Sponsored by the WORLD BEAIIl'B ORlARIZAfiON RliDIOBAL OFFICE JOR THE WE&I!EIRli PACmC
MANIIA I
PBILIPPIlmS
20 - 31 January 1966
lfO'l FOR SALE
Printed and DistrIbuted by
the ~
RmIONAL OD'ICE JOR
WJ!B.l!EBft PACInC
of the WOrld Health OrganIzatIon Ma111Ja, Ph1lIppines June 1966
The views expnssed in this report are those of the consultants and p6rt1c1pants at the seminar and do not necessarily reflect the pollcy Qf the World Health Organization.
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This report has been prepared by the Western Pacific Regional Of'fice of the World Health Organization fOr Governments of Member States in the Region and for those who participated in the First Regional Seminar on Health Education which was held in Manila, Philippines, :from 20 to 31 January 1966.
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1. 2.
mr!l()IlJCl!IOI
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BErIBW OF SEMIIAR D!SCUSSIOIS
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2.1 Health education developments •••••••••••••••• 2.2 !be three 1II8Jor topIcs ......................• 2.2.1 !be importance and use of health education services in national health progr8111111e8 - Topic 1 ••••••••••• 2.2.2 DeYe10pinc qualified health education
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leadershlp - Topic 2 •••••••••••.•••••• 2.2., Organization and administration of health education services - Topic' 2. , '0.
6 8 10
SuaIIIary Of group discussions on the three 1II8Jor topics ............................... .
mJIIM.R'!' .AlfD OOIfCUJSIOBB •••••••••••••••••••••••••••
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AIDX 1 .AIJI!:l[
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LIS'.f OF COl'ISUIJl!Alfl, PARrICIPABTS I 0JSli:flV'DS .AID ~ •••••••••••••
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.A01BllA. • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • MJ!MBEBS OF THE mEB l«>lICIl'U GROUPS •••
ABIEX, AlmEX 4.
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39
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SOHWUBS OF PLElIABI PAll![, DISCUSSIOllB lI'OWSIBG OB 'mE HEAIlJIft EIlJCATIOlf JOB !l'O BE OOBE •••••••••••••••••••••••••••• SP.&mAL IN'.I!ERl!8l' GBOO'P SESSIONS •••••••
Al'mEX 5
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ADElC 6 .AQBX
FIELD VISIT 'l'O THE APPLIED mlTlUTION PBOJl!lC'l! A'l BAYAMBAliG I PABGASIBAN •••••• ~
55/56 57
7 - LI8l' OF WOBKIBG PAPBBS .AID
BElfBHi!iliCE ••••••••••••••••••••••••••••
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'!'he First Regioll&l. Seminar on Jiealth Education organized by'the WHO Western Pacific Regional Of'f:l.ce was held in the WHO Con:f'irence Rall, MaDila f'l'Om 20 to 31 Jaauar,r 1966. Twenty-five participants f':rOm. fifteen countries attended aDd included public health adm1 n1 strators and health education specialist. in government service and in medical and health worker tra1nins programmes. The list of consultants, partiCipants, observers and members of the WHO Secretariat is given in Annex 1. The agenda for the sem1uar .1s given in .Annex 2. The participants elected Dr. C.K. Chang, Cha1rman; Dr. Trinidad A. Gomez, Vice-Chairman and Dr. John Krister, General Rapporteur. Dr. Francisco J. Dy, Director of Health Services, and Actins Regional Director I opened the sem1uar by satins the three principal objectives:
(a)
to seek agreement on the important elements in developins an organized and effective approach by govel'Dlllents to health education of the public; to formulate guid.el1 nes for preparins qualified leadership in health education; to determine the organization and administration necessar.Y to establish national health education services in national health ministries or departments.
(b) (c)
Dr. D.r emphasized the necessity for leadership in national health education services to be as vital among health administrators as among health education specialists. The three major topics for tl1es em1 nar were: (a) (b) (c) The Importance and Use of Health Eaucation Services in National Health Programmes; Developins Qualified Health Eaucation Leadership; '!'he Organization and Administration of National Health Education Services.
Each topic was introduced in plenary session by a workins paper 0f the 2 consultant for the particular subject. Three discussion groups each
1
Two of the participants were sponsored by the South Pacific Commission. 2 See Annex 3 for of'f:l.cers and members of the three discussion .groups.
- 2 devoted f'ourteen meetings to the three topics. Daily plen8.l7 panel. discussions f'ocused attention of' the participants on the health education j~b to be done in 8QIIle of' the major health services and programmes. Participants were 1nv1ted to select and atteDd ~ one of' f'our special interest groups organized accord1Dg to the results of' a questionD&1re sent out pr1orto the lJem1nar. Four . . .ioDs each were allotted to the f'ollowing subjects: (a) (b) (c) (d) Special Studies, Research and ~uation in Health Education; Preparation of' School Health Personnel aDd Teachers in Health Education; Preparation of' Medical aDd Other Categories of' Health Workers in Health Education; Health Education Methods and Materials. 2
A field trip enabled the participants ~ gain first-hand inf'ormation of' a Philippine Government project in applied 1II1trition were the health, education, agricultural aJId other agencies are involved. 4 Educatioaal materials f'raIl Kember countries were exhibited and several educational films produced in Member countries were reviewed by the participants. A steering committee met regularly with the Secretariat to deliberate on matters Concerning the coDduct of' the seminar. The committee included the General Chairman, Vice-Cba1rman and Rapporteur as well as the cha1rmen and rapporteurs of' the three technical discussion groups. Through an evaluation schedule prepared jointly by the Secretariat and the Steering Comm.1ttee, the semi nar was evaluated after the presentation of' the dr&f't report of' each of' the technical discussion areas.
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1
See Annex 4 f'or sUlllll&l"ies of' plens.ry panel discussions.
2 See Annex 5 f'or resumes of' special interest sessions. }
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JOintly assisted by WHO, tmESCO, FAD and UNICEF. See Annex 6 for report on field trip.
4
- :3 2. R!.VII!oW OF SEMIRAB DISCUSSIOllS
2.1
Health education dmJ.opaents
Participants gave oral reports on health education developments in each of their own countries. Health education services are by no means a new developnent in this area of the world. :Both the origins and pattern of their derelopnent vary videl¥ depending on ~ factors such as population pressures, indigenous health problems and the degree of developnent of national health administrations. There is great interest in health educat10n~!!.1 as well as in significant recent developments in health education theory and in research findings and their application in publlc health practice. Many countries place emphasis on the paramount importance of the health education iDwlications of the dail¥ task of the health worker as pert of the services which he renders to the public. There is also a corresponding evolution of interest in the health education specialist as the organizer of health education services and health education training of health and other workers. In some cases, rural health workers, who have a major responsibillty to bring health education to the people, have been provided at district or vUlage level bef'ore natioDal health education services have been organized. In other cases, systematic services have been established centrally in association vith bureaux or divisions responsible for major public health programmes, such as maternal and child health or eaviroDlllellta1 sanitation. It now seems to be generall¥ recognized that for full development of the healt!1 education potential. of natioDal health services, it is necessary to establish a ~ecial unit for health education at the national level. As a result, many countries are seeking to establish an adequate organization on sound administrative principles, headed by suitabl¥ trained and uper1eneed speeialists of high calibre.
It was very clear f':rom the reports ot the varied eJq)erience and developments in di:f'f'erent countries of this area. of the world that the objectives of this seminar, i:f' adequatel¥ realized, would go far to assist all goveriunents to take action appropriate to their own needs, perhaps the chief of which were: (a) (b) (c) (d) definition and ~sion of professional trB1n1ng for health education ~ecial.ists; training in health education for other categories
ot health workers; planning and eva1.uation of health education services; preparation of teachers 8l1d others for school health education.
All countries envisage strengthening and. expandj ng their. health education services by: .
- 4 (a) consolidat1n8their present podtion through 1JII;proved organizatloaal structure and increasi118 the n'llllber of trained health education personnel; integrating health. education activities in the overall health prog1'8llllLes i contiDU1ng the 1mp~t of tra1n1118 courses in health education for aU health personnel. as well as for the health education Officer; iDWroving or establishi118 institutions :f'Gr advanced study in health education; seeking internatioaal assistance in the :tom of fellowships and consultant services; improving. testi1181 and increasins production and Judicious distribution and use Of health education materials;
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(b) (c)
(d) (e)
(:r)
(g)
systematic evaluation. special studies aDd research in health education.
The director of the seminar stated that health education is .till in it. earl.yst&ies of development in most countries in the Western Pacific Regi~n and there is still much to be desired before it reaches maturity.
... 2.2 2.2.1
The three major topics The tmRortance and use of health education services in ns.tioaal health ;progr8lllllleS - Topic 1
The importance and use of the health education services were brought into clearer perspective tllroush seven pleary panel discussion .essions in which the participants were Joined by WHO regioaal advisers and field staff' in considerins the' health education Job to be done in various speci:f'ic health progr8llllle8. The Regioaal Adviser on Public. Health Aaministration introduced these iDformatloaal sessions by pointing out that health education has become an essential part of the public health prograume as the earlier emphasis on legislative control of health hazards has increasiDSly failed to keep pace with the ri.iDS aspiratiOns of the people for good health. aDd sympatb,y with, the aims
There has developed a need :tor public understanding ot. ot public health and for coDtidenC8
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1
WPR/BE/."
Developments in Health Education in the Western Paci:f'ic Region, by Dr. Teodora V. Ttglao, 14 January 1966.
- 5in its policies. aDd its of'ticers aDd agents. i'be kind o~ i~ormed, though ~tlma~ critical, appra18e.l o~ health ~ aDd possibilities wh;l.ch health education o~ the co....nn1t)" e.~s baa st~ted public health 1IOl'kers to greater 1nventiwaess :I.D their ~s. 'l!he iII,portance otaee1d.Jl8 direction f'rQn. public health adad.n:Lstrators, directors o~ spec1t1c. health Pl'Ogr8llllDeS and varied specialists was demonstrated in the seven plens.ry sessions on "FoCWJiDg .on the Health Education Job to be Done". Some ma,1or health education tasks 'Which health depe.rtmenta sboul.d seek to perform were emanerated:
(a)
promot:I.Dg public awareness and use ot health services of all types, thus ra1siag their etf'iciencyand focusiDg attention on spec1t1careas of ~; prov141ag health worker tra1n1ag des1sned to ~ staf'f CCIIIIIlIm1cation aDd influence on the public; estab1ish:I.Dg liaison with the ~ agencies and organizations interested in health, both governmental andotherw1se, with a vievto co-ordinatiag andassistiag their health education roles; securiDg voluntary response to legal. health requirements :I.D the interests of sustained im,provemeni; in sanitary and health conditions; research, inc1ud:Lng pilot stu4ies to determine effective and w1de~ applicable methods of health education; enl.ist:1ag CQIlIIlnnit)" support tor and acceptallce of health prog1'8Dlllles.
(b) (c)
(d)
<e> (f>
i'bere are a var:1et)" of W8JS in which health education services can be of value in plaimiag health programmes by providiag information on publ1c kDowledge, attitudes and probable responses, and by advisiag on measures to encourage the public support and co-operation which are es~t1al to the success of an;y health programne. 'l!he need for dependab1e bqet support and tor constant evaluation of effort to allOW' the developaent aDd refiD,elllent of 1 efficient and ecoDDlllic health educationtecbniques was eqmasized. 'l!he Consultant on Public Health Mutiaistr.tion and a.J.th' Education enunciated the viewpoint of a publ1c health a(hninistrator as he referred to the 1'unct1ons perta1 niag to the department of public health; advocated the p1acement of the health education division in the highest l.ev'el of this department; 1Dd1cated the
1
See Annex 4 tor sU/llll&ries of plenary pane1 discussions on
"Focusiag on the Health Education Job to be Dolle in Public Health Progrlllllll8s".
- 6 re~nsibilities o~ this division and their priorities: planning, research, evaluation, co-.ord1nation, staf'f' training, pre-testing and adaptation o~ audio-visual aids; described the resistance met by educational. action within and without; suggested means to overcome this; and outlined the problems o~ recruitment and training, technical supervision, co-ord1nation and financing. After posing a number of questions related to the need tor and justification o~ a health education service, the level at which it should be placed, wb;V' some governments have not organized such a service, how a health educator can contribute use1'uJ.4r to the success o~ a programme and how an administrator can best use a health education service, the consultant made the tollowing points:
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(a)
Health education is a discipline based on the findings and experience o~ the behavioural sciences but it is also an art which, to be successf'Ul, depends on idealism and altruism o~ the artist. Too ofien the public health administrators have a rather vague idea of the aims and tha methods of health education, as well as o~ the fUnctions o~ health educators. They are reluctant to admit that the latter can point out to them the psycho-sociological aspects o~ public health problems, which will only be fully solved when the human ~actors and changing pattern o~ these problems is taken into account. Tbe participation o~ health education services in the planning o~ any public health programme is a ~ qua ~ of success. Research and continuing evaluation of the needs and resources is a dynamic and democratic process which in itself is already an efflcient instrument of health education for all those who take part in it. !?pic 2
(b)
(c)
2.2.2
Develgping qualified health education leadership
Tbe Consultant On Health Education Training referred to the recent dramatic change in outlook o~ nations in the Western Pacific Region towards the need ~or pro~essional health education specialists within national health services and training institutions. Tbe difference o~ opinion which bas developed as to whether the public health physician or the health education specialist should assume the leadership role in this new activity o~ the health department was mentioned. Each bas a distinct role to p~: one in content and the other in method. Tbe same could be said o~ relationships between other health specialists and the health education specialist. Tbe term "developing qualified health education leadership" was defined to mean training or developing health education specialists who can take leadership in the educational methodology or technical
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WPR/HE/2, Tbe Importance o~ Health Education in National Health Programmes I by Dr. Gu;y loison, 11 January 1966.
-7aspects of health education. Existence of the need tor health education spec1al1sts did DOt, in his view, mean that each country required a train1ns progl"8IIIIle. 1bere were, however, va.r-ioUB aaenc1es, both goveraaental and otberw1ae, which needed such specialists as professional members of tbe health team and it 1fBS necessary to estabJ.1sb the discipl.1ne on a sound baSis of trainiag if its members were to rel.ate in a satisfactory W8iY' to members of tbe other profeasional d1scipJ.ines in the health services. The importance or universal asreement on basic :functions and philosophies of health education as part of CCIIIDUnity health programmes was stressed. Ii' this were DOt achieved, then training and employment of health education specialists liOUl.d be con:1'used and disoriented in the general. pattern of health services.
t
The :functions of the health education specialists, referring particularly to their staf'i' situation as advisors ccmpared with the l.ine fUnctions and specifiC activities of most other health workers, are asSisting the bead of the agency where he is working (a) to give educational techD1cal. advice and assistance to colleague health workers in planning and carrying out health education, (b) to co-ordinate the educational aspects of the health programmes within the agency, (c) to be a liaison ot:t1cer in health education with other ot:t1cial and vol.untary agencies rel.ated to health and health education, (d) to train other personnel. in healtll education, (e) to evaluate the educational. aspects of the health programmes, and (f) to undertake research. 1 Functions dictate train1ns objectives and mention 1fBS made of the twin objectives for selecting and training health education specialists l.a1d down in· the Report of the WHO Expert C<lmm1ttee on Training of Health Personnel. in Health Education of the Publ.ic 2 , 1. e., to establ.ish professional. staDdards and to prepare specialists of high techD1cal competence for responsibl.e l.eadership. The educational. l.evel of professiOnal. preparation needed, i t the health education speciaJ.ist were to be adequately prepared to assume his responsibilities as well as to be a respected and
often col'lSulted member of the health team, 1fBS considered. A post-graduate one-year course was believed to be the minimum requirement to achieve this desirable result. It is necessary :tor the candidate to be adequately prepared at undergraduate level. in social and/or health sciences , with at l.east one year's e:lq)erience in publlc health work.
to
make a good health education specialist.
Academic qualifications alone were DOt, however, suf'f'1cient High personal. and
1
WPR/HE/5, Developing Qualified Health Education U!adership, by Dr. Tadao M1yasaka, 22 January 1966.
2
Wld Hlth Org. techno Rep. Ber., 29, l.56
- 8 leadership qualities are needed, ineludiDg real enthusiasm aDd a pioneeriDg spirit. The content of train1ng needed tell under two main heatJ1 ngs, general public health aDd health education with its social science basis. )i)dern methods of health education such &8 COUIlse1l1Dg, group d1scussion, demonstration and practice, case St~, etc., shOuld be util1zed in the train1ng programme because it has been observed that the methods used 1n professional preparation would colld1 tion the methods used in health education work in the future. Field wrk related real1st1~ to the studentls f'I1'Wre tasks is an essential. No hard and fast rule could be made regarding the kind ot institution which should undertake the tratn1ng except that, in general, those institutioll8 wh1ch undertake the postgraduate training of other categories ot public health personnel were most suitable. For the proper direction of the train1ng programme, it 18 ilIIportant to evaluate continU0U8~ the results otthe various courses care~. name~:
He concluded by reterring to special needs for health education trainiDg of health administrators, school teachers and other health workers to increase understandiDg of the health education job to be done and the canplementary roles of those whose direct or indirect task it is. 2.2.3 OrS8Dization and administration of health education services - Topic 3 1
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The Coll8ultant, when introducing the topic, quo~ BlUIIL and LeonardIs defin1tion of administration as "the aggregate of the processes and methods used in carrying out the agenqls purpo~es &ad 1s a means wbereby the purposes of the society are a:f'.fected". The prinCiples ot administration are no doubt well recognized aDd enunciated but their application to health education 'services has very many implications because of its Unique situation. (a) (b) (c) (d) (e> Health education is many countries. o~ now gaining ground in
No uniform or one pattern can be prescr1bedto all nations. Every health programme h,fus an educational cau;ponel:lt. A variety ot agencies render health education services. A large arrq of personnel - from health workers to COIIIIILU1lity leaders have the fUnctional respoll8ib1l1ty, and
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WPR/lm/6 , Organization aDd Administration ot Health Education Services, by Dr. S. Nagaraj, 25 January 1966.
2
BlUIIL 8Ild Leonard, Public Administration, a public health viewpoint, N. York, MacMillan Co~, 1963.
.. 9 (f) In JIU"Y paris of tbe world the health education spec1alty is a new prof'ession.
Thus, there il:te Ye'rTmaQY areas for discussion as can be gleaned f'raa a;perlence. (a) Health education, being a part of' the total health programme, has to be pl.aImed by a team - health administrators, health education specialists, other relatedspec1alties, other health workers and comm.un1ty leaders concerned with the programme. All are to· reach egreeIlent on specifiC goals and aims on priorities. A time scale and phased plan should be matched with the resources of all countries - big or small - but should provide :fOr growth and development, horizontally and up and down the administrative hierarchy. 'l'he org8ll1_~ion should l.q a :t'r8IIework :fOr building up professional leadership and t'rT to draw· the ''best of' talent" tran a variety of' disciplines like behavioural SCiences, education, jou.rnal1sm, medical sciences, etc. The s~ce ,8lld workingconcU ti,ODS must. help. to retain and ef'f'ect1ve~ use the trained, talented and skilled personnel •. Bt1'1clency, by proper administrat1ve:d1rection, and technical supervision and guidance, has :!;abe ensured. Health education services have very many functions to perf'orm. But where to start and boY to meet the technical standards and administrative danan<is are important. Fill8Zlctng in health educat10n services has 'biIO d1.menslona. One is in terms of' the proportion of the total health budget aJ.lotted for health education. The secoDd, as to boY and on what items the money is spent.
(b)
(c)
Several issues vere raised :fOr the conalderat10n of the. participants, such as: (a) What span of time should the plan cover in order to provide su1'f'ici.ent eJCperience and also resul.t in a sound administrative fOundation? What levels of administration - federal, state/intermediary and peripheral - should be included to ensure general coverage in the organization? Should i t start at the central or peripheral level? What functional units are suggested for the organiza.tional. structure? What guidelines can be provided for smoother and ef'f'ective supervision 8lld guidance to all health education personnel? What work procedUres are essential?
(b)
(c) 1.
(d)
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(e)
What are the desirable min:f.mula q\l8lifi.catioDS ot the health eduCation special1st'l ' What other ~s ot specialists are needed to 88s1st the -Chiet of Health Ed~t1on 1n pert'oDl1na the ascribed f'unct10ns ot the health ed\1Cation'8en1ces'l Up towb.at adm1n1strative level .bQUl.d bealth education
(t)
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(g) (h) (1) (j)
special1sts be posted! What torm ot job satistaction needs to beprov1ded'l What setup is needed tor continuecl co-operation and consistency in public educat10n! What report1Dg aystElll is desirabl.e! What minimum t1na.nc1al provision shoul.d be made tor etf'ective health education semces at a, particular level.! '
(k)
2., 2.,.l
_ &?I!!!!!!.!'f of group discussions on the three major -top1cs IJgportantelements to consider 1n developing health education o~ the public '
1'he three technical. discussion groups reached asreement on a number _ of iDqIortant elelaents gCJVeraaents shoul.d consider 1n devel.op1ng an organized and etf'ect1ve approach to health educat10n ot the puQ;L1c.i'hey asreed that health education services are a network ot co-ordiaated peripheral. and intermediate health education act1vities with a central administration at the national level.. It provides a ayste!ll&'tic means to achieve the educational objectives ot health programmes, through the active, intel.l.1gent and tree part1cipation of the members ot the community in personalalld social actions in accordance with the health policy of the CO\1II.try or territory. Qualified leadership is essential to provide the necessary leadersh1p and to permit vitalization of' the services it !las to otf'er. Health education is an integral part of the total health servicea of the coamn1nity and is,the f'unct100,ot all. health, education, wel:f'are, extension and other all.ied workers. !'he DIOSt important principl.e in determining the succeS8
ot health education services is that the peopl.e shall themselves be activel¥ invol.ved in the educational process. Favourable and auatained cbaDges in kDowl.edge, attitudes and behaviour, when necessary in the interestsot personal and community health, sel.dam resul.t unless such invol.vement ot individuals in sol.v:lng their own health prabl.ems occurs. Without the participation 0'1 individual.
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-llmembers, based,Ob. adequate kDawledgeand an actiVe desire to improve their health, the goal to achieve pbysical, mental and social wellbeing rill DOt be reached. While legislative means ~ result in limited action, olll¥·bT effective health education ma;y demonstrated. aud SU8tained 1lI;Irovement be effected. In e.dd1t1on to creatill8 and :toster11l8 a desire f'or improved health, health education services also make a sign1f'1cant contribution to COIIIIl\Ulity developaent and add to the total capac1ty of' the people. 'l'Ile nations need ,health education services, although the "tnIe and intensity of ef1'ort in particular areas of' health vary widely between countries. National health services are more freely utilized and enjoy greater public conf'1dence when the standard of' health education of' the CQlDlUnn1 ty 1& high.
!i
Every health programme includes elements of'healtb education in plaDnill8 to ensure its acceptance as wen as to involve the people. In many countries eJr;Pftience has now snown that such programmes as pol1~l1tis imml1nization, tuberculoSiS control, the early ascertainment and treatment of' chronic disease require planned health education programmes to achieve their objectives economically and e1'ficiently •
. WhUe the vigour and caaplex1ty of' health education services vary witb the stage of' devel.opnent of' health services f'rom country to country', health education services ~ be utilized in all countries as 1'QlJ.ows, (a> PlanniQg and progrmmninS includill8:
(i)
identitica;t;iQll and a.nalySi8 of' 80cial and educatioaal. elements of health programneSj id.entlf'1cation of' indiViduals and groups who should be involvedj
(11)
(iii) plaDnill8 the health education aspects of' these progr&Zlllle8 ; (iv) (v) (vi)
plannill8 and programmill8 of' specifiC health education projects; organization of' pilot projects and demonstration areas; recru1tment, selection and placement of' personnel and career developllent.
(b)
Training in health education theory and practice of' health and education workers: (i) (11) training of health education speCialists; training of health education personnel. at 81.Jb-apeciaJ.ist l.evel.;
L
-12(i11) tra1DiQg of medical aDd nursiDs pel'8ODDel; (iv) (v) training of the other health lIOrkera, e.g., nutritionists, II8D1tariaD8, phaTmaciats; tra:tDing of other discipJ.1nes, e.g., schoo~ teachers, religiOUS leaders, extension- workers, social lIOrkers and CODIIlUn1ty ~eade.rs_
(c)
Co..ordination. Health education services to be eUective should serve as a (lOntinuous l1aison between health department. aDd other government departments eDPSed in health-related activities, such as generalized social services, education and allied community acenciee. Research. Health education services can conduct surveys and other forma of research to discover and, so tar as possible with present limited techniques, assess the health beliefs and practices of the C(I!I!!11Dity, ~ influence patterns and customary c,obunels ot caaun1" c&tion, and the like. Evaluation. The health education services could assist in the establishment ot basel1Z1e8 and in selecting realistic and lIOrthwbile goals of health education; evaluate the effectiveness and cost/etf1cien~ of the various metbods used so that limited resources are utilized in the best possible ~. Provision of ;public information services. The health education services can use mass media to upla1n regular4r to the public what are the available services and to deal with all questions related with health. The functions ot these 1nto~tion services are:
(d)
(e)
(f)
(i)
the collection, selection and dissem.1Dation of health information, inclUding broadcast material, and health education technical material; the design and production and distribution ot visual aids and publications;
(11)
(iii) the pre-testing of these on Significant pepulation samples .similar to tOOse ot the target groups; (iv) (v) the maintenance of health education _terials and equipment; the traiil1Dg of other personnel in the use and preparation of visual. aids.
•
I f the health education service is
to tunction well, its
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unique COUII1UDication needs must be recognized by tile national. health administration and the facility of camnID i cat1ng free4r with internal divisions of the health department, with other government departments,
- 13 non-sovermnent agencies lUldinterDational asenc1es must be progressive~ afforded its profess1oDal staff as it pins recognition in the health adm i n1strat1on. 2.3.2 Guidelines for provision and preparatIon of quaUfied leadership in health education
There was general ~nt that the term qll8l.1:r1ed health education leadership refers. both to administrative aDd technical . leadership. Administrative leadership stems from the head of the health administration at all levels who .houl.d be well prepared as to the role of health education as an integral part of public health planning and practice. Technical leadership emanates from the chief of the health education service who, with his professional staf't' contributing at all levels, should exercise the national leadership function in health education planning. Health education leadership is best exercised through a team approach which works horizon~ and verti~ in the administrative hierarchy. For such leadership at the national level, it was agreed that professional post-graduate preparation in public health with specialization in health education was necesS&rY to assure adequate handling of responsibilities at this level and to assure the chief of the national health education service acceptance as a professional equal by his colleagues. For administrators who exercise administrative leadership, preparation in health education as part of postgraduate training in public health administration, is likewise essential. It was felt that in some countries, during the ear~ stages of development, it would be definite~ advantageous i f the top post in health education leadership vere to be undertaken by a medical graduate who bas the requisite post-graduate preparation in public health with specialization in health education. Such an arrangement would be desirable to help give status especi~ where health education is a new discipline and until it has demonstrated its worth and been accepted. Same also felt that such an arrangement might be desirable in the initial phases of development in those countries and territories where there is a dearth of university graduates 1'rOm the fields of education, social science or biological science who could be recruited :for post-araduate preparation as health education specialists. Selection and training of health education specialists depend on the functions aeeribed to them by the national health services. These functions should serve as one of the criteria for training. The major areas of function of health education specialists in &r.\Ycountry are the follow1ng: <a> (b> identification and anaJ.y.sis of educational and social factors wilich iDf'luence healthj planning aDd implementation of educational programmes as part of the health services which are organized to
- 14 deal with health problems, tncl.ud1l:Ig prori.sion COD8ultation 8ervice8; (c) (d) o~
,
as8istiug the people organize the CClIIIIlWl1ty for health; preparation in health education of h~th,ed~tion, weltare and other workers in health-related fields of activity incl.ud1ug COIIIIDW11ty leaders and m.-bers of certain wluntary organizations; evaluation of methods and results; re8earch in health education; participation in pilot public health programmes of which health education i8 an aspect in geogrsphic demonstration areas or wi thin specific div1a1ons of national health 8ervices.
(e) (f) (g)
As health education services develop t:ran inception to maturity, there is frequently a shift of emphasi8 in fUnction t:ran community 8tudies, through broad progr8lllDe pJ.anniug to trainiug, research and evaluation.
To carry out these tunctions adequately, the health education speCialist requires very broad tra1niug in the health sciences, social SCiences, particularly behavioural sciences, educational theory and practice, statistical analysiS, research methods and administration. The number of health education specialists who will need to be trained in a part1cular country will be determined by geographic and demographic factors. One group felt that the number of health education specialists should be detem1Ded by the number of health workers and others whose work incl.udes elements of health education, CCIIIIIlUD1cations and available fiD8DC1al ruource8. There should, however, be sufficient health education spec1al.i8ts to provide adequate basic, in-service and refresher training in health education for all those who will need it, as well as to provide the staff services needed by the national health administration and the regional organiziDg and supervisory 8ervices which ~ exi8t in the particular territory.
.. •
A variety of univerSity degree, college diploma and certificate courses are offered by various institutions throughout the world. In the Weliltern Pacific area, formal courses exist in Japan, Korea, the Philippines and Hew Zealand. Excellent trainiug :f'acllities in areas in close proximity to the Western Pacific Region are to be found in India and Hawaii. The level of training of national chiefs of health education should be su1't1ciently high to enable tn-to discharge their tunctions adequatel¥ and to relate in a sat1s:ractory ~ to other professional. heads of health divisions. It is generaJ.ly f'elt that at least one year of post-graduate profeu10D&l. preparation in health education leadiDg to a D.P.H., M.P.H., C.P.H. or the equivalent ClOJIIeS nearest to the academic requirements of' the position.
..
- 15 It is thought to be: iIaportant that «NHes at the .,ecial1st level ~uld be f'lexibl.e enoush· to llleet tbe needII, of' students 1'rca dif'terent ~cipl1Dee. There are, ~, ad:vantages gained in lUI. inte~eclpJ 1 nary approach. When studente f'l'OIIl different public health discip11nes (medical. doctor., DUrses, 4entiats, public health eDgi.neers, etc.) are· able to studT" together and &8sist each other in _tters within their p,rOf'eel1oDal caapetence, to br112g home more stro~ the team concept. Field training ie necel.&ry duri12g the course accord,112g to the fOllow1ag principles: (a) The train1.Ds situation should give the student definite responsibility to CUlT out a task in a specificsltuatiCin under superv181.on.. .
•
(b)
The conditions and situations where be gets a portion of' his experience should be simiJar to those in his .OW ~tZT.
needs •. ,
In most countries111 ·the Western Pacific 'ReSton the number of' health education specialists needed does not at present justify the establishment de IlOVO of' courses at the necessar,y level. Faci11ties are available Iii&' nllllber of' countries and these should be ~ed &nd developed to a hiab.- standard to provide fOr the present
"
CawU,datesfOr health education specialist trainins should posseas admin1strative ariel organiz1ns abll~ty and should pref'erab~ have eJC;per1ence or aptitude in train1ns. !riley should ~o possess theperBODalattributeawhiLch are des1rabl.e in the health education speci&11st including: . . (a> (b) (c) (d) (e) (1')
d.eIIIOns'l;rateci leadership $llity; initiative aDd self-reliance; intellectual qualities of an alert. aDd enquiriDg mind; creative ability, 1ma&1nat1on, aDd an exper1mental but IJl'1IIP&thetic approach to people;
an interest in and ability to ana.l3'ze social problema objective:q; personal and prof'essional integrity;
(s)
tact and resourcef'l1lness.
Candidates should have a university d~or its equivalent ot formal instruction in (a> social sciences and/or (b) bealth sciences, with broad. l1b~ education_ prior experience in public health or related fieldS. -.
- 16 Health administrators need preparation in heaJ.th education and, in this connection, international. organizations should consider 1
reinforcing their present supportive activities by encouraging public health admin;istrators and schools of public health or institutes of public health to consider preparation in health education as an essential aspect of the public· health administrator I s training and must make this an important consideration in granting st~ fellowships. Because health education is the responsibility of every health and welfare worker, the training in health education of health and other workers such as physicians, nurses, sanitarians, nutritionists, school teachers, agricultural extension workers, social workers, pharmacists, community leaders, religious leaders, etc., is essential. Such training includes undergraduate, graduate and in-service training of appropriate professional. workers to establish and maintain a positive interest in the health and educational. aspects of their work. 2.3.3 Points on organization and administration of health education services in national health ministries or departments
Health education services should be introduced with special reference to the principal health problems of the individual country and at a rate closel¥ related to the general development of health services and the availability of trained personnel. The stages of development of the health services and their organization vary widel¥ among the countries in the Western Pacific Region. The size and complexity of such services also di:f"fer according to population Size, which ranges from 0.1 million to 100 million approximatel¥. So great is the variation in size, needs and resources in trained personnel and finance that no sillgle pattern of health education service can be prescribed for all. 2.3.3.1 Planning of health education services The first essential in planning is agreement on clear and comprehensive objectives and definition of priorities which are attainable in terms of available resources. SUch objectives are part of the general health objectives of the country and they will therefore depend on prevailing health problems and poliCies for improvement of the public health. The need for the involvement of camnuni ty leaders, voluntary bOdies and those of other disciplines in the planning of health education services was recognized. One important and specific objective is to demonstrate as e:f"fectivel¥ as possible the capacity of an e:f"fective health education programme to improve the efficiency and degree of public utilization of existing health services. !'here is a wide range of health education activities and priorities vary. fram country to country. One discussion group felt that preparation in health education of health workers and
..
- 17 ot all others wbose work intllien~ed health behaViOur should be a top priority activity. !!he other two groups gave top place to the establishment· ot pilot ana. demonstration areas and other' fol'lllS ot applied research.
In the early stages ot development ot health education services, care shOuld be .taken not to extend services to voluntary agencies beyond such training facilities and other assistance as ~ be provided without impairing the priority objectives wbieh have been determined. The time span within which: health education services should be planned should be intimately related to the plans for devel.opDent ot the health services th_elves. It will generally be desirable to introduce services in phases to allow tor training ot personnel and allocation ot the neces8arytiscal resources. 2.3.
,.2
Organization ot health education services
It'was generally agreed that national health education services should be a function ot the health miniStry or department although large and important aspects ot health education ot the school age child are carried out in schools. Ttle latter should be a joint responsibility" ot the ministry or department ot education and the ministry or department ot health. There sbould be a central service unit tor the healtb education services at the national health administration. The chief of this service unit should be directly responsible to the permanent head ot the national miJl1stry or department ot health. In some smaller countries or those in which health services are ' not :f'ull.y developed, there ~ be ditticultiesin the establishment ot such a central service unit and the initial introduction ot health education services lII8\Y' be in the form ot a peripheral unit engaged in an urgent health problem. In all cases, some form ot direct representation in the national health administration is ultimately necessary for the progressive developnent ot health education services, including planning, advisory and research functions. In this W8\1, the ideal ot integrating health education into all aspects ot plalming and practice in health services ~ be achieved. The health education service at national level should be located in physical ~ximity to the health administration so that the health education staff lII8\Y' work with other protessional members ot the bealth team. !
2.'.'.3
staffing othealth.education services
Every health worker is responsible tor health education. The development ot a high degree ot efficiency among health personael is depeDdent upon the training, advisory and other services provided by an etticient health education service at the national or state level.
-18Compared with other health services, the number of specialists in health education required at the national l.evel is not luge. 1Ihe chief of the MtiOnal services should be of such trainiag and abilitylthat he can work witb national ctISI1ssions a.nd. technical CCIIIIIl1ttees with coa:t1dence in h1mael:f' and the metOOda be advocates; such pro1"eesional leadership is the key' to the establ1ahment and developaent of good ·health education services within the nation. Health education leadership sOOuld be exerted through a team approach. 1'b.ere is need to utilize the ex1atiag services in the health depa.rtment/m1n1atry or other related agencies to prof'1t from various specialties in the pla,ani. a.nd. 1Iuplementation of the educational and social aspects of health programnes. Whenever national resources perJIL1t, a team COD8istiag of health education specialists, social 8cientist8, ed~t1oD1sts (p&rticular~ tOOse trained in adult education), ocaauntc;atlon specialists, statisticians, aawell as technicians (artiata aDd pootographers) and administrative staff ~ be included in the 8tan1ag pattern. The number of disciplines involved will depend. on the objectives to be achieved, the organization a.nd. structure of' the goveroment of ttie country and the manpower potential.
The qual.if'1cations, experience and background required f'or recruitment, and the job description, emoluments, relatiowships, etc., need to be def'1ned. On the question of job descriptions, it must be kept in mind that health education is a full-time job, and clear and precise job descript10ns are necessary f'or.all personnel so that they will DOt be saddled with adventitious responsibilitie8. No new service of major nature can be built through part-1;1m.e 'WOrk a.nd. divided attention. At the intermediate level, provision should be made for positions for health education specialists in the major health programmes and at the regional, district, state or provincial level. In smaller countries and states or in the ear~ stages of development, one health education specialist mq be able to provide services, usiag external agencies such as universities and trainina colleges or scOOols of public health to provide part-time assistance in the special f'1elda required. Even when services are complete~ developed with1n the national health administration, there are considerable advantages in maintainina close li&1son w1t~ such external institutiOns, both in broaden1ag the skills available and in provid1ag a valuable source ot exterDal evaluation of programmes and research. In larger countries, as national public health progr8llllleS develop to advanced levels, it lIIIQ' be desirable to elaborate the 8taf'1' of' the central unit a.nd. to divide the team into 8eparate~ :f'Wlctionina units, viz., plannina, trainiag, research, progr&Dlll1ag, etc. In all cases enhancement of the plann1. and researcb tasks of' the national health education service will occur if statistical asSistance, 1'ull-t1me or consultative o~, is available.
• ...
A variety of o1'1'icial designations are DOW used to 1Jldicate the health education specialists and other personnel in the health 1
See item 2.,.2, Guidelines for provision and preparation of qual.if'1ed leadership in health education.
-
~9
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edw=ation service.l'be sroups fel.ttbat WHO lId.Iht assist. iD evo~viJ:Ig a uniform set ofd~1gna1;10tl8, bl'Oeldli'· eoY'eriog ~he job descriptions and applicable 'to all the cOUDtries.. . .',.. .
2. ,. '.4 Adminiatrat1.ve and technical direction
•
Administrative direction should came from the national through the regional or district progrezdDe Chiefs, whereas technical. supervision and guidance should come :from the cllid of health education on the national level thrOugh the regional chiefs of health education services • . Health education services will tend to grow Simultaneously in. two directions, both vertical~ &bd borizontaJ.4r. As a rule, there is a tendency for horizontal. growth at the n&tionallevel to precede devel.opnent dQwwarda throUgh tile administrative chain; but in Salle cases, tl1ere III8\Y be a case -tOr exp&nsion at the l.ocal level to be followed by development up to the national leVel. . The peripheral growth of health· education services in regions aDd districts Will ultimately depend on the iDcreasiog interest, knowledge and sld.lla of regional health staf'1'. The servicee of a
health education speciaUst for purposes of local trainiog, organi.,.. zation of progreaaaes, iavolvement of' community agencies, conduct of surveys and preparation of materials will be highly desirable as a member of the regional, district or larger city health team.
Health education activities III8\Y' be carried out by government department agencies and alao by "fOluntar,y assOciations, ciVic and religious organizations and the military and police forces. TIle co-ordiaation and facilitation of all these activities will greatly enbance the value of their individual efforts to the OOJIIIIIUDity.The health education services should serve &8 a liaison between th.e health department and other departments. To this end the fomation of a health education advilior,y council, ccmprisiog representatives of the major govermnent departments, educational institutiOns and civic agencies and professional health groups,. was sUSS_sted. This council couldbriog to the attention otthe government the health education needS ot the cailmUnity and suggest m.sures to be taken by all authorities with direct or indirect health education f'uncttons, which can contribute to meeting such needs. Tbe council should be &dviSOl"Y and not executive. .
2.,.,.6
Reporting on health education services . . ; .
t
Regular and complete reporte of health education activities are valu&b~e in demonstrating the work carried out and results achieved to the health administration, the health professions, goverlllJleJlt authorities and. the ~ty. Good repol'ii$ on programmes and procedures add to the stead14r increas1Dg bOdy of knWledge which is acCUlllUlating regarding public response to organized health education efforts. Regular reports are valuable as a training
-20procedure for stat:t and as one aspect of assessment of the :t1naDclal resources needed by health education services. The need to report qua1itat1ve and quantitative resul.ts should direct the attention of the health education service to the need :tor caref'ul. determ1nation of valid baselines and use of accurate statistical methods ot sampling, controJ. and measurement. The desirable characteristics of reports are cJ.arity, reJ.evance and brevity.
•
2.3.3.7 Financing health education services The health education services of a national health department require a specif'1c or separate budgetary al.J.ocation. Health education programmes cannot be ef'tectivel¥ pJ.anned unless it is known that a specific appropriation will be available :tor staf't, transport, equipment, surveys, and research, assistance to various agencies, publicity, maintenance, training progr&DlJle8, etc. There is no singJ.e figure or :tormul.a which can be general.J.y applied to the al.J.ocation of fUnds for health education •. Same authorities have suggested that five to ten per cent. of the total budgetary allocation for the department or ministry of health m8¥ be a desirabJ.e minimum. In India ten per cent. of the budget allocation under each major health programme is earmarked for the educational aspect of the programme. There is considerabJ.e advantage to be gained :from cooperation on budget _tters with those divisiOns of the health service whose functions incJ.ude a J.arge element of health education. In some cases, i t ~
•
be possibJ.e :tor other agencies
and major voluntary organizations to provide funds :tor bealth education progr8Dll1es. Effective liaison with such agenCies is a
valuabJ.e means of promoting such activities. When a specific fund is allocated for health education services, the fUnds BO provided J:IIq be used for the :tollowing items: (a) Salaries and wages of the technical health education sta.f't and supportive personnel, incJ.ud1ng aJ.].owances for traveJ., per diem, training costs for professional growth, etc. Health education activities such as work with camm,n1ty organizations, training in health education of health and ancillar.y workers, information services (production, pre-testing, publication and distribution of mass information), surveys, special studies and research, evaluation and others. Supplies and equi;pment needed by the staf't to carry on the health education activities. Funds should be provided for library faciJ.ities including adequate reference materials and up-to-date abstracts and
(b)
(c)
-21b~b~tographiea
in health eaucat10n. Certain principles should be borne in m:I.Di1 in·the acquisition of equipment: (i)
Bu.dset&r7 provisions.Should be made for their mainteu.nce •
• (ii)
It 111 better to have .lesa rather than more specialized equipment.
(iii) Equ1pnent should be staridardized. (d) COntingent:funds for emergencies.
Budgetary -demands depend .on the rate of srowt;h of health education services which, in turn; .depend on maay f'actors but pa.rt1cular~ on tile rellults ach1.eved. COnvincing evidence of worthwhile and effective prograumes will ~ ensure that budgetary appropl'1at.iona keep reuoD8ble pace with requirements.
3.
SUMMARY AND -COlfCWSIONS
(1.) It Ilas been recogni~ed thathea1.th education services are important in obtaining the veluntary and intell.igent action of the public for supporting tile Ilealth policY of the government and in co-ordinating the efforts of individuals and groups, official and non-official, that are involved in the improvement of the welfare of tile people. (2) programmes. Health education is an integral part of all health
(3) Organization and administration of health education services entail: (a)
Planning, to include: setting objectives, fixing priorities 1 consideration of means and the joint effort of administrators, otller disciplines and health education specialists. Organization of a central unit at the national ~evel d1rect~ under the chief health administrator to provide technical supervision.
(c)
Staff - recruitment, training, placement, job deScriptiOns, suitable rewards and promotional opportunities. In developing the training programme of health education specialists consideration should be given to (i) training needs, (ii) objectives, (iii) level, (iv) requirements, (v) content, (vi) methods, (vii) evaluation and (viii) institutions to undertake the training.
!
- 22 -.-
(d)
Direction -adm1 n1strati.e direction from the progr8illll!le chiet aDd technical supervision aDd guidance trom the chiet ot health education. In order to develop qual.1tied health education administrative leadership, (1) preparation ot health administrators in public health administration with .health education 'as part ot the training programe ami (11) post-graduate professional preparation ot health education specialists are 1Dd1.spenaable. Co-ord1nation with other departments and asencles. Reporting of all activities to help in (i) pro~ interpretation, (ii) traini~, (11i) es~ tabUshing valid baseline data and iv) e'Y8luation. BudgetlE18 to aaaureBPeclf1c aDd ample f'UDdII to carry out the health education tunctions. Evaluation to measure the achievements and to direct f'ul1;her plann1ng. Research tofiDd the needs, to discover attitudes, beliefs and knowledge, to pre-teat media, to evolve better methods and to establish scientific bases tor health education services.
• •
(e) (f)
(g) (h) (i)
•
•
- 23 ANNEX 1
ANNEXE 1
•
ENGLISH/FRlIICH ANGLAlS/FRARCAIS LIST OF CONSUID!ANTS I PAR'l'ICIPAI'l'S J OBSERVERS AND SlXlRmARIAT LI8'rE DES CONSOLTAMS, PARTICIPANTS, OBSERVATl!mIS m W ~
1. Seminar Director and Health Education Consultant Directeur du St91naire et consultant pour l' education sanitaire Dr. Teodora V. Ttglao Associate Professor of Health Education Institute 01' Hygiene university of the Philippines Manila, Philippines
Consultant on Public Health Administration and Health Education Consultant pour l'a.dm1nistration de 1& sante publique et l'education sanita1re
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Dr. Gu;r U)ison Directeur de 1& Section Sant~ Commission du Pacifique SUd Noum~aJ Nouvelle-Caleoonie
Consultant on Health Education Training Consultant pour 1& £'ormation en e<tucation sanita1re
...
Dr. ~ M1yasaka Chief Health Education Section Department of Public Health Practice Institute of Public Health 'l'oQg, Japan
Consultant on the Organization and Administration 01' Health Education. Services Consultant pour 1 'organisation et l'a.dm1nistration des services d'education sanita1re
Dr. S. Nagaraj
Chief Health Education lqaore state Health Department BaDgalore J ~ore State India
l
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, 2. PARTICIPAlfl'S Dr. William. A. Ial:lgstord Camnonwealth Director o-r Health, N.T. P.O. Box ~47, Darwin, N.T. Dr. John Krister Health Educationist ~t of Public Health 52 Bridge street Sydney J N. S. W.
BBlTISH SOID!I)N ISLANIS PRO'l'ICroBATE PBO'rlOC."rolWr BRlTAHRIQUE Dm ILE8 SALO}t)N (Sponsored by South Paci-r1c Commission) (sous les auspices de 1& Commission du Paci-r1que SUd)
Dr. Gideon Zoloveke Senior Health Education Offlcer Medical Department Honiara J Guadalcanal
• Dr. C.K. Chang Director Department of Health Administration MiniStry o-r Interior Taipei, Taiwan Miss Laura Pan Lu
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Chief', Health Education PrOVincial Health Department Wu--reng, Taichung Taiwan
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Dr. David W. Backless. Deputy Director o-r Medical Services Medical Department Govermnent BulldiDgS SUva
Dr. Macu E. Salato Health Educator Medical Department Government Bull.dings SUva
•
.. FBBR'CH POIo¥DSIA
POLXN:t!Slis· F1WICAI8B
•
- .-M.;;,BeilBambridge Educateur S&D1taire -Inatittit de Recherches meaicales ~e.te: ('lahiti)
JAPAN JAJ?OIf
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Dr. Hisubi Teramatsu Medical Offlcer C'('I""'''D1 cable Disease Control Section Public Healtb Bureau M1niatry of Health and Welfare
i'OlI\vO
KDBEA COBEE
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Dr •. Sang!rae Han Chl~
Preventive Medicine Section Bureau of Public Healtb Ministry of Health and Social Afi'airs Seoul
Dr. ChUDg Tat Kim SUb-Bection Chief on Maternal and Child Health Ministry of Health and Social Af'f'a1rs Seoul . H:l.sa Sun Young Kim HealtbJducator
GovermaentjwHo
Team
Assistance to Local Health Service. Project tUnistry of Health and Social A:f'f'a1rs Seoul
MALAnlIA MALAIBIE
....
Dr. Walter J. Jesudason Cbief Medical and Health O:t"ficer State of Selaagor Ministry of Health Kuala Lumpur
Dr. ·BaJa.Ahmad Ifoordin Chief Health Education Division Min1stry of Health Kuala Lumpur
- 26 -
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Medecin C8pita1ne Henri Boutin Adjoint au Directeur du Service de Sante et de l'Hygiene publ1que en Houvel1e-Calecwnie et :Dependances
, •
B.P. "
Houmea
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Dr. C.B. Derek Tqlor Deputy Director Division ot Public Health Department ot Health
Wellington Miss Joan Pilson Health Education ~tor Division ot Public Health Department ot Health
Wellington
PAPUA. .AND lml GUINEA PAPUA ItT HOUVELLE-GUINEE
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Dr. J.L. Jameson Regional. Medical Off'icer Regional Health Off'ice Papua Region Department ot Public Health Port M:lresby
• "
Mr. Kevin Riggall Senior Health Educator Department ot Public Health Konedobu
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Dr. Trinidad A. Gomez Chiet Otf1ce ot Health Education and Personnel Training Department ot Health Manila
Dr. Florencia Herrera Supervising Health Education Adviser Off'ice'ot Health Education and Personnel Training Department ot Health Manila
•
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• •
SINGAPORE SmlAPOUR
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Dr. J. Charan Singh Senior Registrar Min1stry of Health Palmer Road Singapore I 2
'l'ORlA - Dr. Joe Fanamanu (Sponsored by South Health Education Officer Pacitic Commission) Nuku'alofa (S0U8 ~es auspices de ~ Camnission du Pacifique SUd)
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Dr. ~ Uy@n Chef de ~ !Ormation et de l'Education sanita1re Administration generale du Programme de DeveJ.oppement de ~ Sante M1nistere de ~ Sante Satgon Mlle Nguyen Thi ~et Special1ste de l' ~ucation sanitaire Ministere de ~ Sante SaIgon
tJNITED HA!rIONS CHILDREN'S J.i'UND (UNICEF) FONm Dl!5 NATIONS tJ.NJ:FB POUR L'mFAHCE (FISE)
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Mr. I.H. Markuson
UNICEF Resident Representative/ Representant Resident du FISE P.O. Box Malli~, Philippines
88, 88,
Dr. A. Mangay-Angara (Alternate/Suppleant) Programme Officer UNICEF Philippines Country Office P.O. Box Manila I Philippines
-26-
UNI'l!lSD ~ONS EIl1CA'l!IOlIAL, SCD1fWlC ABD CUID.\1RAL OllWf.[ZA'fiON (UHISCO) OPGAIflSA!nOH DES IfM!IOHS UHIES POUR L'EIl1CATIOH, LA SCIENCE El' LA. CUUL'URE
(UNESCO)
Mr.. E. A. Pires Regional Centre for 'rrain1OS of Teacher Educators Centre regional de l'UBESCO pour 1& FOrmation des Professeurs de l'Enseignem.ent normal Quezon City, Phllippines
•
•
POOD AHD AGRlCUIl.lUBE - Mr. Y.H. Yang ORWflZATION (FAO) Nutrition Officer ORGAN1SATlOH DES BNl'IONB UBIE3 Bureau of Public Schools POUR L' ALIMl!2I'l!ATION El' Phllippines-UNECQ National C<Jmmm 1 ty L' AGRICUI4URE (OM) 'rraining Centre Ba\YBmbang, Pangas1nan
SOUTH PACIFIC COlt4ISSIOH COMMISSION ro PACIFIQUE SUD
Mme Hortensia de Hollanda
Specialiste de I' Education smi taire C0IIIIII18sion du Pacifique Sud B.P. No. 9 Noumea Nouvelle-Caleaonie
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INTERNATIONAL UNION FOR HEAIJm mJCATION
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Dr. Carmen del Rosario Secretary
UNION INTERNATIONALE POUR L 'EroCATION SANlTAlRE
Health Education Association of the Philippines Philippine Normal College Manila, Phllippines
UNITED a:rATm AGmcy FOR . IN'J:mtRATIOl'lAL DEYEIDPMIM' AGmcy FOR INTERBAT1Ol'lAL DEVELOPMUfJ: DES El'ATS-U1'f.[S
Mr. Barry Karlin Health Educator U. S. Agency f'or International Development BBIlgkok, Thailand Mr. Scott Fdmonds Health Educator U.S. Agency for International Development Saigon, Viet-NaIll
•
- 29 -
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Miss Virginia I. Mate Health Education Adviser O:ffice ot Health Education and Personnel Training Departmentot Health Manila Mrs. Leonor J. Zamora Health Education Adviser Office of Health Education and Personnel Training Department of Health Manila Mi88
Perla B. Pinto Health Education Adviser Office of Health Education and Personnel Training Department ot Health Manila
..
Mr. Honorio Pasion Chief Health Education Section Bureau ot Public Schools Manila Mrs. Cristina Mamuri Health Education SUpervisor Bureau of Public Schools Manila Mrs. C&rmen A. Mercado Assistant Chief Health Education Division and Liaison Officer Applied IUtrition Project Phllippines-tJBF.SCO National CcIIImun1 ty Training Center B~ang,
Pangasinan
Mrs. IDes P. Gatmaitan Chief Medical and Dental Services Applied IUtrition Project Phllippines-tJIfE9CO National COIllIl1110:l ty Training Center Ba;yambang, Pangasinan
•
- 30 -
4. OPERATIONAL OFFICER CONSmJ·ER BmIONAL RmPONBABLE Mr. Donald C. JohnSon
•
Regional Adviser on Health Education (Conseiller regional pour l'Education sanitaire) World Health Organization Regional 01'f'ice for the Western Pacific Manila, Philippines Mr. A. Beaugendre
Translator World Health Organization Regional Office for the Western Pacific Manila, Philippines Mr. J. Stichelbaudt
Translator World Health Organization Regional Office for the Western Pacific Manila, Philippines
•
RmOURCE PERSONS PERSONNEL D' APPOINT
-
Miss M. B. Armstrong Health Education Adviser Health Education Advisory Services Project Kuala Lumpur, MaJ.a;ysia Mrs. Louisa Haas Health Education Adviser Health Education Advisory Services Project Singapore Miss Winifred Warden Health Education Consultant Health Education Advisory Services Project Port Moresby, Papua and New Guinea Dr. Annie Laurie Keyes Health Education Consultant Health Education Advisory Services Project Manila, Philippines
-31.. •
RESOURCE PERBOlfS PERSOl.'mEL D'APPOINT
(SUITE)
II I I
I I
Personnel du Bureau regional Bureau r~g1Onal de l' OMS ;pour le Paci:L'1que occidental Marrl.l1e I Pbilippines Dr. A.A. Angara Regional Adviser on Public Health Administration Conseiller regional ;pour l'Administration de 1& Sante publique Dr. H. M. C. Poortman
•
Regional Adviser on Maternal and Child Healtb Conseiller regional pour 1 'HygIene de 1& Maternite et de l'Entance II
Mr. J. Arbuthnot
.
Regional Adviser on Environmental Healtb Conseiller regional pour l'Hygiene du Milieu Mr. R. Valdes-Pinilla
II , I I
, , ,
Regional Sanitary' Engineer Ingenteur sanitaire regional Dr. D. R. Huggins Regional Adviser on CommuniCable Diseases Conseiller regional pour les Maladies transm1ssibles Dr. C.H. Yen Regional Communicable Diseases Officer Fbnctionnaire regional pour les Maladies transmissibles Dr. M. Postiglione Senior Regional Adviser on Malaria Conseiller paludologue principal Dr. J.C. Tao
Regional Adviser on TuberculOSis Conseiller regional pour la Tuberculose
•
• Mr. A. Aldama
Resional Statistician and Progr8Dllle Evaluator Statisticien regional et Evaluator des Prograumes Miss M. de L. VerdereBe Regional Nursing Officer Fonctionnaire r~g1onale pour 1~1I So1na 1Dfirm1ers Dr. K. V. Bailey Medical Of'ficer (Nutrition) M~decin
Philippines 80 nutritionniste
Dr. M. Escudero Medical Officer (Mental Health) Philippines 4 Med.ecin (Sant~ mentale)
Miss E. Wilson Public Heuth Nurse Educator Philippines 75 Inf'irmiere moni trice de la Sante publ1que Mr. B. Adan Banitary El'lg1neer Environmental Health Advisory Services
(South Pacific) Ingenieur sanitaire Hygiene du Milieu : Services consu1tatif's (Pacifique SUd)
• •
-33-
• •
1.
IDaugural. Address - Dr. Francisco J. Ib", Director o~ Health Services and Acting Regional Director
Orientation on the organization and conduct o~ the seminar Mr. Donald C. Johnson, Regional Adviser on Health Education 2.
Plenary Review o~
Pres1ding:
Dr. Teodora V. Ttglao, Seminar Director
health education deve10puents aDd country reports
by participants and offlcial observers
•
.
Frida.y, 21 January
1966 Dr. C.K. Chang, Chairman
1.
Plenary
-
Presiding:
:focusing on the Health Education Job to be Done in Public Health Progr8lllllleS Moderator: Panel Dr. A.A. Angara, Regional Adviser on Public Health Administration Dr. C.R.D. ~lor-, Deputy Director, D1vision of Public Health, Department of Health, We1l1ngton, New Zeeland Dr. Tr1n1dad A. GomeZ, Cbief', Of'ftce of Health Education and Personnel Training, Department of Health, Manila, Philippines
2.
Pl.enary:
Introduction of 'l'op1c 1 - The lDq)ortance and Use of Health Educat10n Services in National Health Programmes
.. ,.
Dr.
~
!Dison, CoD8Ultant on Public Health Administration
Three working sessions on Topic 1 (Groups A, B and C) .
- 34 Saturd!;y, 22 J811uary
1966
•
Field visit to health educa.tIon. a.ctivities, Philippines Health Region 1, ~BlIg, P8llgasIna.n ArrBllged by Philippine Department of Health
1.
Pl.enary: The Health Education Job to be Done in Matemal and Child Health, School Health, Nutrition and Mental Health Prograrrmes Moderator: P8llel
Dr. Dr. Dr. Dr.
H.M.C. Poortman K. V. Bailey M. Escudero
C.T. Kim
2.
Plenary: Presentation of draft reports by group working sessions on Topic 1
.
,
3.
Plenary: Introduction of TOpic 2 - Developing Qualified Health Education Leadership
Dr. Tadao Miyasaka, Consult8llt on Health Education
~ing
4.
Three wrldng sessions on Topic 2
Tuesdaf, 25 January 1. Pl.enary:
1966
• Dr. R.A. Noordin Miss L. Verderese Miss E. Wilson Miss J. Pilson
The Health Education Job to be Done in N\u'sing Moderator: Panel.
•
- 35 2. Three working sessions on Topic 2 (continued)
Wednesda"y,
26 J&DU&rll966
1.
Plenary: The Health Education Job to be Done in Environm.ental Health Moderator: Panel M~d.
Capt. H. Boutin
Mr. J. Arbuthnot Mr. B. Bambridge Mr. B. Adan
2.
Plenary: Presentation of draft reports by group working sessions on Topic 2
,. ~
Plenary:
Introduction of Topic 3 - Organization and Administration of Health Education Services Dr. S. Na,garaj, COnsul1;a.nt on the Organization and Administration of Health Education Services
4.
Three working sessions on Topic 3
Thursda.y, 27 Janll!£Y 1966 1.
Plenary: The Health Education Job to be Done in COmmuni cable Disease COntrol, Ma1..ar:ia Eradication and Tuberculosis Control Programmes
Moderator: Panel
• 2.
Dr. Dr. Dr. Dr.
C.H. Yen M. Postiglione
J.C. Tao H. Teramatsu
Three working sessions on Topic 3 (continued)
-;6Frid8,y.
2B
January
1966
.. •
1.
Plenary: The Place of Valid Baselines and. Evaluation Procedures in Health Education !bderator: Panel : Dr. Mr. Dr. Dr.
J. Krister A. Aldama D.W. :Bookless
W.J. Jesudason
2.
!l!hree working sessions on !I.'opic :3 (continued)
Saturday. 29 Japuary 1966 1.
Plecary: The Health Education Job to be n>ne in eo.un1ty Health Development in the Face of Rapid Industrialization and Urbanization )oi)derator: Panel :
Dr. W. A. IAngsford Mr. R. Valdes-Pinilla Dr. Charan Singb Miss Laura P. Lu Dr. J. Hirshman
"
2.
Plenary:
Presentation of draft reports by group working sessions on !I.'opic 3
3.
Plenary:
Presentation of draft reports on special Interest Group sessions which met for four hours each on the following topics: (a) (b) (c) Specia.l Studies I Research aDd Evaluation in Health Education ~tion Preparation of School Health Personnel and Teachers in Health Education Preparation of Medical and Other Categories of Health Workers in Health Education
- 37/?;B -
..
(d)
Health Education Methods and Materials
..
4.
Plenary:
OVerall s'Ullllllal"y of the semi oar Moderator: Panel Dr. S.T. Han. Dr. M. Escudero Mr. Scott Edmonds Miss Laura Pan Lu
II
"
II II
Dr. Joe Fanamanu
Mond.a.y, 31 January 1966 1.
Plenary -
Presiding:
Dr. C.K. Chang, Chairman
•
Presentation of the draft report of the Proceedings of the First Regional Seminar on Health Education 2. Closing ceremony Remarks : Dr. Dr. Dr. Dr.
.
C.K. Chang, Chairman of the Seminar J.L. Jameson, Chairman, Group A D. W. Bookless, Chairman, Group B TU Uyen, Chairman, Group C Semi Dar
Concluding statement Closing address
Dr. Teodora V. Tiglao,
Director
Dr. F.J. Dy, Director of Health Services and Acting Regional Director
3.
Adjournment
• •
• • MDIBERS OF mE !IEBEE WORKIllG GROUPS MJMBmi23 DiS THaIS GPmPBS DE TRAVAIL
II
II , ,
II II
General. Chairman President V1ce...cha1man ViceooPresident General Rapporteur Rapporteur general
Dr. C.L Chang Dr. Trinidad A. Gamez II
Dr. John Krister
.GBOUP A (lBlLISB)
. ORCm'EA (AIIlWS)
•
Participants
~.
M. Ben Bambridge (Cha1rmarl, 1'opic~) . Dr. Sang ~ Han .' Dr. J.L. Jameson (Chairman, 1'op1c 1
2.
3.
Rapporteur, 1'opic 3)
4-. Dr. W111isl A. Langsf'ord 5.' lit. Baja.Ahmad. Noordin 6. Miss Joan Pilson (Rapporteur, Topic l) 7. Dr. Macu E. Salato (Cba1rman, 1'op1c 2)
8. Dr. J. Cbaran Singh 9. Mlle. Nguyen TIli Tu¥et Observers Observateurs l. 2. !be Hortensia de Hollanda
Mrs. Cristina Mamuri
3. Dr. A.Ma.ngq-Angara. 4. Mrs. Leonor J~ Zamora (Rapporteur, 1'op1c 2) Resource Persons Personnel d' appo1qt 1 •. Dr. Annie Laurie Keyes 2. Miss W1n1f'red WardeD
• •
Consultant
GRWP B {ENGLISH} GROUPE B (ANGLAIS) Participants
•
1. 2.
3. 4. 5· 6. 7. 8. Observers Observateurs 1-
Dr. Dr. Dr. Dr. Dr.
Dr. David W. Bookless (Chairman) C.K. Chang Joe Fanamanu Florencia Herrera (Rapporteur) Chung Tai Kim John Kr1ster Dr. C.N. Derek T~lor Dr. Hisashi Teramatsu
2.
4.
;. 5·
Miss Carmen del Rosario Mrs. IDes P. Gatmaita.n Mr. I.H. Markuson Miss Perla B. Pinto Mr. Barry Karlin Dr. Manuel Escudero Miss K. Blanche Armstrong Dr.
Resource Persons Personnel d'appolnt Consultant
1. 2.
s.
Nagaraj
• •
GROUP C {BILINGUAL~ GROUPE C (BILmGUE Parttci;2ants l.
2.
3· 4. 5· 6-
8. Observers Observateurs
7· 1. 2.
Kedecin Capt taine Henri Boutin Dr. Trinidad A. Gomez Dr. W.J. Jesudason Miss Laura Pen Lu Mr. Kevin RiggaJ.l (Rapporteur) Miss. SUn Young Kim Dr. TU Uyen (Chairman) Dr. Gideon ZoJ.oveke Miss Virginia Mate Mrs. Carmen A. MercadO Mr. Honorio Pasion Mr. Y.H. Yang Mr. E.A. Pires Mr. Scott Edmonds Mrs. Louisa E. Haas
•
3. 4. 5· 6. Resource Persons Personnel d'appoint Consultant
• a
II
"
I' I, Dr. G~
Leison
I,
!
I'
- 41 -
• SUMMARIES OF PI.EHARI PAm. DISCUSSIONS FOCUSING ON THE HEA.I.lm EIX1CATION JOB TO BE DONE
1.
The health education job in maternal and chUd health
The 1m,portance of health education in maternal and chUd health care was stressed. )bthers are particularly receptive to health . education during their pregnancy, when the baby is newly born and during the illness of her child. !l'his is why the nospi tal. is an important ple.ce for health education. From the end of the first year of life, however, there is a saP in health education directed to the needs of the child until school age.
•
Group pressures in the village frequently force the mother to neglect the toddler early after its first birth~ while she returns to the field or domestic work. It is f'requentl,y necessary to develop W8¥S of jointly caring for toddlers and to secure acceptance for these. Frequently, it is mistakenly assumed that the pre-school child is relativel,y free· fran health hazards. While infant mortality and morbidity have declined sharpl,y as maternal and child health services have developed, these iDd1ces are o:tten far :tram encouraging in the pre-school groups j in 80lILe countries they are up to or over twenty times the rates in those more tavourabl,y Situated. Children disp~ very earl,y interest in health matters. It is particularly valuable fOr maternal and child health staff to use the health education opportunities implicit in their routine consultations. An important responsibility of the health education specialist in this area is to provide training in health education methods and techniques for all matet'Ilal and child health staff. A further task is to bring the attention of parents to the need for matet'Ilal and child health services and to encourage their use. The health education of fathers is as important as that of mothers in securing provision and use of adequate maternal and child health services. ~ of those mothers wbo most needed health education did not attend health centres or accept gratuitous advice.· A false impression of chUd health problems might be gained f'rOm a study of attendance at centres alone. People wbo tended to reject the advisory approach were usually action-oriented and health education approaches to them had to take account of this. Another major task of the Ilealth education services is to identifY possible obstacles which might mUitate aga1nstmaternal and child health stat'f carZl'ing
•
• •
- 42 out the home visiting f'Unction vb.ich is their DIOst 1IIIportant sphere ot iDtluence~ as well as to help them to resolve such difficulties.
•
2.
The health education job innutrition
Nutrition education pl.qs a major role in maternal and child health work. Adequate assessment ot nutritional problems is still lacking in ~ countries, especi~ in the tropics. Protein/ calorie malnutrition, otten ot mild degree, lead to retardation ot growth, both physical and mental. There is a need to relate nutritional education to customary tood babi ts and crop availability. There is much to be said tor the preparation ot a standard nutritional guide tor each territory to avoid contusion and conflicting advice. It is otten desirable to operate pilot schemes ot nutrltion education betore elaborating costly programmes. !reachers are an important group through whom. to develop programmes. The proper approach to a programme is to determine methods appllcable to the country and to develop a multl-disclplinary approach using health, education, foOd productionr agriculture, welfare and other workers.
3.
The health education job in mental health
•
Mental health intluences should be conceived as a process that continuously takes place vi thin the maternal and cb1ld health team itself. The relatlonship among the varlous team members as they perform their dq-to-daiY activities, including the supervisory process, has an impact on the mental· health ot the mother and child. 'l'be gamut ot variables behind birth - marriage, courtshlp, adolescence - and the complex mental health 1ntluences that ma.Y affect these.normal 11teoccurrences were Consldered. AntiCipatory guidance, an education process in ltself, becomes essential. Much ot the preventive aspects ot mental health tor that _tter can Be carried out through education. Learning the cnmnnmication system and the levels ot aspirations ot people I ~ticularly the lower class, becomes of utmost importance.
4.
The health education job in nursing
There is increasing public demand tor both curative and public health services. 'l'be rise in the number ot patients seeking treatment was associated vitil a reduction in the average duration ot care due to the rapid advances ot medical sclences. There is todq an increased interest in prevention ot disease and ~ntenance ot health. The nurse as a health worker helps people to recognize ttle1r health needs and to understand W8¥s ot meeting them. Sharing her
•
- 43 ~J.eq~ .~P, a read1l1'us.wle WIIiY.' 1s an 1l!Iportant function of the IIIOdEtrn mw-.) in BDiY of bervork.Jl1tuat10D8, whetber as a nursing
II
•
leader, ~ otn~s, Jl1U'8e .su;perv1aor., 'ward nurse 1n a hospital, Qr .PUblic bea.ltb nurse in. the cceutjlm1ty.
II
11
!ene .~. and :«IQt1.llUPus :contact.which 10ke nurse has with patients _ f_U" JQ.ILku·,1t pou1ble ~r' her. to suggest emphu1a. in health ~JI wb1ch .&r.e ~.tn the._~le CQIIIII1lmity, or dit1'ererlt paJl$s ~f 1,t, and. a.lJ:9v&'. her to perform a -vit~ liaison· fUnct10n between fami~ and health workers. The nurse ~ also help develop' _table heal-ttl tea-ebing.~e.ehniques and v14ual aids anQ, part1c1Pfltte in IJtud1u ·aAd.r.esearcb. .In Ol'derc.:to:·t:1I:I:q out. tbe rol.e effect1ve~, the .nurse lIl\lSi<4etlelop. a·sena1.t1-eab1l1ty to s~ :tP-e ~leJ.'lt IS • 'WOrld I as be u.ea 11k FraIl the moment ot qualitication the nurse 1s a teacher at health.
II
5.
The health education job in environlnental health
A paper delU:r1b-1ng hOw sanitarians had progr8l!llJ1ed health educe.t1on ina tropicaJ.. rural area was presented. Four steps were envisaged in tbeprogr8DD.e-, viz.:
• •
(a)
a sOUIld approach to the COlIIIlUDity;
(b) (c) (d)
gaining contidence; teaching;leadingtbe COIIIIIUI1ity. to decision
These steps involved a caretul study of village customs, relig1ons, superstU10ns 1 resources.and influential. people. Convenience of the-.bousebolder and a trie~ and per$OD8l.approach were ilIlportant guides to the behaviour of health workers in preparing to organize the villa8e people into small dolIlestic and neighbourhood groups. Teaching was concentrated on village interests and. the usefulness of the- s~ces in reducing the toll of cOlllllUn1cable disease. Leadership was encouraged from within the community to seek out possible innovators asng tile respected .members. _The_who1e emphasis of' tec.ching was to develop democratic discussion aimed at securing active participation in the building of-le.trines and wellswllicl1 would lead to use by the cOJlll1Ullity. Education of' children at school in food sanitation was al$o not to be neglected.
• •
Many ref'erl."ed totbe classical errors which. have been made in introducing sanitary :facilities inappropriatefo;r the village, or without prior involvement of the people. The health education services could preyent "such errors by lU'epariDg tile cOIIIIlunity in advance. and by advising the sanitarian on Bocial andantbropological factors to be considered in the design.and introduction ot the new facilities.
-44Others felt. tbat.the specific ~ of problem, the, train1Ds &D4 eJq>erience of theHDitation personnel udtbe level of edilcatlonof the population .involved 1IOI1ld determine the nature of support reqv1n4 from the health edUClPotion service.. In a cont:l.DUOus task of control like inaect control, the sanitarian trained in health education coul4 achieve good results 0Tel' a, long })er1'od. TIlere was a geaeral feeling amona ean1tarisDs that health education specialists who came to the villase and worked aloDS81de aan1tv1ansin practioal'1n!p were welcome colleagues, where.. remote pl"OgrIIIIIIIIe plaimer8 vere oot. It vas agreed in conclusion that the praama1;1c san1'tar7 approach and the educational-programme could not be divorced. !I.'he ideal was to give service and educate at.tbenm.e 1;1me. In dCll¥>natrat1on areu, the presence of a health education apecialiat woul.cl be an ad'9'&Dta8e in designing effective prograDlDes,; ,
•
6. Of the !IIB.DY COIIIIlIlD1cable diseases wich infect hu-na, usUal.J.y only a few are of public health importance in a count17 at one particular period. Contusion often arose in assesdng tile' relative 1m;portance of one or another disease, which was not· necessanl¥ indicated by the presence or absence of a quarantine label. POI' eXBIIIPle, gaatro-enteritis i8 a D1UCh more serious problem in some countries than cholera. It is important in health education to give a beJ.anced view of the relative efficiency of control measures such as iDl!!!'rlization so that undue reliance might not be placed on them by the public to the detriment of other control measures such as clean·food or· good sanitation.
• •
MaoiY difficulties arose during communicable disease control progr8DllleS which health education could help to resolve. ExaIIplea are: (a) (b) (c) ( d) (e> refUsal to co-operate in .ereenina tests, especially where physical measures like taking blood were illWlved; regression of the demand fbI' immunization; resistance to change in habitj resentment aaainat household. in.1Ul7j concealment of sociallT prescribed. diseases, like venereal disease and leprosy. .
•
The long surveillance and persistence ot negative public attitudes were inatanced. as being responaible fbrd1:tf1culty in the control of certain dis ...es such as leprosy. Without health education, however, 1t was often Yel7 difficult to reach eases.
- 45 In thelODI,run, control of cOlllllUZ11cable disease depended on public uMenrtana1ng of the btolog of the agent and of the epid~olOsy of the proce8s of infection. The health education senices should not o~ support the dis8.1 nation of health infOrmation but should aleogather important information about the cnmmnoity,whicb would be useful in the plaDning of control measures.
• •
7.
The health education job in malaria eradication
The essential and prolonged transgression upon clanestic privacy necessary in carrying out the malaria eradication programme makes the one hundred per cent. co-operation of the population a !.!!!! qua !!2a of 81lCcessful control. People will give their co-operation onl:y it they understand wb7 all this work ·i8 done and. how it will benefit them. It might involve eight to ten years of intermittent e:f.'1'ort and. the interest ot the caQmun1 ty has to be maintained fOr this time. The health education Job:to be done must be directed to:
(a) (b)
the people; the publ.ic health staff incl.uding,the health educators; the malaria eradication staff
•
(c)
...
It is important to krlow the bel.iefs and. babits, the interests, l.arlguaae and taboos of· the people eo that the educational approach JD8¥ be Consonant with their interests and. otherwise acceptable to them. The heal.th education services have to be made familiar with malaria eradication and should also study the functional requirements ot the malaria eradication team. Mal.aria eradication staff are constant1y in touch with all househol.d8 in the working area and shoul.d be trained in health education techniques so that their potential. educational infl.uence in the villages coul.d be maximized. Attention was drawn to the n~ of seeking the hel.p of the heal.th education services early in malaria programmes. Campaigns which tail.ed had often delqed seekiDs advice and training in heal.th education. fOr malaria workers until. l.ate in the programme.
8.
The health education Job in the control. of tuberculosis
•
III the discussion ot the health education task in tubercul.osis reference..., made to the more hopef'ul outl.ook for tuberculosis in the l.1ght of modern d8;ycbemotherapy. This made it possibl.e fOr DI8.OY, if :DOt lIIOst, cases to be treated in the home. Furthermore , it had recent1y been shown that the infectivity to others of cases treated in the home was DOt higher than that of cases treated in the hosp! tal..
- 46 ~e advent of BeG vacQine, now shown to have defin1te protecti.... value, bad1mprOved the possibility of protect1ng theCODllNDit,y b7 immunization 10 long as at least Beftnty-t1ve per cent. of the suaceptibles accepted it. Tuberculin testias, sput'\IIl epm1.natlon aDd x-rq examinatloas bad provided uaef'ul mass c11esaosia at low cost.
•
In spite of these advances, in many places, it was still impassible to protect, detect infectious cases, or even to treat them adequateq. Studies of cases discovered demonstrated o~ a low percentqe ot patients who compll!'ted a full course of trea_qt. and surveillance; clearqnone ot the programmes could succeed without the willing co-operation of the community.
Health wrkers who are d1rectq in contact with meabera of the public are the best agents ot health education and should be tra1ned in health education methods and techniques to carry out the· task.
9.
The health education
job
in the control of bacillary. c\y!egtery
Attention was drawn to the persistence of bacillar,y Gyaenter,y as a health problem in one of the larger nations of the Region. 'l'tle epidemic patterns bad cb.aDged, the trend being awe;y from 8UI'IIIIIer epidemics and an increase in iD8titutioaal community-wide cases. Antibiotics used without prescription by a doctor were also a cause of de~ in diagnosis of the initial cases in an outbreak. There is need to educate housewives. food handlers, meal and water .upply wrkers, particularq in affected cOllll1UDities, throughout the year. Reference was made to the COIIIIIlUIlication barriers which saaet1mes existed between field wrkers in a control programme and the bealth education service.
10.
Community health development in the face of rapid industrialization and urbanization
The general drift of rural populatiOns into the cities was described, as well as the less ~coSDized tendency which town dwellers dispJ.qed to move into larger cities. It was suggested that in all cases, albeit in d1fferent ~, those who moved into large urban developments felt that there were o~ advantages to be gained from J.eavias their rural or small town dwellings. Public health administrato" realize o~ too well th4t real and urgent probl.ellls of hOUSing, sanitation, environmental pollution, acc1dent hazard and mental health problEIDS wbich were created b7 the unplanned growth of city populations. These problaDa could frequently be dealt with effectively by health education. The many COIIIIIlUni.ty services which have health coDDOtatioDS, inclucl1DS control ot environmental sanitation. clean food and
•
- 47 .. .
&Del health probl. . 1ncl1.ld1»B:
c~;lt7· .-1U .. wr.e:. Qiacuaed~ Mention:... DIBIle. of. bow' uncontro~ US"Ou ~ ",·beea· r..,CNlble for 8Oc1al#.eCClluaj c
•
(a) (b) (c) (d) (e>
social maladjustment of the baneless &Del the transient ~i
poOr
qUalitY or
det1clent water supp~;
iD&dequate sewuase &tid dra1.Dase; def'icient bouslng and. poor sani.t&ry staxIdari.IJ of dwellings; inefficient garbap: coll-eetion.·IID4,.d1spoaal; l.ack-Of' .jn4"strlalb..u:to serrt-ceaj
- (f) (g)
air and water pollution due to uncontrolled domestic and 1nch"atl'1al. -.:-01' .f'uel&·azrd cb em1 oa l "i
(0) (1)
POOr:.II&iDteDanCe.o1' public. places; pOOr ·l.ead.erahiph'CalllNDity 80Cial aDd. bealtb probl.sls.
• •
It is1DrgortaDt tb8t; the health administratiOn .~ be represented in c1.v1c and p 1 ann1 ns bodies. '!here 'is ..&,.epec1al Deed for health' adm1111strat1cas to coosider the needs and h-.J.th. problEllUl. Of mJ.srant populat1oos and to ai!:rl.Seon the matter.!'here.1a also & need tor OO!IIMIJDi 1:7 bealth :education to. develop public' awiLreneas of the Deed for bealtbier li'Yi.DgcOad1tions.1.n the cit-tea aDd to aecure c0operation 1.n. c o nn"n1 ty. measures designed to -iDp'ove ........m 1 ty 8ernces &ad the .llt9'ins.colld1t1oD8 oftbe:1DbiIbit-anta. TheBe health education activities 8houl.d be extended to: . (a) (b) (e) ooam'ixfty devel.opaeAt 8cb_ _ dur1zlg planning and . :lJllplBleD'llaUon;. -..
social and health services fbr.aettl aaeDt-. u4 relocation . of 8quatten.i
water through prosrauaes aimed to
tDdu.i;r1&l hdl.thaad_preVent1on of'poJl:ilt1DD of air and m8Il88ement and labour;
(d)scbool.bealth. education at alll.evels Of education. References were made to tbe increasing problem of urbanization. A large taak'iJr'p •• eutiyec medicine and health. education 1.8 needed to improve the pl.ann1ng of urbm11za.tion and. 1II4us.tr1aJ. health 1.n aucb rsp1~ 1Ddustr1al.1zed and urbaniZed areas • The ~ beal.th. probleu .1111100' ariae wen people are . com:pul.sor1l¥ traosferred to new settlements d'arillg'tbe bu1ld1J1g Of new urban industr1al areas, sucb as chanses 1n fam:1.4r structure I
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-48al.eohol1sm, accidents and aging population, were mentioned. Health education' services can plq an important role in prepar1Dg the p801)le for such movements &ad in helping ~ ~. attitude& aDd behaViour.
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The place of valid baselines and evaluation procedures in health education The aims of systematic evaluation include: (a) (b) ( c) measurement of direct effectsj measurement of unf'oreseen effects; sel.ection of appropriate, ecolUllld c aDd othel'Wi8e suitable methods.
Evaluation in health education' i8 usuall¥ a composite· stud;y of procedures and results. When et"ficiently done, it indicates the suitability of methods and activities in reJ.at1on to a1u, time, personnel, expenses, equipnent, etc. It has value in demonstrating the significance of Ilealth education programmes as well as 1n providing impetus for the Ilealth educator. Rigorous evaluation, when needed, must be planned like a:rJ:¥ other f'orm of social action research. In determining baselines f'or comparison, care has to betaken to avoid the ~ sources of error which could render baselines invalid. It 1s not alwa;ys easy, f'or example, to compare 1nd1cators :f'raa one progr8llllle to another and' caution has often to be exercised to avoid biased conclusions due to increased COIIIII11udty interest aroused by a specific programme. 'l'I118 could lead, for example, to an apparent paradoxical increase in disease incidence through enhanced detection. The importance of a precise definition of the educational goals for health programmes we underscored. 'l'I11s 'WOUld enablewortbwbUe evaluation of immediate results of operational procedures which could be related to the contribution which the programme had made to the solution of the underlying health problems. The value of periodic reports of important accessible actiVities by the health education field sta:r:r over a'sufficient period oft1me as indicators of trends or needs 'W8S stressed. It 'W8S pointed out that there are sane largely unsolved problems of evaluation which require research, including: (a) (b) the factors inf'luencing rate of decay, or C01lV1!rsely acceleration, of induced change; the significance of the altered cognitive state of the individual when a change in knowledge but not in overt behaviour· had occurred; the desirability of evaluation by uncamn1tted bodies such as universities.
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S;pecialStudies, Research and Evaluation in Health Education Chairman : Rapporteur: Members Dr. J. Charan Singh Miss Sun YOUDg Kim M. Ben Bambridge
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Dr. norencia Herrera Miss Virginia I. Mate Mrs. Leonor J. Zamora
Dr. David W. Bookless Hiss Laura Pan Lu Dr.MacuE.Salato
Resource Person Consultant:
Dr. Annie Laurie Keyes II
Dr. Tadao M1yasaka
, It was learned that special studies, research and evaluation in health education have been made on a small scale in same or the countries in this region. Studies have been carried out in regard to the knowledge, attitudes, beliefU and practices in connection with maternal and child health, ram1~ planning, tuberculosis, leprosy, malaria, nutrition and sanitation. There have also been ccuparative studies or values or methods and e:t'f'ectiveness or health education efi'orts in the :face or obstacles such as lack or prepared personnel and shortage or budget. It was suggested that some or the kinds or studies, research and evaluation which ma;y be done in health education include the
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f'ollowing: <a) testing the efi'ectiveness or educational methods ror various groups of the population taldng into consideration age, sex, marital status, ethnic background; religion, occupation, political orientation, social status, economic status, educational status, organizations to which people belong, and value systems; making a com,pa.rative study between health education services in difi'erent countries according to the population, degree of urbanization and s1milar geographical situatiOns; malting studies of cOllllll\lll1cation patterns and educational opportunities found in hospitals and clinics;
(b)
( c)
- 50 (d) studying ttle attitudes and bellefs of physicians, nurses. m1dw1ves. sanitarians and others on specific problems, such as tuberculosis. leprosy. malaria, nutrition, ~ tension. etc.; scientific studies w1th respect to the n.lue of various k1Dds of tra1ning programmes;
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(e) (f)
studies of ttle concepts, philosop~ and understand1Ds of health education to be ·found among all public healttl 'WOrkers; . . study of probl.ems of health education encountered due to specit'ic problems Buch as rapid urbanization.
(g)
It vas suggested that the World Health Organization might help to collect and disseminate ttle findings of studies and research in tlealth education.
2.
Preparation of School Hee.l.tll Personnel and Teachers in Health Education Clla1rman : Rapporteur: Members : Dr. C.N. Derek ~lor Dr. Baja A. lfoor<lin Mrs. Ines P. a.tma1tan Dr. Chung Ta1 Kim Dr. John Krister Miss Blanche Armstrong Dr. Guy IDison Mrs. Cristina Mamuri Mrs.
Mr. Honorio Paalon
carmen A.
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Mercado
Resource Person Consultant:
A study of ttle experience 01' the Bureau 01' Public Scboqla in the Philippines vas made as a basis fOr comparison with the existing systems in other countries. i'he study included f'ield viSits to the Rodriguez Junior High School, a pilot school. at Quezon City, and the Phillppine Normal College in Manila. The history 01' school. healtll education in the PhU1pp1nes started in l.929 when health education vas made a subject in the school. curricul.um, f'irst at elementary level and l.ater at tligh school. and coJ.l.ege level.s. Several mod11"1cations were made in succeeding years. Since l.957 health education has been taught together with el.ementar,y science in grades I through VI. Teacher preparation in health education started in l.935 at the Pbil.ippine Normal College :fOr el.ementary teachers and at the University of ttle PhUippines :fOr seCOlldary teachers. Teacher preparation was given a major st:lmulue for developnent with the
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- 51 settiDs up in 1960 of tbe·~.AnmD~~~~1D1D& .~ in School Health Education. Summer 1mrt1tute. ,..t bel4at. the national lnel for key personnel, followed 'by reSIon8J.,prorlnc1al and JIlUD1.aipal workabops, 1DvolviDs scbool aDd bealth per8OlUlel;. SOmeMndn1a_ trat1ve results ot this tra1 n1 ng PI'" I8l' • 'e 1Dcluded: Ca) (b) (c)
aettiDs
up.C/f
ptJ.o:t. el.ementa.ryaDd b1shscbool
progrlUlllleSj
provision ot scholarships for local and overseas training; preparatIon of teacher mu-r1cula for health education at the University of the Ph1l1pp1nea aDd PhIlippine Normal College 1eei!1 ng to bachelor's degrees In health education (B.S.E. aDd B.S.E.E.), aDd to a Maaterot EducatIon degree with a major in health educatIon; the setting up of Joint co-ord1nat1ng councils at national and other levels.
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(d)
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Applied Butrltion Pilot ProJect at ~. ~e group made
sc~l concept, started in utilIzing the sChool as a fOcus for COIII!Dlpity educatIon aDd activities. An OutstaDcUng example is the
A epec1al feature ot the Ph1l1ppine a;perience 1s the ¢OI:m'mi ty
1948,
(See Am1ex 6).
the following Ob8erVat1oDS: I I
<a) (b) (c) (d)
the Deed tor· s1a'ong support frOm top-level administrators;
the need for orientation of all level.s of workers, including. health workers; tbe need for props'
superY1810n;
the proven value of seminars and workabops In obtaining support :tor a .school bealtheducatlon programme.
School health .Berrlce. 1'he group d1sc:ussed school health serrices aDd streBsed the need for close l1aison between the . Depvtment of Health and the Department of Education. COncluslon. The group felt tbat countries in .the Western Pacific Region have IIJIlch to learn from. the Ph1lippine experience which recognizes the great importance of' teacher preparation in health eQueation. 1'be" Phll1pp1nes baa a wealth of' l1terature on this experience, tmd the group auggeated that the World'Health Orpll1zat;lon Western Pacific Regional Offtce JII18b,t assist in the preparation of' a bibl1ograp~ tor tbe reterence ot Member countries.
- 52 3. Preparation of MAAical aDd other Categories of Heal.tll Workers in Health Education Cbairman :
Rapporteur: Members
Dr. Will1am A. LaDgsf'Ord Dr. Gideon ~loYeke Ml!decin Capita1ne Henri Boutin Dr. Trinidad A. Gomez Dr. Saag 'fae Han MIlle. Hortensia de HoJJanda Dr. Walter J. JesudasOn Mrs. Louisa Jlaas
, Dr. A. Manga.Y-Angara Miss Joan Pilson Miss Perla B. Pinto Mr. Scott Edmonds
Resource Person: Consultant:
Dr. S. Nagaraj
'fhe types of health education training :round in various countries of the Region were considered. These ransed ~ specialized courses to the incorporation aDd integration of health education in the tra1n1ng of all categories of medical and health writers. It was agreed that all. health writers, administrative, curative, preventive aDd even such persons as receptionists and cashiers in certain institutions should receive some appropriate preparation in this field. Priority attention should be given to providing adequate preparation in health education for the fol.low1ng: {a} those whose poSitions, status or influence could material.ly help or hinder health education planning aDd programmes, e.g., senior administrators, directors of assisting agencies and the like; those who by reasoll of their close contact or in'Yol.vement with camnun1ties, families or individua1s would be best placed to favourab1¥ influence health attitudes aDd practices; those groups who vere implicated in special local problems, for example, pharmacists in places where overuse of druss causes concern.
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(b)
( c)
This preparation can be carried out through orientation, pre-eenice .. in-senice, post-graduate and refresher courses. The place which health education .preparation must have in other disciplines not direc~ related to health work was stressed. It was realized that a detailed scheme applicable to all areas could not be evolved. General principles of f'llndamental 1mportance were therefore considered and the following were agreed upon: (a) Ereparation in health education should begin as ear1¥ as possible. Many differences were noted among countries represented.
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- 53 (b) Preparation in health edUcatiOD should continue as an integral. partot tra1n111S tor all. health workers at basic, post-basic, graduate &rid post-grad:uate levels. 110 matterhov sbort &rid l1m1ted the training or what the level ot the health worker, e:f'torts must be made to include. health education. Even in post-graduate courses tor higher specialist posts in clinical work . th1a is important. At present this area is overlooked. The type ot preparation in health education .needed by the health worker can be determined by considering the target groups reached by him in his work and the spec1tic purposes tor which educational e:f'torts are required.
(c)
4.
Health Education Methods and Materials Cba1rman : Rapporteur: Members Miss Ngu;yen Thi 'l'u;yet Protessor Carmen F. del Rosario Dr. C.K. CbaDg Dr. TU Uyk Dr. Hisashi Teramatsu Dr. Joe Fanamanu Dr. J. L. Jameson Dr. Kevin Riggall
Resourc~
Person
:
Miss Winitred Warden Dr. Teodora V. Tiglao
C.onsultant:
The group exchanged id-.s on tbebasic principles to be applied in the selection of methods and visual aids. In addItion, a field trip was made to the Philippine Normal College Camnunity-School Health Education Centre to observe the Production Laboratory and the health museum. Some guidelines intbe selection of educational methods and materials were then formulated which f'ollow: (a) The method used should be adapted to f'it the culture of the people 'Where it is used. This can be done by: (i) (11) studying the customaJoy wa,y of learning; know1Dg the pattern of' authority in the fam1l¥
and CQ!D!\!JDity;
(iii) studying the channels of' communication available. It was suggested that the role of' the school as one of the channels be carefUlly studied. . (iv) finding out what peOple think and do about health problems &rid how these are related to their general outlook.
-54(b) The metbod J!lU8t be practical 8I1d related to the objective of tbe health programme. It 18 e8HDt1al to:
(i) (11)
know the Deeds and probl.elll8 of' the peoples
kPDV tbe level of. education of' the people;
(i11) understand vbat motivates the people to accept scientif'1c health practices. (c) The metbod of' choice should include &8 much participation of' the people as poss1bl.e. It should: (i) provide opportunity f'or leamiDg and doing; reach the people for which it is intended p~ical.ly, intellectually and. emot1o~.
(ii)
The di<1actic and. socratic methods were discussed by the group and. their practical application to specif'1c situations. 'lIle groUJil f'elt that tllere is DO single ideal method for all situatiOns. Some guidelines were formulated in the selection of' materials and otller visual aids. ~hey are: (a) (b) Consider the cost of' the materials to be used. The adaptive range ot tile materials should be suited to the group and to the country. SuitabUity is determined by pre-testing the material. It should allow participation by the group. 'lIle materials should be durable. The visual aids should be appealing to the eyes. They should be easy to use and prepare. Use local materials as much as possible. The educational matel1.als must be scientif'1cal.ly accurate. The choice ot materials will depend on the subject to be presented, purpose, space allotted, aUdience and vbat material is easy to get. Visual aids. sl10uld create interest in new solutions to
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(c) (d) (e) (f) (g)
(11) (i)
(j) (k)
important health problems. fuJy visual aid used must be associated witl1 SOllIe actions
available to the viewer.
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:rIELD VISl'l '!O mE APPLIBD lItmtH'IOJr BAYAJIBAJIJ, PAlIIASDWI
~ A'l
prosra-e
a pilot applied nutrition edlJcation IUld improv Tnt area. '1'he partiCipaa.ta in the • •'M!' visited the proJect area on 22 JaDU&r'I to stud¥ the progr ....... at ftrat bud. Since baa been in operation in tbe ~
1964,
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Buical.ly the proJect 1a.wlves acbools 1a. the rural. area 1a. a proSl'GIW ot scbool nutrition education based on actual experience ot srow1as crops 1a. school gardea.s I UId is aeaipecl to r~ deficienci.. 1a. local diet. 'l!he aain def'1ciea.cies are prote1a. ad vitam1a. A, IU'ld a D.UIIIber at iDd1geaoue as vell .. ua.U8U&l plents haTe local potential tor diet&t7 reintorceMD.'t. 'l!he crops grown 1a. the school p.rdea.8 are uaed to provide dietary 8upplaea.ts in a 8choOl. teecl1DS prosr-e. Pa.reDts donate food UId labour. At tile .... t1M, exteDaioD.8 at the school . i cultural prop- are betas clevel.oped 1a. ~ garden plots, botb by cl11'ect iDtluea.ce over parents u4 by 1Dd1rect 1a.tluea.ce traa tbe scboola through tile cbildren. Centres are DOV alao beiDa set up tor providias diet 8uppleaea.t8 tor tile pre-scbOol cb1l4. A VW7 b1&b decree ot parent "8i8tfu1ce aad co-operation bas been achieved in tbe area, supported b7 entbusiastic eftOrt8 by teachers. 'l'bere i8 pressure tor extea.aion at the progruae IU'ld tbe impression was gathered that beaet1cial eftects have also been realized onpa.eral tQwieae 8D4 saa.1tation ot tbe villages.
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'!'be orpa.1zatlon ot tbe project bas been JllDat caretul.l3' planned at natiODal., reg10Dal aad local 1 ....1, build'n. u;poa. ccwnmity 1.cier8hip 1;ra1 n1 ns wtdch bad been 1a.troducecl scaet1Jle betore the pre_ent scheme. As a pilot proJect, IIILlCb 18 beiDS leara.ed about the 1a.teraction aDd 1a.tluea.ce patterDS between scbool and COlJlllnntty which IIIII¥ have profound value 1a. estabU_biDS pr1a.ciples ot cawmlty 1D'IolvemeDt 1a. other ar....
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WORKIl'fG PAPERS Document Bo. WPR/BE/1 Title Technical Discussions on the Use of 26 October 1965 Health Ed~tion Service. in National Health Programmes, WHO ·Regional CoIIIm1ttee Meeting, Seoul, Korea, September 1965 The Importance of Health Education in National Health Progr8llllles, by Dr. Gu;y !DiSon, Executive Of'1'icer for Health, South Pacific COlIDIlission 11 January
WPR/HE/2
1966
WPR/HE/3
Developments in Health Education in the 14 January Western Pacific Region (Resume of Country Reports), by Dr. Teod.ora V. Tigla.o, Associate Professor of Health Education, Insti tute of' Hygiene, Universi ty of the PhUippines Developing Qualified Health Education Leadership, by Dr. Ta.dao M1yasaka, Chief, Health Education Section, Institute of Public Health, Tokyo, Japan 22 January
1966
WPR/HE/5
1966
WPR/HE/6
Organization and Administration of' 25 January Health Education Services, by Dr. S. Bagaraj, Chief', Health Education, M;ysore State Health Department, Bangalore, M;ysore State, India
1966
Country Reports WPR/HE/4 Health Education Development in New South Wales Health Education Developnent in Fiji Fact Sheet on Health Education . in Viet-limn
21 December 1965
WPR/HE/4 Add.1 WPR/HE/4 Add. 2
28 December 1965
26 December 1965
-58DoC\lllent No. Titl.e Health Education DeV'elopaents in Republic of China Health DeV'elopllents. in Queensland, Australia Health Education Deve10pnent in New Zealand Health Education Developments in Japan Healtb Education DeYelopnentln the TerrItory of Papua and New Guinea Developnent of the Health Education Service in Mala¥a Health Education in !few Caledorl1a Health Education Phllippines Deve~ents
WPR/HE/4 WPR/HE/4 WPR/HE/4 WPR/HE/4 WPR/HEA WPR/HEA WPRftmA WPR/HE/4 WPR/HEA
Add., Add. 4 Add. 5
4 Januar,y 1966
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Date
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S January
1966
6 January 1966 15 January 1966 11 January 1966 10 JuU&ry 1966 11 January 1966 15 JuU&ry 1966 ,.;
Add. 6 Add. 1
Add. 8 Add. 9 Add.10 Add.11
in the
Health Education Developaent in the Republic of Korea Health Education Deve10paents in Singapore Health Education Development in Cambodia Situation de l' Education sanitaire en Polynesie Franc;a1se Brief Outline of Health Education Service MedIcal Dep&rtment, British Solomon Islands Protectorate
12 January 1966 ~
WPR/HE/4 Add.12 WPR/HEA WPR/HEA WPR/HE/4 Add.1, Add.14 Add.15
J.8 January 1966 15 JuU&ry 1966 20 janvier 1966 21 Jaauazy 1966
Education for healthier living. CUrrents in Public Health, Vol. 2, No.7, July-August 1962. Ross Laboratories I Columbus 16, Ohio HAWAII I unv:EllSDY OF. Report of the Institute on CoDIInm1ty Health Education. Honolulu, Univ. of Hawaii, 1964.
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- 59 Health education of the public. Report of the TechniCal discUBs10naat the Twelf'thWOrJ..d Health AsSembl¥. WHO Chronicle ,1959, ~} ~ JUly-A\lgUSt,
320-332p.
Information Bulletin of the Division of Health Education, Of'f'ice of Healtb Education 8.DdP~SODDeJ... '!raining,' Department of Health, Manila, 1959. ' International Conference on Health and Health Eaucat10n, Phila., Penn., 1962. PrOf'essional preparation in heal til education'. (vol. 6), Held on 30 June - 7 J~ 1962. sponsored by the International Union for Health Education in collaboration with World Health Organization. Geneva, LJ"HEil962. 641-772p. International Conference on Health and Health Education, Phila., Penn., 1962. Studies and research in health education; (VOl. 5). Held on 30 June - 7 J~l962. Sponsored by the International Union for Health Education in collaboration with World Healtb Organization. Geneva, IJHE, 497-64Op. Joint Commission on Central and Scottish Health-Services CouncilS, Report on health education. Lol,ldOn, H.M.S.O., 1964. PAHojwHo Lqter-RegiopalCQnferenceon the Postgradu&tePreparation of Health Workers for Health EdlWeot10l1. Phila. ,8-7 ~ 1962. 48p. (WHO techno Rep. Ser. no. 278) RAMAKRISHNA, V.
Building national healtil _ edUcatiOll' _sel'Yices'. Health Education !t)nographs, no. 18, 1964. 39p. Society of Public Healtb Educators, ,Inc., Bye, New York. 3-32p. Review of research related to health education practice. Health Education Monographs, SuppJ.enentllO. 1, 1963. Society of Public Health Educators, Inc. ,Bye, New York Roberts, Beryl J., et ale Health education bOOkshelf. Repr1J).t from Amer. Journal of' Public Health~,l96; •. (vol. 53). 53l-543p. 'l'aylor,. C. I; • D. The use of' health edlWeotion services in national health programmes. Working paper presented at the Technical discussions of the Sixteenth Regional Committee Meeting for the Western Pacific, Seoul, 1965 (WP/RC16/TD5) (mimeographed document) Tiglao. T.V.
Health practices in a rural community. Quezon City, Community Research Council, University of the Philippines, 1964. 232p.,
- 6c> -UlIESCO. Education Abstracts. Health Education Vol. XIV Bo. 1. 1962.. UDSCO, Pari.
umco/WO. pJ anni DS
...
for health education inachoola. b1 Professor C.E. Turner. Ed.M•• Ih'.P.H., WIO,IUlIESCO Consultant. Paris. um:sco/WHo, 1966.
U.S. Agency tor International· Developnent. Educational approaches in the malaria eradication program, by D.B. Nyawander. Norman A. Craig and Mary Jo Kratt. WaahiJlgton. D.C., USAID. 1959.
u.s.
Agency for International DeYel.opaent. Education in health. WashIngton. D.C., USAID. 1962. J.27p.
U.S. Agency for International' ])eve1opaent. Health education worldJlg conference. Cholburi. 1'bal l aDd, 1959. WashiJlgton. D.C., USAID, 1959.
lllp.
WHO. EXPERT CCMIr.l'TEE ON BEAI4'H. EroCATION OF THE PUBLIC. First Report (Paris. 1953) 41p. (WHOtecbn. Rep. Ser. no. 89)
WHO. E.XP'ER.r 00MMl'r.l!EE Q 'l!BAIRIlIG OF BEAIll'H HEAI4'H ErJJC.AnON. OF THE PUBLIC. Report. Geneva, 1957. 4Op. (WHO tecbn. Rep. Ser. no. 156)
PERfK)1lfEL·
IN
WHO. JOINT WHO,/uNEsco CO!IoII'l'TEBON TEACHER PREPABM'ION ltIR HEALTH EmCATION. Report, Geneva, 1959. 19P. (WHO tecbn Rep. Sere no. 193) WHO/FAO. .
Report
ot an international .em:! nar on education in
health and nutrition, Bagu1o. Philippines, 1955. 91p. WHOjurmsco. A study guide on teacher preparation tor health education. Paris. WHO jf.JJrmco, 1957.