UNITED NATIONS
NATIONS UN!£:.:,
WORLD
HF.Al'!'H
ORGANISATION MONDIALE ~
ORGANIZATION
DE LA SANTE
EIGHTH 1 ,-lORLD HE.i,LTH ASSEMBLY
A8/Tec~nloa1 1T~~si~~/3 R&V.l 21 May 19.- ;
ORIGINAL l REPORT OF TECHNICAL : -. SCUSSIOi'iS AT THE EIGHTH.. W07.W HEALTH ASSEMBLY
-ENGLISH
The Seventh W")rl.d Health .Assembly decided that the subject "Publio-Health Problems in Rural Areaett should be maintained for the teohnical disrussions at the Eighth World Health Asserubly to take place in Mexico and that a programme of field visits tA the rural health services in Mexico be organized in ~10nnexi('n
with the
technical disnussions, with the assistance of the Mexican Gtwernment. Field trips The field visits to rural social welfare centres and health centres . to~k
plaoe
on·Saturday, 14 May and Sunday, 15 May, with the delegates of the Assembly travelling in five groups to the follcwing areas: A. · Taltizapan, Chiconcuac and X.ochitepec Centres of Rural Social Welfare and Health Units of Cuernavaca, in· the State of Morelos. This aea of Mexioo e>orrespondt:
to a sub-tropical zone with production of sugar cane, rice and fruits, mostly on •'
irrigated lands well distributed among the population.
.
The group was 00mposed of
·so B.
persons. Health Unit of Celaya: Centres of Rural Social Welfare in: Sarabia,
Valtierrilla and Cuatro. de b.ltam.ira; .Maternal and Child Health Centre of Salamanca; Health Centre (Under constructton) , hospital and Iacdical school of Leon anJ waterworks r-f Guanajuato, in the State ar· Guanajuato. of the ~ountry,
This area, in the eentral part
is situated in the temperate zone wlth a rather hi.gh population 'J f
density;
there is a good development
agriculture > a certain amount of home
A8/Technical Discussions/3Rev.l page 2 industry and also one of t he principal oil refineries. towns is essentially agricultural. C. The population in the small
The group was composed of 40 persons.
Rural Social '\>/elfare Centres and health centre of Villa Cardel, and Centro de H ealth Unit, hospital and m edical school and The centres of rural
Bienestar Social Rural de Cempoala;
malaria programme centre of Ver acruz, in the State of Veracruz.
social welfare are established in agricultural communities devoted mainly to sugar cane cultivation. The city of Veracruz is one of the main ports of Mexico, with incipient The group was composed
industrialization of s ea products and of fruit preservation. of 11 delegates. D.
The group visited first the Health Unit, the hospital and medical school. in the
city of Veracruz and then proceaded to the Centres of Rural Social :·Telfare of Santiago Tuxtla, San A ndrtSs Tuxtla, and Sihuapan . This s outh zone of Veracruz, tropical like
the north one, derives its livelihood fr om cer eal crops, citrus fruit, sugar cane, coffee, tobacco and cattle raising. E. Rural Social ~velfar e
The group was composed of nine delegates.
Centres of Tamuin , Ejido Primavera, Vcl.les and Tarinul, in This ar ea , in the sub-tropical zone, is essentially
the State of San Luis Potosi.
agricultural, with a certain amount of citrus f r uit, coffee cultivation, and cattle raising. The group travelled by plane from Mexico City, and was composed of 11 delegate. PROMOTIONAL ACTIVITIES OBSERVED DURING THE FIELD VISITS A.
Community organization , Food production and consumption: (c) poultry farms, (a ) fre e canteens, (d) bakeries, (b) collective and family .(f) orchards,
B.
vegetable gardens,
(e) bee-hives,
(g) food preservation . C. Educational and cultural activities: (b) anti-illiteracy centres , (a ) promotion of school enrolment and (c) r eading clubs, (:l) manual arts,
attendance, (e)
first-aid.
AS/l'ecbnioal.:D1-eousiODs/31tev.l page 3 D. Arts and crafts: (a) music., (b) theatrical groups, (c) sewing and dress-making.,
(d) masonry, E. F•
(e) carpentry,
(t) ·tanning.
Recreation and sports:
(a) 7outh clubs,
{b) sports teams,
(c) puppet shows.
Maternal and ~hild Care including: (c) nurseries,
(a) maternal and child health centres, (d) breakfasts tor children, (e) :hm!'lln:fzations,
(b) maternit7 centres,
(t) training of lq midwives.
G.
Environmental imprONifllltt
(a) ·:f.mprOvement ot hOUSinl with provision ot better I
cooking facilities,
(b) aobDol building improvement,
(o) protection
ot water supplies, (h) village
.(d) Ganstruotion ot Nm.~ .:latrines, le>cal authorities on public works, planning and embellishment.
(e) disposal ot ·refuse,
(f) teGJmioal advioe to
(g) maintenance
ot roads
in the localit)",
H.
Technical aid tor the sooial and eoonoird.c improvement ot comrmJn:fty. Re·settlement of excels ~ation in suitable areas. ESTABLISHMENT OF RURAL SOCIAL WELFARE OENTRiS AND The Rural IT~
I.
PRINCIPLES ..
SooW Weltare Centre Programme ~~·the aim
was established b)" the Government of
Mexico in August 1953,
ot promoting comprehensive activities tor
the
improvement ot l&neral.linng. condi tiona and health in coll'lllUDities whose social. an<l eoonardo lev~l
is suoh u to.
~~t
them to be organized to take an active part in the
programme.
Rural had
activi~es
for the promotion ot
publi~
health and co-operative medical services
alr~ady'
been undertaken .in the pe.st in various sectors of the ooutitry, as earl.1' as
1929. The Ministey ot Public Health and Wel~are,
in order to institute suitable methods.
tor tile stu47, organization and awakening ot the communities, established in 1953 tour pilot centres in zon~s
repl"esentative o£ the different ethnological, economit., a!:ld There was •·Aver,- favourable response
health conditions pr~om::lnant in rural Mexico. .from the rural inhabitants
to this ettort.
AS/Technical Discussions/3 Rev.l page 4 _ The programme has been extended gradually to cover
59 zones throughout the. country.
After a survey of the 'communities ·the following activities were set in motion: and child care; health education;
maternal
campaign to combat illiteracy, raise the cultural level and promote pranotion of stock-breeding and improvement of nutritional standards housing improvement, sanitation and community . . progr~s
and of oo+leotive and family eoonQm7; embellishment;
community participation in specific recreation.
for the solution cf
· publio-he&+th and medical problems;
In the personnel;
develop~~ent
ot this programme emphasis bas been given
to the training of
selection and preparation of auxiliaries within the aoJIIIlUllity to act as
promoters of the progra.mme; resources and of the work
and the OQ-ordination of all governmental activities and · the communities.
ot
The field trips were organized for the purpose
ot demonetrating in the work areas
the practica:. application of the theory underlying the progt"8lXXIle as well as the execu.tic
ot the programme
aotivit~s.
general disgussioQ . The technical ~scussions took ple.oe in two sessions tota1Hng siX hours, with
an average attendance of 125 persons at the two sessions on and Saturday, 21 May. The Chairman we Dr M Martinez Baez,
Wednesd~,
18 May
designated in advance by the Director-Gen....:ral, and the member of the Secretariat assisting was Dr M. E. Bustamante. ·{El Salvador); (Yugoslavia); A Working Party composed of· Dr Allwood Paredes Dr A. Stampar
Dr H. van ZUe Hyde (United States of .America);
Dr Le-Van-Khai {Viet-Nam);
Dr M.P. V. Tottie (Sweden); cy the Chairman to present the report c£
Dr C. K. Lakslimana.n (India) was appointed
th.e discussion.
AS/Technical, ~.-D1-=ssioDs/} -Bsv-.1 ~ page 5
During the discussions reference was made to the interesting experiment being carried out by the Mexican Government to combine the promotion of general welfare with that. or. the h~e.lth
ot .the people in the rural centres.
The importance or a complete
under$tJu\ding between cloctora 1· sanitary engineers, agriculturalists and other members or the cormmmit7 coneel1184. in -the development or rural welfare programmes was empbe.siz&d,
\4th the· need tor the··p&"cper:education or people in charge ot the work, eapeci•lJ7 the preparation ot ~a,~to·
UDderttand the relation or health io all the other faotora
or seoUl. devel~pment•..:. ~:raieing or the standards ot living,.waetber with educ:ation1 was oon•ld~ ·to be :the most important aspect of rural welfare.
'-lth.
0c&l'8M
planning and devel.~t··ot ~al demonstration centres could serve as a guide in ~~·~t
.oount-1:7-v.We :programmes. partie~
It was mentioned that the
sue~
of the programme
dependes· on .the
.dependinr, on the cc:'m'munity in the
~gramme,
the extent oor-mun:l.ty.
ot its participation ia,part on the J.evel or the economic well-being of ~ oountrt.ee.,iWh~ trans~t:f.Qil 8.2.'8
the
the rural population is widely scattered and in wh:l.oh means ot
liJaiW;: the hee.lth services may be init.iated by the use ot vitd:U.ng
teams for tbe. OQDt:fo.l·
ot apecific diseases, ·prior to the est£".blishment ot permanent
services, bes.rini,~-~ Iliad .the.t .temporary services do not sut'rioientl7 e.rouse the interest of the .peoplthizbhaal.th or well-being and .that the community does not part:l.c:l.pe.te·:l.n.thia 1t1Pe':Dt programme. · · JU1other ¥1iha4 whim·. has been tried in the developnent ot health services iii the · rural area·.· waa -the eatabliabm.ent ·ot health units covering a certain area and
pop.Uat:l.ol1• .. The e.otivitiea or these units were, however, confined to purely m.edioa.l and. health matter&; end there was no parallel development of other social servioes · contribu.ting-to:the wltare of the oommunity. The results were n- tural.ly n0t very h~th
successful• · The local heel.th unitl" set up with the task ot improving
onl.y are
AS/Technical Discussions/) Rev.l page 6 now being modified in tQanf countries by a multi-purpose approach, such as the one in use by the Mexican Gov~nt
and observed by delegates during their field visits.
It was suggested that especially where the population density was high it would be desirable to establish in rural areas at first a small hospital as a basis tor all health activities, rather than to start rural health centres dedicated exclusively to preventive medicine. and curative medicine.
Emphasis was also given to the idea· of integrating preventive·. The person in charge or the multi-purpose
programme mat be a The need to ·b&ve
doctor trained in health services, taking the expression "health" as indioa.tinc'aol"e than public health exclu~ively
and expressing other aspects or life.
health personnel trained in rural health work was much emphasised and it was felt. ,t,bat, doctors, nurses, sanitarians and other health workers, before they are deputed in ·the rural area, should be given an orientation training in health work •. In rural districts with a large percentage of illiterate population and with people having different values and ideas concerning health, it is necessary to establish certain guiding principles. Firstly, there must be a survey of the district to stud7
tor work
the culture of the people and to find out their attitudes towards medicine and mec11oal care. After the study, individuals from the oommu.nit7 should be .trained to aot as As a third ·
promoters of public health in co-operation with the health oti'ioials.
principle, every e~fort should be ·made to develop other social services in the community along with the developnent of medical and health services, . since heal.th cannot be considered as an isolated activity but only as a part of the general community development programme. Several delegates referred to the integration of all health servioes, Another principle enunciated was the
preventive and curative, in the health programme.
importance of the participation of the community in the health programme and the education of the people in health work. The wishes of the people should be first taken
AS/Technical Discussiona/3 Rev .1 · page 7 ..... ·, . into account and priority should be given to those activities w~oh
the.
~ople
themselves
desire to have rather tham imposing on them those services which the health . . authorities think ought to be given. Another aspect to which reference was mads by many d~legates
was the paucity of health workers in rural areas and the diffiauJ.ties experienced by health administrators in attracting trained health workers to the rural areas.
A
vie'! was expre.ssed that to overcome this difficulty it would be necessary to ensure . that the health workers ·are given a t'easonable living wage, are provided with the basio amenities of life, and that the dispensaries and health centres . ' w~re
they are expected·
to work are. adequately equipped to enable them to exercise their technical lmowledge to the best advantage. Swwyizing, the main points brought out by the general disoussion are the following: 1. The proroquisitc !or ~::;tablishi.ne
rural
~ealth
programmes is a survey to study the (b) culture (e.~.
coll1Ill1ll'lity, obtaining knowledge of its (a) geog!"aphy and climate, attitudes towards disease, habits, community action,_etc.), population; (d)
(c) health states ot the
economic level and structure (ee g~. ~nd ownership, type. of agriculture (e) educatipr.al levels, (f) GoveiT'llental organization administrative compet~ce;
or husbandry, etc .. ),
(centralization versus decentralization;
tex structure;
health and welfare services if any and their organization.) 2. . The multi-purpose programme for the community development and for the integrated
programmes for the general improvement of the community, offers the best approach. Health matters should be a part of the welfare community services.
3.
For the success of the programme the participation of the community is essential,
with the interest of the people as an essential part t":!nd with the understa.ndi.ug that the programmes are not imposed from above upon the commurJLtyo
I
AS/Teotmcal D.iacussiona/3 Rev .1 page s .
4.
The geD:eral programme for the suooess:tul health ·work depends on other soo:l.al and·
teahnioal services, with health aons.idered not as an isol:: ted actirtt:r bat ae a part or the general community developnent programme embracing agrtoulture, education,. home
industrJ" etc. (a)
The general integrated programme shoilld. includea
ol)II'Jmmity participation {local funds, local oommittee, local personnel., eto.)
{b)
integration of health care in the e.anomic and oW.tural life of the .,.,..~·:t;7; central support (leadership and guidance, technical aasistazloe)
(c)
(d) . traiiled personnel. (broad training and education, espea1•ll7 ot pbjeioiau, and proper prepai-ation of s~t dertTed fran rure.l areas.
The ·measures tar
re&l'Uitment or staff should provide: pay;
(i) basic amenities ·of life;
(11) aclequ&te
{iii) fao111ties for professional work.
s. ~
jn certain oases with specific health problems, it may be necessary to iDitiate the health progr&IIIID8s
b1
undertaking specific health aotivitieas
to be integrated later
in the general rural programme. ·
Throughout
the
teohnical discussions .tlle participants expressed tb.eir apiJNaiation oo~sidu
of the rural social welfare programme of the Government of Mezioo, wbioh th•7
to be the right approach to the problem.
The pe.rtioipa.nta also thanked. the Mexiaan
Gcwermient for the opportunity given to the delegates to vi~t the various cien~s 1D ·
the. country and to get acquainted themselves with the working of such oentres.
'q;
.
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