homes, content themselves with simple living, which could be afforded by agriculture and inland fishing just to have enough rice and fish for the families. There was no electricity and communication was thru people coming in and out of town bringing newspapers and information. In 1954-1963, with the implementation of the Rural Health Act, the health needs of the barrio was provided by the four-man Rural Health Unit (RHU) Team from the town with a one-day monthly schedule for basic health services. The RHU personnel were service providers, while the community were the receivers. Decision-making in matters concerning their health was a one-way process from the service providers (the RHU) to the receiver (the communi ty) •

- 37 Annex 7(a)

In 1964-1968, a permanent midwife (RHO) was assigned in the area and a new pattern of leadership evolved. There were no existing organization to back up any programme/activity, the midwife sought the tiniente del barrio, the recognized head for help, thus, a partnership, although in a limited degree started. The barrio people were cooperative but their interests were short-lived and efforts were uncoordinated. 1969 - The RHO initiated the organization of a mother's class, which started her information education campaign in the community. This a81lle group later became the mother's club, with officers formally inducted the same year. The mother's club has been very active and spearheaded all health and welfare projects in the barrio, which the RHU decided to implement. Soon other organizations appeared carrying the objectives of each agency which organized them. The mother's club expanded its membership to include all women in the barrio and in 1971 changed its name into women's club. As an organization, the women's club gained status and popularity in the barrio. It successfully sponsored and financed notable projects. 1972-1979 - With the advent of the Philippine Martial Law, the government geared its machinery toward "countryside" development. More organizations initiated by government and non-government agencies, with the objective of developing the people and community, sprouted like mushrooms. It was also at this point when the barrio was recognized as a government unit and was converted to barangay, and its head change from Barrio Lieutenant (Tiniente) to Sarangay Captain. In 1980, the RHU initiated a three-day live-in seminar of barangay leaders of Panabingan and three adjacent barangays. In this seminar, the leaders realized; (a) (b) (c) (d) that they have quite a number of organizations with the same/similar goals and objectives; the need to organize the efforts of these organizations so that they will not be confused or overtaxed as members; that with proper guidance, they could identify their problems and workout solutions to these problems; they have potentials/capabilities in managing their own affairs/programmes/projects.

August, 1981 - Panabingan Sarangay Inter-Organizational Committee (SIOC) for Primary Health Care was organized, for proper collaboration and coordination for community action.

- 38 -

Annex 7(a)

Present status - The Barangay (1) Thru the Barangay Inter-organi~ational committee (a) (b) (c) (d) (2) Identifies problems/needs of the community Prioritize said needs Makes plan of action to solve such needs Implement projects

Assesses/utilizes/secure (a) (b) Local resources for their own needs Outside resources for their needs

(3) (4) (5)

Manage barangay projects with success with minimum guidance Community is very much aware and responsive to the activities of the barangay. Barangay leaders has developed capabilities and skills to be able to discuss openly and with anybody, pertinent matters concerning their barangay. Community develop pride in their accomplish~nts.

(6) (7)

Initiated a Barangay Health Insurance Scheme, so that all members are categorized as "e" (category which can give donations and afford basic medicines when hospitalized). No one as purely indigent or category "0" so that the patient will depend on purely charity. Up to the moment, the Barangay leaders continue to study the possibility of amending the scheme to ensure continuous benefits to the members. Adopted and develop a lay monitoring system which could be utilized in Barangay planning. From the assessed lay monitoring reports, the Barangay leaders were able to pinpoint the need for holding a session/class on child care for mothers at least once a month, which was started this month of March. The leaders has discussed their wish to change the name of the Barangay Inter-organizational committee to "Barangay Working Body" which they felt more fitting and proper based on its observed functions.

(8)

(9)

- 39 Annex 7(a)

Future (1) It is envisioned that this will be a barangay socially, economically productive barangay where: (a) (b) each family enjoys health and basic necessities in life; Improved facilities: - Social sports - Health - Transportation/communication (c) (d) They could join other places who can boost excess product8 for market for additional income. Peace and order prevailing always.

Barangay officers Barangay council: Severino Tagash Mauricio Tutaan Felipe Magno Juanito Soliman Anenia Mudlong Nicomedes Tugawin Leonardo Garcia Cosme Pambid Joaquin Gajonera Barangay Inter-Organizational Committee: Guillermo Angeles Bartolome Galindo Anacleto Bautista Zacarias Aquilazan Gorgonio Gajonera All purok leaders All service brigade Chairman Vice Chairman Secretary Treasurer Auditor Pros EXO Members Barangay Captain Secretary Treasurer Councilman Councilwoman Councilman Councilman Councilman Councilman

- 40 Annex 7(a)

MAP OF NUEVA ECIJA

- 41 Annex 1(a)

HEALTH SERVICES Province of Nueva Ecija

INTRODUCTION

The province of Nueva Ecija occupies a fairly large portion of the fertile plains of Central Luzon, though some part of it lies along the Caraballo and Sierra Madre mountains. It is bounded on the North by the provinces of Pangasinan and Nueva Vizcaya; on the South, by Sulacan and Pampanga; on the East, by the province of Quezon; and, on the West, by Tarlac province. It has a total area of 5094 square kilometres ~ith 29 municipalities and three cities. All of the municipalities are accessible to all types of land transportation during the dry season. During the rainy season ho~ever, some of these municipalities are quite difficult to reach because of damaged roads or because of innundation. All except Gabaldon and Carranglan are fully energized through three electric cooperatives. The main and principal source of livelihood are agriculture and trading of agricultural products. II. HEALTH RESOURCES Manpo~er

In terms of physicians, pharmacists, dentists, nurses, and midwives, both public and private, it appears that available manpower is adequate. Nonetheless, all indications point to a severe maldistribution as these conglomerate in big municipalities snd business centres. Other categories such as sanitary engineers, medical technologists, dieticians, nutritionists and social workers are sadly wanting. For the government health sector, the Rural Health Units have 42 physician items of which only 25 are filled. This leaves 11 vacancies which poses a very serious manpower constraint, the removability of which is quite questionable as no applicant seems to take any interest in the position. There are 49 public health nurses with nurse-population ratio of 1; 18 088. There are 181 rural health midwives with a midwife-population ratio of 1; 4891. Rural sanitation inspectors number 31 giving a population ratio of one RSI for every 23 954 inhabitants, ~hich is slightly higher than the standard of 1; 20 000. On the other hand, there are only 13 public health dentists with a dentist-population ratio of 1; 68 118. Each of these dentists together with 10 dental aides serve from 2-3 municipalities with cris-crossed assignments.

- 42 Annex 7(a)

Ill. A.

HEALTH STATUS Population

The 29 municipalities have a total population of 886 308 inhabitants. This is composed of approximately 50.48% males and 49.53% females, with a dependency rate of 51.0%. The population of the province is relatively young, i.e., with a relatively high proportion of young people aged under 15. ~opulation distribution is as follows: 19.06% live in the poblacion (urban) while 80.94% reside per barangays (rural). Population density is 173 persons per square kilometre, allowing 5747 square kilometre per person. There are no available recorded migratory patterns. 5. Vital statistics Number Total Total Total Total Total Total live morbidity mortality infant mortality maternal mortality foetal mortality 23 617 26 570 4 033 723 13

Rate 26.64 2997.82 4.55 30.61 0.55 6.31

149

Except for a slight deterioration in the maternal death rate, there is a remarkable improvement in all the other vital rates for this year compared with that of last year.

Environmental indices (1) Water supply sources - Of the total estimated number of households, 89.19% have a definite source of water supply. Of these, however, only 11.76% have a relatively safe water supply source. This indicates a slight improvement over last year's figures. (2) Excreta disposal - More than 52% of the total estimated number of household. are provided with sanitary excreta disposal facility (water-sealed). (3) Food establishments - 100% of the total existing food and food related establishments were issued sanitary permits. Likewise, 100% of foodhandlers working in these establishments were issued health certificates. This indicates an improvement by more than 10% in terms of health certificates issued to foodhandlers. (4) Industrial waste disposal - The province is typically agricultural with scill very few industrial establishments. industrial waste disposal does not yet pose a problem. Hence,

- 43 Annex 7(a)

Progress of the different programme and projects (1) Maternal and child health - The average overall accomplishment of activities under this programme is 94.12% compared to 93.21% for last year, implying a slight improvement. Family planning activities showed a significant improvement by as much as 38%. On the other hand, nutrition activities particularly in terms of organized and completed mothercraft classes showed a slight deterioration by 10%. (2) Communicable diseases control - Under this programme, the overall percentage accomplishment against set targets for this year is 70.19% compared to 85.03% for last year, or a deterioration by as much as 16%. This is mainly due to a deterioration in the overall percentage accomplishments of activities under the expanded programme on immunization particularly OPT, BCG and oral polio vaccine. This deterioration stemmed from the fact that for the past year up to the first half of this year, targets were based on actual counts from the registry books of the local civil registrars. At the start of the second semester or just before the second round of immunization started, targets were determined on an estimated rate of 3% of the population to represent the number of 3-14 months target group for OPT, BCG and OPV. The resulting discrepancy from the two methods of determining targets brought about the deterioration. (3) Environmental sanitation - The average overall accomplishment of activities under this programme for the present year is 72.21% compared to 62.07% for the past year. This indicates an improvement of 16% due to significant improvement, issuance of sanitary permit and health certificates to food and food related establishments and to foodhandlers, respectively. (4) Dental health services - Activities under this service registered an overall average of 140.72% compared to 93.82% for the past year, depicting an improvement by almost 50%. This does not include special ongoing projects which were maintained at 100% accomplishment. (5) Student affiliation - Several batches of new nursing and midwifery student affiliates from the five nursing and midwifery schools were given orientation trainings before exposure to public health in the six affiliation centres in the province. Periodic evaluation of these students affiliates were conducted, as well. (6) Other activities - Dental health service - Mouthrinsing with 0.5% Naf solution and toothbrushing drills in 15 municipalities are ongoing projects involving 31 public schools and four day-care centres. Duraphet varnish application is another project carried out in two municipalities.

- 44 Annex 7(a)

Nueva Ecija is a pilot province for PHe in tne Population Project I. Tne social preparation pnase for tne operationalization of PHe was conducted during tne year and saw tne organization of tne following; 29 municipal PHe committees; tnree city PRe committees; and 128 barangay PHe committees. Moreover, a total of 108 botika sa barangay were establisned; 112 nerbal gardens; nine beautification projects; 205 projects on environmental sanitation; and a total of 80 income generating projects, broken down as follows: 60 agro-livestock; tnree aquaculture; and 21 cottage industry projects. Attacned is tne breakdown of tnese by municipalities.

- 45/!J.6 -

Annex 7(a)

ORGANIZED PRe COMMITTEE Province (Pls check) Nueva Ecija Total No 29

NUMBER OF BARANGAY-BASED PROJECTS Botika sa Barans:al 108

Tot Drs 29

Baransal Tot No Tot erg 667 26 29 19 16 51 15 123 7 4 6

Herbal sarden 112

Environmental sanitation 205 17

Beautification 9

Income ~eneratin& eroject Aqua Aqua Cottage Livestock culture industries 66 10

3 1 2

21 2 3 2 4

Aliasa Banlabon Cabi.ao Carranglan CU;iai!0 Gabaldon Gapan G. Natividad G. TiniD Guimba Laen Laur Licab Llanera LU2ao Munoz Nam2icuan Paotabansan Peilaranda Quezon Rizal Sao Antonio Sao Isidro San Leonardo Sta. Ross. SCo. Domingo Talavera Talultug Zarasoza Palayan City

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

5 1

3 3 1~

13 20 10 64 27 16 10 19 24 37 21 14 6 16 2S 16 9 10 17 24 53 28 19 6

6 4 12 13 4 3 2 6

39 3

2 1 17

1 25 1 1 1 4 1 1 SS 1 1 1 1 2 1 1 1 1 ~~ ~---

16 9 3 16 2 43 3 24 3

2 10 9 S 4

24 6

8 1

3 3 15 3 5 3 8 4 3

6 15* 1

9 8

1 1 1 1 1 1 1 1 1 1

23 9 1 3 4 2

5 2

1 4

1 2

N.B.

*Exiscing prior to 1981 Botika sa Barangay under the Governor's office not included in this report.

- 47 ANNEX 7(b)

PRIMARY HEALTH CARE IN THE REPUBLIC OF KOREA

Introduction

Korea nas made tremendous efforts to solve nealtn care problems toward building a truly welfare nation, complying witn the world trend of regarding the primary hea1tn care as one of the most important tasks in making national health policies. In accordance with these national efforts, a special law on health care for rural areas was enacted, as of 31 December 1980, in order to provide effective healtn care services in rural areas through the primary health care approach. The enl'.ctment of the law cleared the way for nationwide extension of impiementing the Community Health Demonstration Project, which KIPH had implemented only in a few demonstration areas since 1977. The Government now has a plan to train over 2000 CHPs in a four-year period, 500 CHPs each year starting April 1981. With the initiation of the nationwide extension of the project, 400 health practitioners were trained and assigned to under-heal tn-cared fishing and farming areas for health Care services during 1981. 2. Implementation of primary nealth care

Tne implementation and actions of primary health care involved in social cnange of social advancement can no longer be thought of as mere policy imposition from above or from outside authority to the people without whose participation no programme can accomplish its ultimate goals. The importance of community involvement and people's participation in the implementation of primary health care is thus given much attention at the international convention of the WHO by the participants from allover the world. For the implementation of the nationwide primary nealth care, tne government has developed not only PHC councils and village health volunteer but also the establishment of PHP to which CHPs are posted.

- 48 -

Annex 7(b)

The PHC delivery system at each level is shown as

follows~

Level First

Hea 1 th wor ker One community health practitioner One community physician One or two community physician and other paramedical personnel

Facilities Primary health post Health subcentre at township Health centre at county

Population served 1 000-5 000

Second

5 000-10 000

Third

70 000-100 000

Primary health post

The primary health post consisting of one CHP is established by the country governor according to the special law on rural health care. The location of PHP will be in designated area such as doctor less and underserved area, and the distance of PHP from most of residents will be within 30 minutes by common transportation mode. The PHP will be serving a community of about 1000 to 5000; in fact 1000 to 3000 population for islands and 3000 to 5000 population for remote areas. For the facility of PHP, the community provides a building, and the government (central and local) provides 65 kinds of medical equipment and 55 kinds of drugs. The size and type of PHP will be therefore quite varied, for instance the existing village meeting hall, Saemaul hall and private or public house was remodeled as a PHP building. 4. Primary health care council

The council is administered by an operating committee. The operating committee in principle consists of Ri Chiefs, Saemaul leader and/or community development members. In this capacity, Ri Chiefs usually represent their community people at the operating committee.

- 49 -

Annex 7(b)

Operating committee holds plenary sessions and extraordinary sessions, and elects a chairman, a vice chairman and 10 to 12 executive members. The committee deal with: (a) (b) (c) (d) (e) (f) (g) (h) (i) 5. Collection of funds to operate the PHP Budget and settlement of accounts Work plan and reports of activities Management of funds Acquisition and disposition of assets Amendment of rules and agreements Appointment and dismissal of employees Recruitment and withdrawal of memberships, collection of premium Other matters necessary for implementing the council

Community health practitioner A. Selection

The qualification of CHP applicants should be registered nurses and/or midwives and applicants are screened on the basis of personal career and other docu~nts. Preference is given to residents in the community and work experience in the health field. B. Main functions of CHP

Their main functions can be summarized as: (1) Curative services, to deliver primary and ambulatory health care including visiting identify most common diseases take general medical histories perform physical examinations handle frequently required laboratory tests provide treatment for a defined range of conditions provide treatment prescribed by a physician including regular follow up of chronically ill patients - make efficient referrals of complicated cases Preventive services, to - administer immunization

(2)

provide ante- and postnatal care attend normal delivery provide nutritional guidance undertake public health education carry out family planning diseases~

- control communicable

tuberculosis, venereal disease,

etc - enlighten the residents about sanitation

- 50 -

Annex 7(b)

(3)

Community development and others, to - advise on PHP council's activities enlighten community to participate in maintaining their own health status and living condition in better way - plan and evaluate the performance of health services - manage medical, health, and administrative supplies - educate and lead village health volunteer support and participate in the community agencies - record and report data with accuracy

Training programme

The community health practitioner training programme lasted 24 weeks. The 24 weeks training course was separated into eight weeks classroom training, 12 weeks clinical practice and four weeks field practice. The training was carried out in seven regionalized medical or nursing faculties. A total of eight weeks of theory is divided into five major content areas; management of curative care, maternal/child health community development, related community health maintenance, administrations of PHP. During this phase, the trainees are thus instructed intensively in basic knowledge and skills in order to provide comprehensive primary care services. Clinical practice 1S the second phase of CHP training and was a continual part of preceptorship or internship. It directly followed the theoretical phase of training and lasted for 12 weeks. Its goal is to learn skills on diagnosing and managing commonly encountered acute, chronic, emergent and health maintenance care problems. The basic framework for the CHP trainees in caring for a patient is as follows, History taking, physical examination, treatment plan, teaching and counseling, referral, follow up including diagnostic studies, medications and other specific treatments. The field practice for four weeks is carried out in an anticipated recruiting post. They are encouraged to expose themselves as much as possible to provide an opportunity to apply attained knowledge and skills to an actual field setting in rural community. Main activities provided by CHPs during field practice are as follows, Assessment and treatment of common and minor health problems, emergency care, maternal/child health, health education, participation in conference with the community leaders to give information on PRC councils activities.

- 51 Annex 7(b)

Village health volunteers

It is generally agreed that community participation and self reliance are vitally important components for planning and developing primary health care programmes. To facHitate the community participation, a woman who is literate and active is chosen as a VHV by the community. The VHV is trained by the community health practitioner and works voluntarily to take care of her village people. The scope of VHV activities cover such areas as listed ~elow:

Home visits conducted Villagers consulted with health problems Cases referred for pap Various health related information collection Number and nature of attendance to village meetings and relevant educational gathering RURAL HEALTH CARE SPECIAL LAW

CHAPTER 1.

GENERAL RULES

Article 1 (purpose). This law is aimed to enhance the health status of the people in area of designated under served health care. Article 2 (definition) (1)

Public health physician is defined as a physician or dentist engaged in public health activities unde: 70mmand of.minister of health/social affairs according to the m111tary serV1ce law. Public health activities in this law is defined to provide ~ health services in area or institution designated by follow1ng respective paragraphs. Paragraph 1. Medically underserve d area, such as area near DMZ, remote area, islands, other areas designated by the presidential decree. subcentre at Myon level. Gun Health Centre or Health Medical care facility designated by the presidential decree.

(2)

Paragraph 2. Paragraph 3.

- 52 -

Annex 7(b)

(3)

In this law, the community health pract1t1oner is defined as the health worker, appointed by Gun governor, to provide a curative care.

(4)

In this law, the primary health post is established in doctorles8 areas, operated by Gun governor, to provide a curative care for CHP to the residents in underserved remote areas. COMMUNITY PHYSICIAN

CHAPTER 2.

Articl .. 3 (Duty of CP) (1)

The CP should trustily serve on public health work for three years. The CP should reside within his designated area during the duty period and can only leave with permission by the Governor of the province. The CP can not operate his own clinic or are not allowed to get any extra profit for his work.

(2)

(3)

Article 4 (Reporting of CPs' name list) The Director of the Office of Manpower Administration should report the name list of doctors and dentists who are on the reserved list to the Minister of MOHSA, under the regulation of the Ministry Service Law, article 30. Article 5 (Service order) (1)

The Minister of MOHSA is responsible to conduct a training course for the CPs and dentists who are reported under the regulation of the article 4, for not more than 12 weeks, and order them to work on public health in the given area or office designated. The duration of training course can be included into the duration of his obligation shown in the item 1, article 3. The contents or other matters concerned to the training course mentioned in the item 1 can be decided by the administration order of MOHSA.

(2) (3)

Article 6 (Changes for the working area or office) The Minister of MOHSA can change CPs' working area or office if necessary. And, if the change would be occurred within the Governor can do it with permission of the Minister. the same province,

- 53 -

Annex 7(b)

Article 7 (Military service of CP) (1) (2) the CP served on public health can be excluded from the formal military service under the Military Service Law. the Minister of MOBSA should report the na.e lists who have served or not served as CPs' to the Director of the Office of ~npower Administration.

Article 8 (Payment) (1) (2) the Minister of MOBSA can decide the pay scale for CP within the limit SDOwn in the ailitary pay role. Beside the pay scale decided by the regulation item (I), the CP can be provided the necessary expenses for hi. work such as travel expenses or else.

Article 9 (Service) All other necessary matters for the service of CP apart from this law shown, will be decided by the national public service law. Article 10 (Extension of service) (1) If the CP had left the designated area for a total of leaa than seven days without permission against the regulation item 2, article 3, the Minister of MOHSA can order to extend his aerving period for five items of his absent dsys. If the CP has been hospitalized or cared for more than one month, the Minister of MOHSA may order to extend his service the same as the duration of his absence.

(2)

Article 11 (Reporting of the unserved) If the CP had left his designated area during his serving period without exact reason for more than eight days, the Minister of MOHSA should immediately report the name list to the Director of the Office of Manpower Administration. Article 12 (Suspension of license) If anyone has not served this duty as CP, the Minister of MaHSA can suspend his license as physician or dentist for less than five years duration. Article 13 (Service supervision) The Governor is responsible to supervise CP services in his area.

- 54 -

Annex 7(b)

CHAPTIil 3.

PRIMARY HEALTH POST AND COMMUNITY HEALTH PRACTITIONER

Article 14 (Operation of primary health post) (1)

The Gun chief is responsible to operate the PHP in order to provide aedical services for the people who live in the medically uDder served remote areas. The PHP should be staffed, at the minimum, one CHP and more if necessary. The setting standard of PHP is shown by the administrative order of KOHSA.

(2)

(3)

Article 15 (Required qualification as CHP) (1)

The CHP should be either nurse, midwife or certain persons qualified under the presidential decree and should complete the 24 weeks CHP traini~ course offered by MaHSA. All necessary procedures and the contents of training course are directed by the administrative order of KOHSA.

(2)

Article 16 (Appointment of CHP) (1) The CHP can be appointed by the Gun chief for the medically under served areas by recommendation of the health centre directors concerned. The Gun chief can discharge the CHP if she (or he) is in a condition as follows: (a) (b) (c) (d) (e) If she provided any kind of curative services at, out of ber designated area. If she provided any kind of curative services beyond her limits shown in the regulation, article 17. If she left the post for more than 10 days without permission shown in article 18. If she is seriously ill or disable to perform her work as CHP. If ber performance level is extremely poor according to ber low level capacity as CHP.

(2)

- 55 Annex 7(b)

Article 17 (Limits of curative services as CHP) In spite of the medical law prohibits by its article 25, the Cap can provide the minor curative services shown in the presidential decree within the designated, aedieally underserved areas. Article 18 (Residential obligation of CHP) The Cap should reside at the area designated and can only leave with permission of the Gun chief by the regulation, item 1, article 16. Article 19 (Primary health post council) (1)

To operate the Pap effective the primary health post council consisted of representative of residents should be set up in the area of Pap located. The Pap council has the following functional - Support on the operation of Pap Suggestion on management of PHP in better way - Other functions delegated by Article 20

(2)

(3)

The other required articles on the organization and operation are decided by Gun administrative regulation affairs.

Article 20 (Delegation of duty) Under authorization of Gun Governor, few duties of Pap could be delegated to Pap council. Article 21 (Subsidy) (1)

The central government provides subsidy for supporting a partial expenditure of PHP operation. The scope of central government subsidy is within two-third in covering establishment with procurement of pap and within one-half in annual operation expenditure. The scope of provincial government subsidy is within one third in covering both the establishment with procurement and operation expenditure yearly.

(2)

Article 22 (Remuneration of Cap) (1)

The remuneration of CHP i. decided by minister based on MORSA's regulation. It is provided other allowance including transportation fee for caps.

(2)

- 56 -

Annex 7(b)

Article 23 (Supervision) (1) (2) Gun Governor has an authority of supervision of PHP's affairs

Gun Governor denotes health centre director or health subcentre director will supervise on the CHP's curative care. If it is not available, a private physician who is practiced in near site to PHP located could be in a position of supervision of CHPs.

Article 24 (Duty of CHP) The other matters on CHPs duty, excluding this rural health care special law, shall apply to local government officials regulation. Article 25 (Fee for curative care) (1) The PHP can decide a fee for curative care according to the Gun regulation on the basis of regulation decided by Minister of Health and Social Affairs. Requested fee for curative care according to Article 25, Item 1 can be directly used for operation expenditure baaed on the local financial act 72, item 2. SUPPLEMENTARY RULES

(2)

CHAPTER 4.

Article 26 (Enforcement ordinance) To enforce this act, required matters will be promulgated under decision of presidential decree.

- 57 ANNEX 8

CLOSING SPEECH BY DR HIROSHI NAKAJIMA WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC AT THE MEDIA SEMINAR ON HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE Seoul, 23 April 1983 Ladies and Gentlemen, You have now come to the end of this week-long Seminar, in the course of which you have covered a wide-ranging progra~ of topics. Your observations and discussions had the purpose of identifying the situation in countries in relation to community activities being extended to the Health-for-All strategies, and of determining the future development of that action should be taken, both by countries and by WHO. You might notice many themes during the Seminar; such ss:

the goal of Health-for-All by the Year 2000, and, the primary health care concept, the importance of the community participation, in relation to human resources and utilization of many factors in various social science fields in addition to pure health field, the generation of public motivation for community health programmes, the projection into the future planning of national health progralllDes, the need for the support by the private sector in stimulating the policy formulation for the health field, and SO forth. Your future, activities to arouse public sentiment bases on the experience during the Seminar, when translated into action and applied, will contribute much to create greater awareness of the importance of health aspects in the planning and management of social development in each country. Your suggestion will also be brought to the attention of the Member States of WHO and WHO itself who have the important task in the years ahead of translating into reality the guidelines for future action you have identified.

- 58 -

Annex 8

And, I trust that the past week during which we have worked together is just the beginning, and, that we will continue to work jointly to achieve our final goal, that is, the Health-far-All. I wish to thank all of you for your big contribution, and hard work of our very active Temporary Advisors and other supporting members in making our Seminar successful one. Thank )'OU

again, and, Bon Voyage.

- 59 ANNEX 9

MEDIA SEMINAR ON HEALTH FOR ALL THROUGH PRIMARY HEALTH CARE

Philippines and Republic of Korea 18 to 23 April 1983 Dear Delegates, Speaking of "Health for All Through Primary Health Care", we should first and foremost speak of the setting-up of a grass-root health network and the task of propaganda and encouragement of the people in actively engaging in the health work. Througn more than 30 years of work in the special historical conditions, the Vietnamese health service has always considered his foremost task to set up a countryside health network together with a provincial one. That is why, in spite of all difficulties, we have built up a dense countryside health network from the plains to the remotest areas in the country. Each district has got at least one general hospital with some hundred beds, each village has got a health station with physician. (assistant doctors or doctors) in charge. Aids to village health stations are health groups in production teams and the network of Red-cros8 members down to each household. The dense and effective countryside network has met the requirements of medical care of health preservation for the people in the past years and even in the war time. The health network today is still being consolidated so as to meet the increasing needs of medical care of the people and to put into practice most effectively the watchword by WHO to the health services of all nations; "Health for All by the Year 2000". We lay emphasis on the local health organizations as through these organizations and mainly through village health stations, people enjoy their health care benefits. Village health stations are the basic health organizations and the fundamental cells of the countryside health organization, the centre of prophylaxis and disease treatment for villagers - the majority of them are labouring people - who account for 80% of the Vietnamese population. In order to do well their work, the health workers in the local health organizations shouldn't simply fulfil their professional duty such as diseases treatment, midwifery, dealing with emergency cases, etc. '" but should also do well the work of propaganda, education and mobilization of the people to practice hygiene, carry out prophylaxis, prevention and eradication of epidemics, family planning, etc. '" so as to make the people fully realize the benefits of the above-mentioned jobs to consciously engage in the health protection work.

- 60 -

•

Annex 9

We are going to talk about the role of newspapers in the work of propaganda and educating the people in health protection. Many forms and means of communication can be made use of to propagate and educate the people in health protection\ newspapers, the radio, exhibitions, posters illustrated booklets and films, lectures and local broadcasts through ' loudspeakers. Yet, in this field of work, newspapers play an important role. Articles not only can meet the immediate tasks but can also be made use of in the long future. Articles can be kept back and serve as necessary documents for the members of the family for study and practice according to guidance. In our country we have got different newspapers to meet the needs of different readers\ youths, women, children, workers, peasants, intellectuals, etc.. In general, each paper has its own columns about health care, although the number of articles are not in a great quantity. The health service in our country has also got quite a few newspapers and periodicals among them one is specially entrusted with the task of propaganda and directing the people in health preservation. The journal bears the title of "Health". "Health" is a popular journal. Its readers are the vast labouring people. Its task is to guide the people in health preservation and prophylaxis. The journal is published two issues a month by the Ministry of Health and enjoys a large circulation among the people. It is also supplied to the smallest health organizations-village health station, construction-site, state farm and factory health groups - in the whole country. Thanks to the dense health network, the journal has been widely read by the people in the whole country, including those in remote mountainous regions. Local health workers in villages, offices and factories have made use of "Health" as a document propagating the necessary things in health care among cadres and local people and right in the units. Owing to the strict above-mentioned combination, the paper's usefulness has been brought into full play, becoming a dear friend to its readers and district health workers. The papers are bound together at homes and at village health stations for future use in need. In a word, in order to achieve the aim "Health for All Through Primary Health Care", the two following things must be properly carried out\ 1. As far as organization is concerned, there must be a grass-root health network. Each smallest administrative unit, either a village or a hamlet, must have a physician responsible for everyone's health in the locality, regardless of one in the deltas, the mountainous areas or far-off islands. Each citizen's rights to health care should be regulated under the guarantee of the State, the local health organization serves as the basis to achieve the aim.

•

- 61/62 Annex 9

2. The important role of the masses. The aim "Health for All" cannot be achieved when the most fundamental things about health, diseases, disease presentation for the sake of one's own in particular and the society in general aren't conscious of and the engagement in hygiene and prophylaxis, prevention and eradication of epidemics and the protection of the mothers and newborn, etc •••• are neglected by t~e masses themselves. The duty of arming the people with this basic knowledge lies with the health network, the newspapers and periodicals and the other means of communication and propaganda.

Speech given by Dr Phung Chuc Phong, Editor-in-Chief of "Health" Journal (SR Viet Ham) at Media seminar on "Heal th for All Through Primary Heal th Care 11

- 63 ANNEX 10

MEDIA SEMINAR ON HEALTH COUNTRY PAPER FIJI by Mr Seremaia Tuiteci and Mr Eparama Turaga

INTRODUCTION The FiJi Group of islands is situated 15 0 and 20 0 south of the equator. The group straddles the l80th meridian or the international Dateline and so becomes the gateway of a new day. The biggest island in the group of 332 islands is Viti Levu which is 10 429 sq. km. Suva, the capital city with a population of 68 000, i. on this main island of Viti Levu. Fiji gained its independence on 10 October 1970 after almost 100 years of colonial rule by United Kingdom. As a member of the Commonwealth, Fiji maintains close ties with Great Britain and pays homage to Queen Elizabeth II who is represented as Head of State in Fiji by a Governor-General. Fiji's second local Governor-General was sworn in last February. The economy of Fiji is primarily agrarian and sugar is its backbone. Sugarcane is grown mainly on small holdings and remains the country's major export after being crushed and partly refined by the Government-owned Fiji Sugar Corporation. In its attempt to breakaway from the country's dependence on sugar, Government is attempting to diversify into broader agricultural products and other secondary industries. Emphasis is on developing those areas that have lagged behind in the country's contemporary development programmes. This means channelling Government resources mainly into rural areas whose growth potential have not been fully realised. The population of Fiji is 645 000, the majority being Indians who make up 50 per cent of the total population. The Indians came to Fiji originally as indentured labourers to work in the sugar cane fields. After the indentured labour system was abolished, most of them stayed on as independent farmers and businessmen. Fijians, (Fiji's indigenous race) make up 45 per cent of the population, and the rema~n~ng 5 per cent is made' up of other ethnic groups - Chinese, Europeans and other small minorities mostly from around the South Pacific region.

- M Annex 10

The role of the media in Third World countries has been a frequently debated subject. Its importance and relevance to national development is being realised by the respective Governments. It has become an effective organ in the dissemination of news which are being classified by respective Governments as essential for the education of the public. Some Governments, if not most, feel that the media deliberately ignore its information handouts in their own commercial pursuits. This attitude as other members of the journalistic cadre will tell you is debatable and sometimes they do not see eye to eye with Governments' aspirations. A decision on whether and where to draw a line is sometines difficult and understanding between the two parties, the media and Government would contribute 1mmensely to the effectiveness of news dispatches which government wants the people to know. Suspicion and hostility would subsequently arise in the absence of an understanding. As one of the two national dailies in Fiji, the Fiji SUN, with a circulation of between 25 000 and 30 000 recognizes Government's efforts to project its development progress but because a Government news release, could be withheld for later release by the newspapers does not necessarily mean that it had been neglected.

There are of course issues and subjects which newspapers, radio and television cannot afford to hold because they are of national interest. The news media have their priorities and because of limitations in various aspects of the industry, they have to present a better and more interesting newspaper that people are interested to read. To do otherwise is working against the interests of the media. The current trend in the newspaper philosphy is that newspapers must be reader oriented and not producer oriented. That is the choice which newspapers have to make. But modern research has shown that successful newspapers have switChed their leanings more towards their readers, the reasons of which are fairly obvious. In this context, therefore, I touch on a very important subject that is being implemented with vigor in many countries Primary Health Care. Sometimes a number of the appropriate authorities have tend to ignore press quiries on controversial subject that overall are part and parcel of the subject above.

- 65 -

Annex 10

From our experience there is the "no comment" syndrome when we follow up stories we believe people should know. Too often people think of their own status without realizing that readers are being deprived of information they should know that should benefit society. I stress again here that public education, and newspapers help greatly in this area, is imperative for any national project to succeed. Public disclosure is a necessity to increase people's awareness. In Fiji the Ministry of Health has launched a concerted drive to educate people about public health care. International seminars that expound on the subject like this one ought to look at definite plans and ideans which are easy to read and interpret.

Some international meetings have lost their effectiveness because post communiques are clogged with vague terms that the man in the street, village or a rural settlement is hard to comprehend. Dispatches from seminars like this must be simply written and distributed as soon as possible. They save half of the work of journalists who have to rewrite them keeping the readers in the mind. A new idea has to be sold like a commercial commodity and intense promotion is a must if the objectives are to be attained. There is a vast difference between a simply written press release and another prepared using terminology from the field. The first one has a chance of being read more than the second. The question is~

How to get the poeople? What is the effective means?

As explained above, the newspapers can get it quickly to their readers if people are able to understand the subject being discussed.

The media must be informed promptly of any development, meetings or for any moves by the authorities, all the time. The media must feel that they also are needed in enhancing the project and at this juncture I would like to express my appreciation for being invited on this trip to attend this seminar. I am looking forward that whatever I learn from here will broaden my attitude to enable me to look at the subject more objectively and fromn different perspectives.

- 66 Annex 10

I feel that I would be leaving something out if I do not say a few things about the Fiji SUN. The paper was started in 1974 because owners felt there was room for another. Opposition Fiji Times has been around for 106 years and obviously it was felt that good stiff competition will open a number of new doors. A recent survey showed that the paper i. most widely read paper in the country. with that note I would like to close off and sincerely hope that everyone will learn and benefit from this seminar. People who reside in urban areas and rural within the main islands are more exposed to the impact of radio and newspaper in comparison to their counterparts in outlying islands. Consequently, the radio remains the main source of entertainment and information for those in remote areas and outlying islands. It i. the most effective means of disseminating information on national development policies. There are two major daily English newspapers in the country; the 'Fiji Time' and 'Fiji SUN'. My colleague, Mr Eparama Turaga is from the SUN. Both papers put out a weekly each on Sunday and vernacular papers on Thursdays. Fiji has a very high literacy rate of about 80 per cent, so the vernacular newspaper always finds itself in the hands of a farmer under a shady tree in some interior village, or outlying island. The radio which is still a popular provider of entertainment and information, is still the instant source of contemporary happenings for the rural people. For those who live in the urban area the radio supplements entertainment and information needs. The urban dweller is more immediately exposed to newspapers, magazines, the latest movies, and more recently, video. The staff of the Department of Information recently inaugurated a half-hour programme on current events. This was well received by members of Fiji's Cabinet and by the local media. This programme is part of an overall Government policy aimed at enabling the media sector to contribute more fully to achieving national development objectives, including health education. It is envisaged that the Department of Information, will branch out to educational programmes whereby it will promote attitudes and values in Primary Health Care for the attainment of the WHO Global aim of "Health for All by the Year 2000". The media in a multi-racial and developing country like Fiji has a vital role in helping to determine the type of social and political climate that is to be enjoyed by the people.

- 67 -

Annex 10

Fiji's record of stable political, social and economic development can be attributed much to responsible and balanced media coverage, as that of good leadership and sound government policies. Government has a mobile film unit which travels to districts and outlying islands showing developmental films with emphasis on promoting community initiative and awareness. Films, whether they be documentaries or features, have proved popular in villages and rural settlements. It is not uncommon to find a number of films being hired by rural women to raise funds for institutions and community activities. THE HEALTH SECTOR Fiji's Ministry of Health works on the policy that all health workers are health educators and it bas always made it the bounden duty of every bealth worker to disseminate healtb information. Activities in this field needed to be coordinated and strengthened so in the early 1960s a health education unit was formed. This unit is responsible to the Permanent Secretary for Health through the Director of Preventive Medical Services and is responsible for all components of health education, the most important of wbich is the dissemination of health information. Staff of tbe unit consists of a Senior Medical Officer with postgraduate training in Public Health and Health Education, a Senior Health Sister with similar training and a Health Inspector who has been earmarked for training in Health Education. To fully appreciate Fiji's health information dissemination system one needs to be acquainted with a general overview of its Health Service Organisation. The Healtb Education and Family Health Unit forms part of the Ministerial Headquarters administration. For administrative purposes, Fiji is divided into four divisions each headed by a Divisional Medical Officer assisted by a Senior Health Siater, a Senior Health Inspector and back-up clerical staff. Divisions are further divided into subdivisions and further still into Medical Officer areas with a health team of a composition similar to that at divisional level. At the periphery are the district nursing zones staffed by a single nurse who either operates from her own nursing station or from a health centre. The district nurse performs all facets of primary health care with a heavy leaning towards promotive and preventive services. The Ministry of Health has recently incorporated a new component into its district teams, that of the village health worker. It is at this level that we acbieve the greatest contact between health personnel and the people at 'grass root' level, hence a greater opportunity for disseminating health information.

- 68 Annex 10

CURRENT APPROACHES TO HEALTH INFORMATION DISSEMINATION AND THEIR RELEVANCE TO FIJI'S HEALTH SERVICE ORGANISATION Our current approach covers a wide variety of act1v1t1es ranging from personal discussions between health worker and client, through posters and eventually with the use of video. PERSON TO PE&SON APPROACH This is our main channel of disseminating information district nurses on home vis1ts, in Maternal Child Health clinics, and doctors in health centre outpatients special clinics exploit these opportunities of contact to advise patients and where clients could inquire about all components of health care for themselves, their families and their community. PRIMARY HEALTH CARE SEMINAR APPROACH Primary Health Care is a multisectoral effort to improve health and quality of life reflecting, and evolving from the economic condition, socio-cultural and political characteristics of the country. It aims at maximum community as well as individual self-reliance. Seminars are organised at district or village level where participants from various community groups discuss with health workers the importance of health in development. Participants use the seminars as appropriate forums for discussion with members of the community health aspects in development. At such seminars, factors as traditional leadership, the role of women in development, intersectoral coordination and cooperation, community participation and cooperation, and the revival of village health committees are widely discussed. By the time International Conference on Primary Health Care in Alma-Ata adopted Primary Health Care as the key tool to attain the global target of Health for All by Year 2000, Fiji was already implementing the concept. In 198v, Fiji launched a pilot project where the first village level seminar was organised. The aim of the seminar was to demonstrate that, through such seminar, health problems and health status of the people are discussed and wsys of overcoming their health problems worked out. It could be said then, that 1980 was the year when Fiji formally commenced to use Primary Health Care as the approach to develop Family and Community Health.

- 69 -

Annex 10

GROUP APPROACHES Various community groups serve as a means of disseminating information and exchanging views. These include Mothers Club in village and settlements and in urban and peri-urban areas, Services Clubs, Youth Clubs and religio"s groups. Doctors, nurses and health inspectorste staff establish close contact with these groups and utilize meetings with them for discussion about family health and community health problems and related needs; for passing on information and for obtaining ideas and information from the groups. Contact on an official basis is also made with more formal groups such as village and provincial councils, rural development committees, etc. Opportunities provided for in these more formal settings are exploited to the full as contact at this level is of vital educational importance as a means of interpreting priority health problems and the need for family health services to both policy makers and financial authorities. APPROACH THROUGH OUR EDUCATIONAL SYSTEM The primary school curriculum includes health as a separate subject and the subject content is planned jointly by officers of the ministries of health aod education and covers mainly the preventive aspects of health. In secondary schools, health teaching is incorporated into the biological sciences. School visits by school health teams also utilize these visits to disseminate health information. APPROACH THROUGH THE ORGANISED SECTORS - EMPLOYER ORGANISATIONS AND TRADE IJIolIONS Two Seminars on Family Welfare for the Organised Sectors which were organised and funded by ILO expressed strong support for positive action from Trade Unions and Employers Organisation on Family Welfare. This support is presently only vocal but this is a potential avenue for the dissemination of health information and needs to be seriously explored. MASS INFORMATION APPROACHES This is the direct responsibility of the Family Health and Health Education Unit. The only mass media services in Fiji are the press and radio. Radio has a much greater outreach and surmounts the problem of illiteracy in the population. Cost is the major constraint to its fuller use, but the Fiji Rroadcasting Commission which runs the only radio station in Fiji does allocate time for health broadcasts as part of its service to listeners.

- 70 Annex 10

Radio broadcasts on issues concerning health have been rather varied but I will only dwell on the present state of health broadcasts and these fall under the following categories. RADIO TALKS Lasting several minutes is a weekly broadcast session, and the contents are broadcast in the three major language in Fiji. A programme is drawn up for the whole year. Scripts are prepared by specialists in the various medical specialities and in public health and are channelled through the Health Education Office. RADIO SPOTS These come on daily in the morning. Scripts are prepared by health workers and again channelled through the Health Education Office. WOMEN'S PROGRAMMES This consists of daily sessions and often features interviews with nursing personnel RADIO NEWS RELEASES These feature in the news sessions whenever the need arises usually in emergency situations such as epidemics, threat of epidemics and natural disasters and whenever there is an untoward trend in disease patterns and major development in the health services, etc. Panel discussions are not as yet a regular feature and we have not as yet ventured into serial radio plays. The use of the press has been limited to news releases in the same situations that I have outlined for radio news releases. A weekly health bulletin run by one of the dailies has since lapsed. All radio and press news releases are channelled through the Ministry of Information in collaboration with Ministry of Health. PRESENT PROBLEMS finance. These broadly are finance and manpower - but basically

We will continue to depend on health service personnel such as doctors, nurses, health inspectors and other cadres of health workers. Obviously, this would require a very active coordinating unit to consolidate and systematize our health information dissemination activities to ensure that the right information is propagated. This in itself entail. identifying the real problems and employing the right approaches not only in terms of service provision but also in information dissemination.

- 71 -

ANHEX 11

DANG MOK PRIMARY HEALTH POST

22 APRIL 1983

AN SEONG GUN GYEONG GI PROVINCE

- 72 Annex 11

4s GYEONG GI PROVINCE Seoul

REPUBLIC OF KOREA

•

Gyeong Gi

•

Administrative Districts:

8 19 29 162 6 442

citie. Guns Eups Myuns Dongs F: 1 981 701)

Population: Area:

3 961 906 (M: 1 980 205)

10 875 sq km

Public Health Facilities Provincial Hospital: Health Centre Health Subcentre : Primary Health Post: 6

27 173 100 in operation 94 to be established

- 73 Annex 11

DISTRIBUTION OF PUBLIC HEALTH FACILITIES IN AN SEONG GUN

+ $

Primary Health Post Health Subcenter

,'\ / I

(' . \.

;

-+ ',-, '\..

,./

• Il Jook

I '-(t:J , Yang

'-'\

ton Gok

}

('~' Dae

" ,Gong D

} ,-. "'-... (

./ .'\.

e \.f ............ \

1" S h Won ')

\i Administrative districts: Population: Area: 596.86 1 Eups 12 Myuns 129.350 (M: 65.322 F: 64.208) sq km

Public Health Facilities: Health Centerj 1 Health Subcenterj 12 Primary Health Postj 5

- 74 Annex 11

DANG MOK PRIMARY HEALTH POST

Established on 7 October 1981 Population in Jurisdictional District: Number of Household: Major Industry: School: 639 (Farming: 3 546 (M: 1 809; Non-Farming: F: 1 787) 65)

574;

Agriculture

Elementary School: 1 Pupils: 245

I Community

Health Practitioner

I Primary Members:

Health Care Council

5 Ri Chiefs 12 Saemaul leaders and/or Community development members

Supports the Primary Health Post

I Village

Health Workers

5 Leaders of Women's Club Assistant Programmes for MCH, family planning, TB control, environmental sanitation, and health promotion

- 75 -

Annex 11

WEEKLY ACTIVITY SCHEDULE OF COMMUNITY HEALTH PRACTITIONER

Monday

Tuesday Home visit Clinic

Wednesday Clinic Clinic

Thursday Clinic Clinic

Friday Home visit Home visit

Saturday Clinic

A.M. P.M.

Clinic Clinic

Content of Weekly Activity Activity Community health education Home visit p.nd health education Health consultation in clinic Patient care Paper work Miscellaneous Hours 2:00 l3:lO 14:00 11:00 3:30 4:20 Percentage 4.1 27.4 29.1 22.9 7.2 9

- 76 Annex 11

ACHIEVEMENT OF DANG MOK PRIMARY HEALTH POST IN 1982 1. Family Planning Service: Number of women in reproductive age with spouse: 159

Contraceptive method Vasectomy Tubal-ligation Oral pills Condom

Achievement 3 17 50 32 15 42

Percentage 1.8

10.6

31.4 20.1 9.4 27.4

IUD Others

2. 3. 4. 5.

Regis tration of infant Registration of pregnant Til case-finding Patient care:

: women~

53 15 5 2 499 4 992

Number of patients : Number of patient days:

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1983

Source World Health Organization