INTRODUCTION
First edition,1982
Health for all by the year 2000 has become the goal of the World Health
Organization (WHO) and most countries around the earth.
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Such a world-wide goal is very worthy. But in some ways it is dangerous. For
there is a risk of trying to reach that goal in ways that become so standardized,
so impersonal, so controlled by those in power, that many of the human qualities
essential to health—and to health care— are lost.
There is already evidence of this happening. In the last 10 or 15 years, a great many
attempts have been made to bring basic health care to poor communities. Billions
have been spent on large national or regional programs planned by highly trained
experts. But the results have often been disappointing. In most countries, the number
of persons suffering from preventable or easily curable illness continues to grow.
On the other hand, certain community health programs have been more or
less successful in helping the poor meet their health-related needs. Studies by
independent observers* have shown that programs generally recognized as
successful, whether large or small, often have the following things in common:
1. Small, local beginnings and slow, decentralized growth. Even the more
successful large programs usually have begun as small projects that gradually
developed and evolved in response to the needs of particular communities. As
these programs have grown, they have remained decentralized. This means
that important planning and decision making still take place at the village or
neighborhood level.
2. Involvement of local people—especially the poor—in each phase of
the program. Effective programs recognize and try to deal with the conflicts
of interest that often exist between the strong and the weak, even in a small
community. Not just local leaders, but the most disadvantaged members of
society, play a leading role in selecting their own health workers and determining
program priorities. A conscious aim of such programs is to help strengthen the
position and bargaining power of the poor.
3. An approach that views planning as a ‘learning process’. The planning
of program content and health worker training does not follow a predetermined
‘blueprint’. Instead, planning goes on continually as a part of a learning process.
Participants at every level (instructors, student health workers, and members of
the community) are invited to help shape, change, and criticize the plans. This
allows the program to constantly evolve and adapt, so as to better meet people’s
changing needs. Planning is both local and flexible.
*See, for example, David Korten’s analysis of successful programs in Asia, “Community Organization and
Rural Development: A Learning Process Approach,” Public Administration Review, September/October,
1980, p. 480-510.