Comment: Primary Health Care: Back to the Future? (1)
Dr. Rajesh Gopal, India
[Mods note: The posting below is the first response to a perspective piece on the World Health Report 2008. Read the original posting and find links to the report here:
Dear SEA-AIDS members,
I was at the World Health Organization (WHO) in Geneva in August 2008 when I first came across the World Health Report 2008, while working on ways to facilitate better functioning of healthcare managers.
I fully endorse the view expressed in the posting regarding the need to clearly define the issues under health and not conveniently equate health to healthcare. More often than not “health seeking behavior” has been confused with “healthcare seeking behavior.” The perspective and felt needs of the community are of paramount importance. It would be a major mistake to still the community as 'beneficiaries' of healthcare instead of the proactive facilitators that they are and must always be seen as.
It has been established beyond doubt that socio-economic determinants play a huge role in the scenario of physical, mental, emotional and spiritual health. The community has to be empowered enough to plan for its health, chalk out appropriate activities and implement and monitor them with tools - almost like a social audit. A tokenist participation of people in healthcare programming and healthcare service delivery will not take us anywhere - as has been the experience throughout the world, in developing countries in particular.
Keeping the Millennium Development Goals (MDGs) in proper perspective, all stakeholders and all implementers of health programmes and service providers in particular, must appreciate that "Health for All by 2000" never just meant healthcare services for all, though issues of inequity and inaccessibility still mar even that.
People have to take charge and find out global solutions through the localized communities acting on evidence (facilitated by evidence available throughout the Globe) in the most cost-effective manner.
Concerted collective action is the need of the hour (and all hours to come) to plan and work in accordance with a needs-based approach on sound and indisputable evidence generated by the community itself and not according to the mandate of some agency/funding organization or some theoretical/transplanted assumptions for replication of the "best practices" with "proven success" elsewhere.
Let us get over the biggest impediment in the desired way of operating accordingly - our mindsets that health is just a matter of hospitals, doctors and healthcare.
Being a medical professional trained at premier national medical schools, having worked as an government AIDS control programme manger for more than 8 years, I am crystal clear about the vital need of ensuring that the people play a central role in their health in a very empowered and proactive way.
Dr. Rajesh Gopal, AIDS Control, Government of Gujarat, India