ATIVIDADES DE SAÚDE PÚBLICA NA ZONA RURAL COM ESPECIAL REFERÊNCIA AO ESTADO DE SÃO PAULO, BRASIL

Abstract

The authors begin their paper with discussion of what constitutes a rural area. After pointing out the impossibility of a rigid definition, they accept the concept of rural communities as those of less than 2,000 inhabitants and those of greater population which present public health problems similar to rural areas. They then touch upon certain aspects of public health activities for rural areas, principally sanitation, medicai care, maternal and child care, the control of transmissible discasses, but they consider basic, above all, an integratecl program that serves the needs of the population. The importance of knowledge of the cultural patterns of the community and the use of education to bring about the best possible participation of the people themselves in the programs that are to be developed, are emphasized. In a review of the organization of the services directed toward carrying out the activities, the authors distinguish between two general types: mobile units and permanent public health departments. They describe the two types of organization, citing various examples from Latiu America and Brazil. In a study of the situation in the State of São Paulo, existing plans and services for providing assistance to the rural population are analyzed. The authors comment on these services, pointing out the disadvantages of mobile and specialized services, and the advantages of permanent units adequately equipped with personnel and equipment to serve the population under their juridisction. Based on these considerations, the following conclusions are presented:1. From all points of view, it is reccomended that the rural public health program should be the responsibility of an adequately staffed regional polivalent public health center, which may stablish small permanent units located in those rural areas where there are concentrations of population. 2. A permanent unit (sub-center) in a rural community should have a staff of at least one and possibly more public health workers who preferably should be residents of the local area. They should be under the supervision of professional personnel of the public health department. 3. In the local area it is desirable to have a public health nurse who m the course of her activities keeps close contact with the local population. The sanitarian is also of great value in carrying out the sanitation program. Both may have the help of trained auxiliary personnel who should be local residents. 4. Specialists from the central health unit may periodically provide services to the local population; however, when necessary, the rural population may seek those services at the central unit. 5. As to the situation in the State of São Paulo, m place of creating specialized services for the rural population, it whould be more highly recommendable to reorganize the vast system of Health Centers and "PAMS", already in existence, in order to make it possible for these units to carry out their true role of multi-purpose organs of public health; simultaneously there should be developed a program for the training of professional public health personnel and indispensable auxiliaries, in order to develop the best possible program of medicai assistance and public health services in the rural areas. 6. In that a program of public health is one aspect of rural welfare, public health personnel of all categories and leveis should develop a spirit of cooperation and team work not only among themselves but also with all others who are striving for the promotion of the well-being of the rural population. 7. An important objective of a public health program is to stimulate the local population to work toward their own improvement and thus the public health team should see as one of its functions "helping them to help themselves" to raise their own levei of living and consequently achieve a better state of health.