Provision Of Basic Health Care Research Articles

School-based mental health services in the United States: history, current models and needs.

Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.

Is liberalisation damaging Albanian women's health?

Albania is suffering from low levels of economic development and political instability, which have led to impaired provision of basic health care. With 40% of the population under age 15 years, Albania is experiencing a high rate of natural increase and a high but falling birth rate. In January 1992, Albania legalized abortion for women over age 16 years who are less than 12 weeks pregnant. Women outside of these parameters must face a special commission to obtain an abortion. In the first quarter of 1992, there were 0.8 births/abortion. Rapidly deteriorating conditions in maternity homes and women's hospitals are characterized by a lack of anaesthetic, reuse of equipment including needles, and failure to change sheets between patients. There is little access to contraception or sex education, especially for poor women. Child care facilities are being closed as factories shut down and private individuals reclaim the villas used by the government as child care centers. Albanian children suffer from a very high incidence of viral hepatitis, diarrheal disease (with no production of oral rehydration salts in the country), and parasitoses. In rural areas, one nurse serves two or three villages, most births take place in single-roomed homes which lack disinfectants, and people suffer from poor nutrition caused by lack of access to food. Access to water is also limited and available only on a strict timetable. Current conditions in Albania make it dangerous for women to walk abroad at night alone. In addition, the number of traffic accidents is increasing, as are incidences of domestic burglary.

Recovery, Resterilization, and Donation of Unused Surgical Supplies

THE CRITICAL shortages of medical supplies in many impoverished nations limit the provision of basic health care and may be as demoralizing to physicians and nurses as is their huge workload.¹Arthur Hartman, former US ambassador to the Soviet Union, writes, "The new commonwealth can produce only 15 to 20 percent of the medical supplies it needs, and it does not have the hard currency to import them... medical workers are forced to reuse syringes and needles."²While it may be difficult to anticipate the usefulness of elaborate medical equipment in developing nations, it is clear that the people of such countries desperately need basic supplies. For editorial comment, see p 1462. Although poverty will affect health care in developing nations for decades to come, this does not preclude effective care of the sick and injured.^3-5"Poverty in material resources is not matched by poverty of intellect

Community response to primary health care: Obadan project in Bendel State of Nigeria.

This paper describes a pilot study in which a rural community in Bendel State was involved in the provision of basic health care for themselves. The communitys contribution to planning and support for the project the services provided and their utilization are described. In view of the problem of lack of medical care a maternal-child health center was established by community members. The responsibilities of the village health committee were: the planning and supervision of the operation of the project; liason between the health team the elders and the people; collaboration with the health team; and periodical reports on the progress of the project to the Committee of Elders. After 1 year the response of the community was assessed in terms of their participation support utilization and services rendered. The Health Committee was very active in the planning and implementation of the programs of the project. Weekly antenatal clinics were run served by traditional birth attendants (TABs). A fee equivalent to US$1.5 is charged at the time of 1st antenatal attendance. All personnel for the clinic are TBAs and village health workers (VHWs) who receive no enumeration for their services. TBAs were instructed on how to estimate gestational age to identify a few risk factors in pregnancy and when to refer patients for more skilled care. VHWs weigh and chart children under 5 and treat some minor ailments. The male members of the health committee dress wounds and dispense drugs. Issues not agreed on by the committee members are ultimately decided by the Council of Elders. Support for the project was provided by the community itself. Additional services rendered are: screening children for malnutrition home visiting by VHWs and TBAs for health education and surveillance of at-risk families. Given motivation guidance and supervisory support the community can provide adequate health services.

The Chimaltenango development project, Guatemala.

The director of a rural community health project in Guatemala the Chimaltenango Development Project states project findings--namely that health care should be made available to people on their terms; provision of basic health care requires a multi-faceted approach; and liberal experimentation is needed in manpower training of those selected for this purpose by the communities. Health workers in Chimaltenango an agricultural Indian community list population control malnutrition health training of community members and community selected health workers and curative medicine as medical priorities. They also feel that by aiding villagers with agricultural production and marketing and attempts to gain land tenure they can raise their standards of living thus improving community health. The importance of self reliance for health care--breaking the medical monopoly--is emphasized.