POST 00933E : COMMUNITY HEALTH PLANNING
Follow-up on Posts 00888E, 00893E, 00907E, 00916E and 00922E
8 May 2006
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The following contribution comes from Makhaya Ndlangisa
(mailto:[email protected]) from South Africa. As others on this topic
it is cross-posted from The Connection network (mailto:[email protected]).
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I would like to comment on a technical discussion raised by Dr. Koku
Awanoor in Post 00916E on the joint possibilities. In post 00922E Dr.
Anthony Theophilus Seddoh commented on the consistency of the denominator
and numerator issues. As an epidemiologist, I would support Dr. Awanoor
and agree with him on his explanation that is scientifically correct and
does not have any inconsistencies regarding denominator and numerator.
Regarding the CBHS I would say that the approach described in Dr.
Awanoor's contribution is sound and based on primary health care (PHC)
principles that are proven to be effective through many operational
research throughout its implementation. I personally find Ghana experience
as working "with" the community which is the key in attaining success as
documented in the paper. Unfortunately, we witness many activities for
rural communities that is not based on these principles and function
mainly as working "for" the community. Fixed sites, even difficult to
sustain, have many advantages compared to all other alternative methods of
service delivery especially on the "acceptance" by the local communities.
We have many examples that when the support is over such alternative
initiatives despite demonstrating good results in short period of time
have the tendency to decay fast.
I agree with all counter arguments that fixed sites require more effort
and resources, but once communities are the "owners" they defend their
case. This is why in some ex-USSR countries even health workers are not
paid (or extremely under-paid) for months - they never ever shut the doors
of the health centre. Every morning they come to serve their communities.
We should ask ourselves what makes these health workers to come to work
every morning regardless they are paid or not. The answer is the
"community". Community provides support to these health workers to survive
as a return. Because these health workers are the ones who work "with" the
community. The community gives support not to lose what they have invested
in - that is the community's future: their health. Community based
initiatives are the key, they are critical, but these initiatives should
never be used as an excuse by the government (state) to invest less and
less every year to health field and human resources. We need more
commitments from the governments for their own people.
Warm regards and greetings from South Africa,
Dr. Makhaya Ndlangisa
Epidemiologist
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