Articles

HEALTH FOR ALL BY 2000 A.D.- A REALITY OR A MYTH ?

            Dr. K. RAGHAVA PRASAD

            Prof. Of Social & Preventive Medicine &

            Vce-Principal, S.V. Medical College

            TIRUPATI

            It was historic moment when the World Heaith Organisation, in May 1977, resolved that  the main social target of governments and the W.H.O. in the coming decades should be the attainment by all citizens of the world by the year 2000 of a level of bealth that will permit them to lead a socially and economically productive life.

            This global initiative, first of its kind in the annals of mankind, cullminated in the objective of Health for all by the year 2000 as the social goal of all nations. Though the objective of the W.H.O. itself set out in the preamble of its constitution, is “the attainment by all the peroples of the highest level of health to all people – a level that enables them to work productively and to participate actively  in the social life of the community in which they live such that the individual and  family needs are adequately met.

            HFA does neither mean that nobody in the year 2000 will be stick or disabled not that the best medical care will be provided for everybody for all their ailments. It means that there will be an equitable. I.e. need-based, distruibution of available resources and services along with improvements in related social and economic spheres. The health services have to be reoriented and restructured towards this goal of HFA.

            The joint WHO/UNICEF  International conference in 1978 at Alma Ata endorsed the call for HFA / 2000 and proclamied Primary Health Care as the stratery to achieve HFA. The Alma Ata conference further declared that “ existing gross inequality in the health status of people eapecially between developed and developing countries as well as within the countries is politically, socially and economically unacceptable”. The primary health care approach is based on five cardinal principles viz., equitable distribution of health resources, community participation, focus on prevention, intersectoral cooperation and appropriate technology.

            It is to be noted that though the goal of HFA is universal, the levls of health aimed at and the strategies are not uniform for all countries. Similarly though the Priamry Health Care Approach is equally valid for all countries, the problems addressed at the level would differ between and among developed and developing countries depending on the political, social, economi, georaphic and other factors.

            India as a signatory to the Alma Ata declaration is  committed to attaining the goal of HFA/2000. Our National lHealth Policy enunciated in 1983 reflects this commitment by the emphasis laid on providing uniform and comprehensive primary health care services through reorganization of the health service infra-structure, thorough overhaul of the current systems of education and training of health personnel and completer intergration of all plans of health and human human development sectors. It has laid down the goals for health and Family Welfare Programmes to be attained by 2000. Some of these goals are given below shown against the current status.

Indicator                                                         Current level                       Goal/2000

Infant Mortality Rate                                        73 (1994)              below 60

Maternal Mortality Rate                          29 (1994)                 21

Crude Death Rate                                        9 (1994)                  9

Babies with low birth weight (%)                   30 (1992)                 10

Deliveries by trained birth attendants                   47 (1992)              100

Though there have been notable imrpovements in mortality, there are serious problems in the areas of communicable diseases, malnutrition, environmental hygiene, population growth and reach of health services. The same is true of other develping (poor) countries where hunger and disease are rampant and health is far from being brought within the reach of everyone. Political and professional leaders are voicing concern whether HFA/2000 proves to be a realistic dream or a utopian dream. Only four years are left and the goal seems less probable than it did in 1978.

            In India, the concept of Primary Health Care did not really take roots and is beset with the following problems and constraints.

1.      Inadequate financial allocation to health care delivey.

2.      Lack of quitable distribution of resources both geographically and in terms of levels of care.

3.      Poor coordination and linkages of health with other sectors of development and (b) among diifferent susectors of health.

4.      Lack of appropriate manpower policy.

5.      Poor management practices and use of inappropriate technology.

6.      Lack of community privatization of health care posing a threat to public services.

7.      The increasing privatization of health care posing a threat to public services.

The National Health Policy does address the above issues by stating the problems in very general terms but did not give any specific directions nor set any time frame for solutions.

            HFA is holistic concept calling for efforts in ariculture, education, housing, communications and industry as well as in health. Someone said recently “No HFA by 2000, not for many generations without concerte and credible actions to alleviate poverty”. This statement only highlights the importance of poverty alleviation as a precondition for HFA. In other words social justice in health and other fields as land reforms and wages is essential opportunity, in the ultimate analysis. Hence a broad based movement of radical redistribution of economic and political power and deep transformation of ideas, attitudes and values are called for to achieve HFA. Thus measures for poverty alleviation and social justice hold the key to HFA in all developing countries including India.

            The other areas needing urgent action are :

1.      Programmes promoting community participation.

2.      Transformation of ideas, attitudes and values among professionals and administrators.

3.       Increased budgetary allocation for health sector.

4.      Steps to consolidate the primary health care system, to provide back-up support of higher levels and to strengthen epidemiological services.

After the above overview of the goals, achievements, problems and prospects, I wish to point out that the philosophy and concept of HFA have to be understood in the correct perspective. It the turn of the century or some other historically important date. Great importance need to be attached to the deadline of 2000AD as long as the efforts are made in the right direction and results are encouraging.

      Devlopment programmes should focus more on quality of human resources, on human well being and on productivity. Access to health services, education food security and clean environment are the basic prerqequisites for HFA. To ensure these for all people may be a distant dream, but a dream which we should strive to realize.