REPORT OF THE REG IONAL COMMITTEE
41 ANNEX 5 (WP/RCll/J2)
TECHNICAL DISCUSS IONS 1 SUBJECT
The" subject was "Organization and Administration
ot Rural Health
Services" as selected by the Committee at its tenth session. 2 I .~
ORGANIZATION OF THE DISCUSSIONS
The first session consisted of
~he
opening remarks by the .technical
discussions Chairman and an explanation of the procedures and panel presentation o;f the topic "Planning and:,A.ssessment of Health Services". This was followed by group discusslon meetings. In the second session the second topic "Organization and Administration" was presented and followed by short open discussions. The participants were divided into three groups and conducted a free discussion of the subject in accordance with guidelines prepared in advance of the meeting. more rapporteur. Each discussion group had a discussion leader and one or Each group submitted a report on its discussion.
The third session was held as a general session and consisted mai~ of the presentation of discussion group reports. followed by a discussion. during this session. The topic for the technical discussions during the twelfth session of the Regional Committee was considered. Each presentation was
An evaluation of the discussions was undertaken
3
PANEL PRESENTATION
The panel discussants raised the following points: (i) Definition of the problems in rura1 health services through
a survey of needs and resources;
48
REG rONAL COMMI'l'rEE: ELEVENTH SESSION
(ii)
Establishment of short- and long-term priorities within the
rural health service. The assessment of health services was also presented. In the field of
maternal and child health, planning and assessment of health services for mothers and children in rural areas was highlighted. H alth planning and community organization concluded the first panel pr sentation. The second panel presentation raised such problems as the structure of th local health unit, including staffing pattern; the relationship of
the local health services to higher levels of administration; and financing and cost of the health services. The concept of community participation,
including community development scheme, was also raised by the panel discussants. The types of health services, distribution and coverage of
the population from static health centres and sub centres , training and supervision were also highlighted by the panel members. 4
GROUP DISCUSSIONS The groups met independently and various points of particular interest
were discussed. 4.1 Planning and assessment 4.1.1 In connection with the planning and assessment of health services,
it was agreed by all the groups that some form of vital and statistical data should be available to indicate a.general disease pattern and the problems related thereto. It was evident that the content of this degr~
information would vary with the ar a or rural community.
of development of any particular
REPORT OF THE REGIONAL COMMITTEE
49
4.1.2
In areas where the gathering of accurate data is difficult, it is
necessary that health officers evaluate the available material carefully and when appropriate, use sample surveys. 4.1.; Concerning the aims and contents of the service, it was felt that the aims of the rural health units can be divided into general and specific o~ea.
General aims refer to the basic health activities, while the specific
ones reter to special problems in the area. 4.1.4 Any rural health programme should be planned within the financial resources and considering the availability of trained medical and anci1lar.1 personnel. The possibility of encouraging the employment of local persons
for rural areas was stressed.
4.1.5 Due consideration should be given to the demands of pressure groups (felt needs) as a guide in planning 4.1.6
a. rural health programme.
In any rural health programme there should be co-ordination between
the governmental health activities and other agencies working in this field. Community development should also be considered. 4.1.7 Integration was agreed as a necessary factor in rural health services
(both preventive and curative services should be rendered by the rural health unit). In establishing programme priorities attention must be given to
important disease problems against which effective control measures are available. At the same time such control may give rise to other pressing problems, such as population increase , malnutrition, etc., which should
receive due consideration.
REGIONAL COMMITTEE: ELEVENTH SESSION
4.1.8 The
goverTh~ent
should take as much responsibility as possible to
subsidize rural health units •. 4.1.9 It was considered that assessment of health work is essential, but In >--
no specific criteria could be set as to the frequency of evaluation. principle, it should be done regularly and fairly frequently. 4.2 Organization and administration
4.2.1 Rural health units can be financed in one of three ways: (i) (i1) (iii) Central government fuUds Local government funds Voluntary donations or grants
The point was raised that there is need to "health educate" persons responsible for funds. 4.2.2 Distribution of service should be based upon the size of the ",--
population, geographical area, administrative set-up and receptibility and r adiness of the population to accept the service. 4.2.3 Supervision at various levels of administration has been emphasized in all group discussions and should be integrated at local level. 4.2.4 The groups agreed that the health unit should be headed by a physician, should include a nurse, a midwife and a sanitarian. For better /
,
co-ordination of services it is essential that the duties and responsibilities of various categories of health personnel should be well defined. The utilization of non-trained but supervised personnel, suCh as "hilots", herb doctors, etc., can be considered useful under certain circumstances provided they are licensed and supervised. It was
REPORT OF THE REGIONAL COMMITTEE
recognized that they can play a part in the health service.
The general
reluctance, however, to take this type of people on the payroll of the unit has been expressed.
4.2.5/
Midwifery service is considered as a basic component in the It was agreed that when full-time
service proVided by the health unit.
services of maternity beds are provided in health centres there should be a full-time service available. It '\'18.S
recognized that in very many
countries and territories it is not advisable to provide maternity beds at health centres. 4.2.6T.raining of personnel should be adequate and dependent l1pon the needs of the personnel. This training might be done at the national,
intermediate or local levels, depending upon the training needs of the personnel. done abroad. In some countries the training of personnel would have to be
5
RECOMMEND\TIONS
The technical discussion group made the following recommendations to the Regional Committee: (1) that the topic for the technical discussions during the
twelfth session of the Regional Committee to be held in New Zealand should be "Dental Health"; (ii) that it irould be very useful to appoint the chairman of
the technical discussions well in advance of each session, the .selection being made by the Regional Director in consultation with the Chairman of the Regional Committee.
52
REGIONAL COMMITTEE: ElEVENTH SESSION
6
EVALUATION
Of the
~ompleted que~tionnaires
received; seven rated the Technical
Discussions as excellent, twenty-three as reasonably good and one as mediocre. Several evaluation questionnaires contained the statement that the topic was too wide and too important to be adequately discussed in the time allocated.