Dear All,

The Indian capital of New Delhi and many places in the north of our country are having a chilly(by our standards) winter at this time.The same may hinder the process of reduction in the severity of the problem looming large in our part of the world also.

The problem of H1N1 is continuing unabated and we need to reaffirm our faith by revisitng the issues of community systems strengthening(CSS) besides the much needed health systems strengthening(HSS) in our part of the Globe.

Consideration of the right to health(and not mere right to health care) by all,its protection,promotion and fullest possible assertion which must be ensured through a committed concerted collective action.

Right to health is not just an option but the only solution to many of the socio-economic ills plaguing our societies in the developing world .

The same is writ large on the faces of the people and is visible(though not palpable at the moment)
as a prominent writing on the all.

We need to ensure the health systems strengthning and assertion of health as a human right .I wish to share my views about the CSS and the present flu pandemic.

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 extantpandemic 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’.The same pertains to the so called 'curative' interventions also.

The 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 full faith in ourselves and in our pursuits.


Rajesh Gopal.

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Comment by Dr Rajesh Gopal on December 22, 2009 at 4:27pm
Yes that CSS initiiative for malaria has been chalked out very nicely in some African countires as per the reports.
Comment by Laurence Gilliot on December 22, 2009 at 3:33pm
I agree with your arguments, Dr. Gopal. Community System strengthening is a very interesting initiative. Did you know that Malaria Competence will be used in CSS in several African countries?
It would be interesting to explore how we can adapt the Community Life Competence Process to the issue of H1N1.

Best regards,



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