Community Systems Strengthening(CSS) and Swine Flu

Dear All,

The need to specifically look into the ways of strengthening the community systems cannot be emphasized more at any other time than perhaps in the present scenario of the extant(though some still say imminent)pandemic of Influenza A ('swine flu/Mexican flu).

In the past we have always worked on health systems strenghening(HSS) in isolation under the mistaken presumption that it alone would be adequate to ensure access to equitable healthcare ,in an emergency or otherwise, to all those who need them.

Even under the rights perspective it was just the right to health-care which was considered to be focussed in our plannings and interventions.

It is ,however,strongly felt by me that it is imperative to ensure fully community based and community led interventions backed with directed efforts for a sustained community systems strengthening(CSS) .All the pursuits must be in accordance with the reguirements of establishment,protection,promotion and full assertion of the right to health.

All the socio-economic detrerminants of health have to be clearly delineated with a strong community perspective on the basis of evidence generated and /or validated by the community.Behaviour change for practices like hand washing,a 'cough etiquette' cannot be just adopted in all parts of the globe by a mere dissemination of 'IEC materials'.

Just released WHO Guidance package for pandemic influenza preparedness and response clearly mentions the need for "whole-of-society" approach based on a comprehensive response from the community at large and not the traditional 'health sector' in isolation.

The WHO Guidance,Interim CDC Guidance and the national/technical guidelines and literature must be consolidated to meet the local requirements to strengthen a community based response supported by an effective and adequately monitored(say by social audit) quality service delivery.

Together we can definitely tide over this or any other crisis in future also with that approach.

Do provide your valuable feedback and critical commments to faciltate finetuning of the perspective,line of thinking and approaches.

Thanks and best wishes,

Dr Rajesh Gopal,Gujarat,India.

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Comment by Dr Rajesh Gopal on May 3, 2009 at 9:40am
I will keep the itinerary in mind for any feasibilities of meeting in person.
Best wishes and a very warm welcome to India!!
Comment by Gaston on May 3, 2009 at 9:25am
Thanks for the quick response. My itinerary: 4-9 Dimapur, 10-12 Delhi, 13-17 Bangalore/ Chennai. If it's not possible to meet physically, let's continue communicating online.

Comment by Dr Rajesh Gopal on May 3, 2009 at 9:03am
Dear Gaston,
I have already acquired the wonderful tool and we are in the process of assessing the preparedness for Influenza A pandemic.
Incidentally I was in DIMAPUR last November(in the extreme east of the country) to facilitate mainstreaming of HIV/AIDS with all the government departments of the state government as invited by them and the NACO /UNAIDS.

Did my Human Rights Law from National Law University,BANGALORE and have studied medicine from the AIIMS at NEW DELH(the city has our national headquarters at NACO)I and keep going to KOLKATA often
.I,however, work in th western most state of India with no immediate plans of visiting this cities in the near future(I was in Delhi in the last week).

Do communicate your itinerary to facilitate meeting in person.We can always interact through electronic communication.

Thanks for you message.

Rajesh GOpal.
Comment by Gaston on May 3, 2009 at 7:47am
Dear Rajesh, testing the self-assessment tool in India would be a great idea. I was one of the coaches that facilitated the development of this draft framework on Human Influenza Pandemic Preparedness and it can generate a very valuable discussion (going beyond swine flu) in a community.

I'll be in India for the next two weeks (leaving tonight). I'll be in Kolkata, Dimapur, Delhi and Bangalore. Are you anywhere near these places so we could meet and discuss further on using the approach/ tool on this topic? My email: .

Best regards,
Comment by Dr Rajesh Gopal on May 2, 2009 at 11:20am
Dear JL,

I really don't know why these virual meetings give me a feeling of having 'known' you for umpteen years.

We in India have always had a system where the 'patients' are made totally dependent on the prescribers of medicines.The language used in the prescription is not just Latin and Greek but akin to pure heiroglyphics intelligble only to the 'blessed few'.

We started a 'movement' induring my days in the medical school to use full sentences in the client's own language with drawings of tablets /capsules in the number they have to be taken in a day.There was a tremendous improvement in adherence( I don't prefer the word compliance) to the precribed drugs besides building up of good rapport with the physicain who was seen as a friend ,counsellor and faciltator of medical treatment rather than just a Mr/Ms.Treat All,Heal All-almost a demi-god.

We would definitely like to test self assessment for Human Influenza Pandemmic Preparedness here.

Best wishes,
Rajesh Gopal.
Comment by Jean-Louis Lamboray on May 2, 2009 at 10:47am
Dear Dr Gopal,

What makes people who never met think in harmony?
You give such a clear example of the need to distinguish between the health system where the key decision maker is the individual within the family and the community, and the health care system, where the "prescribor" seems him:herself as calling the shots.
Constellation coaches and colleagues from IFRC and the Liberian Red Cross developed a self assessment for Human Influenza Pandemmic Preparedness. Would you want to test it in Gujarat?
Self-Assessment tool- prepare flu pandemic.doc


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