LEARNING FROM THE THIRD WORLD

Abstract

The author outlines 4 guiding principles for the design of health services: 1) prioritization of low-cost remedies of proven effectiveness; 2) close collaboration with with other agencies such as water sanitation housing and transport; 3) good communication and referral links from the 1st contact level to the specialists and vice versa; and 4) mutual confidence and a sense of joint enterprise between the community and the primary health care service. These principles are as relevant in developed countries such as the UK as they are in deprived communities of the Third World. In fact some of the poorest urban communities in the world have much to teach developed countries about health care. Third World cities require pure water antenatal care growth monitoring of children oral rehydration and measures against common infections. The measures required in urban centers in developed countries are different yet the principle of prioritizing basic proven remedies remains. The concept of a strong referral network is established in countries such as the UK but it is often forgotten that the effectiveness and efficiency of health services depend on 2-way referral and communication between primary and other levels. In addition the Third World experience shows that 1st-line health workers must belong to their community in the sense of sharing its culture being accountable to it and living within it. If professionals and families are working at cross-purposes poor health care will be the result. Although countries such as the UK are privileged enough to think in terms of comprehensive health care even in Third World countries much can be achieved for as little as US$5/year/person.