Development & Aid, Global, Global Geopolitics, Headlines, Health

Health: Global Conference Urges Bottom-Up Approach

Marwaan Macan-Markar

MEXICO CITY, Jun 11 2000 (IPS) - In the western reaches of Kenya, a quiet revolution is taking place: officials are working with communities to solve local health concerns.

The programme, that began in January 1999, is part of a global trend that encourages community participation in tackling public health issues.

Consequently, close to 270,000 people living in Bondo, in western Kenya, stand to benefit from a programme that seeks remedies for such diseases as malaria, scabies, acute respiratory infections, intestinal worms and HIV-AIDS (Human Immunodeficiency Virus- Acquired Immune Deficiency Syndrome).

Already the results are evident in the fewer number of children afflicted with intestinal worms since such community-centred efforts began. “We have succeeded in reducing it by 40 percent in a number of schools,” said Calleb Aroko Osana, a member of the Kenyan-Danish Health Research Project (KEDAHR), which has been administering this scheme.

Schools have been the primary targets of KEDHAR, which has involved both students and teachers to participate in a wide-range of health education programmes. In addition, other members of the community, too, have been encouraged to become involved in both identifying pressing health concerns and suggesting solutions.

“This is a typical example of community participation in health,” remarked Osana, who considered it more effective than the way public health problems had been dealt with hitherto, which were directed by a heavily centralised health systems that had very little input from those who mattered, the community.

The achievements in Kenya were one among a number from the developing world that enjoyed the spotlight during the weeklong Fifth Global Conference on Health Promotion, which ended on the weekend in this city.

What is more, such efforts at health promotion illustrate the central message that emerged during this gathering – the best prescription for a healthier world was greater community participation in the shaping of public health policies.

According to Dr. Gro Harlem Brundtland, the director-general of the World Health Organisation (WHO), the landscape for international health has changed in fundamental ways, and among the features distinct in such a shift has been the need to “empower people to make healthy choices for themselves and their families.”

And this, stressed Brundtland, needs to be recognised by public health policy makers, requiring them to transcend the “narrow slot” traditionally labelled “health promotion.”

“We in WHO have learnt that programmes and policies are most likely to be sustained and successful if the people they are meant to serve are engaged in their design and implementation,” added Brundtland, during her address to the conference. “Initiatives that rely on one sector alone are less likely to be effective than multi-sectoral efforts.”

Brundtland’s view was supported by health ministers from more than 60 countries who were present at the meeting. In the statement they endorsed – the “Mexico Ministerial Statement For The Promotion Of Health” – the governments acknowledged the urgent need to address the social, economic and environmental determinants of health, which “require strengthened mechanisms of collaboration for the promotion of health across all sectors and at all levels of society.”

They also pledged to ensure that “the active participation of all sectors and civil society” be guaranteed, “in the implementation of health promoting actions which strengthen and expand partnerships for health.”

The rationale for such community-based initiatives has emerged following “hundreds of research and demonstration programmes world-wide,” declared Maurice Mittelmark, in a report presented to the conference. It confirms that “through the use of tried and proven community development techniques, communities are capable of achieving important improvements in health conditions and in strengthening their capacity to respond to new challenges and opportunities.”

Moreover, added Mittelmark, of the Research Centre for Health Promotion at the University of Bergen, Norway, there is ample evidence that a participatory community health development process can shift peoples’ thinking beyond illness problems of individuals.

That has often led to people considering how programmes and policies could either support or weaken community health and illuminate a community’s capacity and control to “improve local conditions for a healthier society,” he observed in his report, “Promoting Social Responsibility for Health: Progress, Unmet Challenges and Prospects.”

However, admitted Mittelmark, such a rationale has still to be translated into a global reality, since many health policy initiatives are national and international in scope and do not focus much on local action. “There is a tendency to think of policy-making as a large, very complex enterprise, and to think of policies as being ‘handed down’ by experts.”

According to Purabi Dutta, non-governmental organisations (NGOs) can contribute significantly towards such a “bottom-up” approach given those they work with — grassroots communities.

“We have achieved that in Bangladesh,” added Dutta, director for the Health, Nutrition and Population Programme at the Dhaka-based Bangladesh Rural Advancement Community (BRAC).

Since its inception in 1972, BRAC, with a 56,000-strong workforce of full-time and part-time community activists, has directly contributed to a healthier world for 35 million of Bangladesh’s 120 million people.

Primary health care, family planning and combating tuberculosis are among the areas that BRAC has concentrated on through its efforts to mobilise local communities. “The people are much happier as a result, since they have a voice in identifying problems, they participate directly in searching for remedies, they feel a sense of ownership,” said Dutta.

Peter Hybsier, the WHO’s representative in Sri Lanka, agrees with Dutta. In South Asia, he pointed out, the success rate in eradicating polio can be directly attributed to the activism of NGOs to encourage greater community participation.

“Direct public involvement needs to be fostered at all levels to achieve healthier solutions,” he observed.

 
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