Primary Health Care
High Priority

By Jhabindra Bhandari

IN a developing country like ours where majority of the population live in rural areas and have limited access to health care, primary health care is of central importance among many other priorities of development plans and policy. As public health is an integral part of national development, national and international development community have emphasized much on primary health care to reach the social goal of health for all.

Despite the strong commitments of primary health care as only approach to health for all, the achievements are still dismal. Undoubtedly, there are still problems and challenges ahead to deliver quality health care to the entire population with the existing meager physical and human resources.

The rapid population growth has been a constraint to all aspects of development. Among other important issues of food security, sustainable use of natural resources for environmental conservation, the demands for health care and education are on rise due to the increasing population. The emerging problems of public health have therefore been a matter of serious concern particularly in the poor developing countries of the world.

The new national health policy has given high priority to provide health care for all. The policy explicitly has an emphasis on the significant reduction in maternal and infant mortality as an important priority. Moreover with the help of existing heath facilities at sub-health posts and health posts (S/HPs), the policy mentions the provisions of primary health care to all people in the rural areas.

Primary health care receives high priority while developing community based health policy and programmes. In this regard, it is important to note that one of the important objectives of the primary health care outreach clinic is to improve the accessibility and coverage of primary health care through developing a network of three to five outreach clinics per village development committee. To make this more effective, there needs regular monitoring and supervision from the district and peripheral health facilities.

Among many others, local resource mobilisation in health sector especially at the village level is still poor. Recognising the importance of rural health care, local health volunteers and development workers at the grassroots can play significant role in providing primary health care to the rural population. Community participation in primary health care is of utmost importance in service delivery and optimum utilisation of available health care.

On the other side, capacity building of these volunteers and health workers in information, education and communication aspects of primary health care has been a very crucial issue as these are the frontline service providers in the communities. There needs regular supervision and monitoring of primary health care programmes in the district and villages. Unless there is local recognition of health facilities in terms of managing and delivering primary health care in the communities, the impact of the investment would be minimal.

Recognising this, the launching of primary health care is definitely a major landmark. In order to reach the rural population at the grassroots, this strategy is extremely significant to promote primary health care services. Creating social, political and physical environment to improve the health status of the people requires a multi-sectoral approach.

In a country like ours where poverty and illiteracy are remarkable challenges, the health status of the majority of the people presents a gloomy picture. This is true that poor health is closely associated with poverty. No doubt that the better health of people contributes to greater economic security and development for better livelihood in society.

The indigenous health seeking behaviour is largely influenced by the social and cultural aspects. Still people prefer to traditional healers for health care in the rural society. Awareness on health and sanitation and provision of services in the local facilities is very poor. There is still lack of increasing access to adequate supplies of clean water and sanitation for all communities.

To improve the health seeking behaviour of community people, partnership provides linkages and better access to first line health care providers. Thus, there are urgent needs of community based health and education programmes that place an emphasis on empowerment and community participation for health promotion.

There are many rooms for improvement to strengthen district health system. With poor physical facilities and institutional capacity of health facilities, there lacks quality health care in the district and peripheral health facilities. There needs bottom up planning approach in health sector, too. For the information on mortality and morbidity pattern at district and village level, participatory operational research give clear direction to programme development and service provision.

In the context of local self-governance act, Village Development Committees (VDCs) and District Development Committees (DDCs) have to play key role to give high priority on primary health care in its annual and periodic development plans. Strengthening the management committees of the S/HPs, primary health care centres and district hospitals is extremely essential to increase access to quality health care in the communities.

Though emerging issues of child rights are much talked in the recent years, there needs focus on children and women while planning health programmes. True, children and women in the community provide a critical role in health development and promotion.

After all, the right to good health is a fundamental human right as reflected in the universal declaration of human rights. The priority health problems in the country should therefore be addressed in planning and implementation of both preventive and curative services at all levels.

In order to accomplish the ambitious goal of health for all, the government and civil society should, more importantly, work together in strengthening access to quality health care and services to the entire population in an innovative approach. In this regard, promoting local leadership with a greater emphasis on political commitment and partnership can make a difference to the health of people.

Brooding Over The Next Plan

By Mohan K.C.

THE Ninth Plan is coming to an end. In fact, it had a belated starting and the effects can be seen in that the objectives set forth has come nowhere towards fulfilment. Poverty alleviation was the basic thrust of the said five year plan. The annual plans, though designed to do piece meal jobs of the five year plan, could not do much in achieving the stated objectives.

The Ninth Plan was ambitious in a way. The basic aim of the plan was to take the country, in the new millennium, to chart new heights. But as it is, not much achievement has been made. The plans and programmes designed to meet the requirements at least in theory but when it comes to the implementation aspect, there are always many reasons to be dissatisfied. This is an inherent weakness on our part so the objectives howsoever modest they may be are not met. This is the reason for the rampant poverty that still exists despite the tall slogans on the contrary.

There is a saying that peace is the biggest need for development in the actual sense. But the country has lagged behind in it. And there are some districts in the Western and Far Western regions that are affected by the Maoist problem. To solve law and order problem is the supreme need if the development activities can take place smoothly and without any impediments.

Now the formulation and the implementation of the Tenth Five Year Plan is round the corner. Hectic activities are taking place so that it would be ready for implementation in the next fiscal year. As has been the case with the poor country that Nepal is, the focus of the Tenth Plan (2002-2007), as the indications are, will be on poverty alleviation. As per the strategy that is being worked out the number of those below the poverty line is to be reduced to 30 per cent by the end of the five year period starting next fiscal year. This is by all means a modest objective.

Though there have been many programmes during the Ninth Plan like the BP with the Poor but the implementation aspect has been the toughest. First of all, the identification of the underprivileged people or the families has been quite difficult. This can be understood from the simple example that the census works could not be conducted in a number of districts this year. This shows that results were no commensurate with the envisaged aims. The loose implementation of the poverty alleviation programmes coupled with the law and order problem has delayed the country’s objective of alleviating poverty.

The economic growth rate that was expected to hover around 6.5 per cent has not materialised as yet. The agricultural production too has suffered. In the industrial sector too, the growth has been disappointing. Unless the industries come to the rescue of the agricultural sector no overall change can be expected in the national economy. With the population standing at almost 24 million, the growth has to be between 6 and 7 per cent if there is to be an equitable distribution of income. It is not that no development has taken place but the fact remains that the present growth rate is not enough to take the country out of the underdeveloped state that it is in at present.

The Tenth Plan is estimated to have a budget 12 per cent over the Ninth Plan. The projections may sound as sweet music. But estimates alone cannot present a rosy picture.

Moreover, the dependence on foreign assistance, whether loans or grants, is still expected to be around 14.5 per cent. The efforts to reduce dependency will not come even about six years later when the turn for the Eleventh FiveYear Plan comes around. The reason for the dependence on foreign help is that the development activities in the country have not picked up the pace that it was expected to. Moreover, in the recent years, the attacks on industries, primarily the tourism industry, have been quite devastating. The industries have seen a sharp drop in their production that has directly affected the revenue generation which is so essential for keeping the development activities ticking. Recently the breweries have felt the attack intensifying on them. With the agreement regarding the sale, distribution and consumption of alcohol, the concerned industries have felt the blow with production being curtailed.

The tourism industry has also been reeling as the arrival of tourists has not been as expected. When the arrivals should have gone over the 500,000 mark (made in 1998), it is very unfortunate that it is no where near it at the moment. Various events have been responsible for this sad state of affairs.

All these have had their repercussions on the national economy and the non-fulfilment of the expectations of the Ninth Plan. But with a strong will specially concerning the implementation aspect, there is no reason why the number of people below the poverty line cannot be reduced to 30 per cent. And rapid pace of industrialisation is the only weapon in hand.

US-Mexico Border Booming With Business

By Julie Watson

ON paper, the region looks like Mexico’s poster child for development. President Vicente Fox’s government calls it the motor driving his country’s economy.

In the past six years, Mexico’s border with the United States has captured nearly one-third of the country’s foreign investment. Salaries and education levels are twice the national average.

Yet while the border is home to operations of the world’s wealthiest corporations and Mexico’s highest skilled work force, thousands live in shacks on dirt roads crisscrossed with a maze of strung-up electric lines.

Diseases, such as Hepatitis A, are well above the national averages on both sides of the border, and uncontrolled growth has left cities with crumbling schools, overrun hospitals and dilapidated sewage systems. Officials say the main aquifer feeding the twin cities of El Paso and Ciudad Juarez at Texas’ western tip may run out in 25 years.

Both Fox and President Bush have pledged to build a new frontier, but just how they will do that remains to be seen.

Many say the squalor is the outcome of a binational industrialisation programme between Mexico and the United States that drew thousands of foreign-owned assembly plants, mostly American, to the border in the mid-1960s with lucrative tax breaks and cheap labour. The plants, known as maquiladoras, spurred growth but left city coffers thin.

Then the North American Free Trade Agreement came into effect in 1994 and the region boomed with even more jobs, and more shantytowns.

The situation has sparked a debate about the tax-exempt status enjoyed by the maquiladoras - some of which have been in Mexico for decades.

Mike Allen, a trade specialist with the non-profit McAllen Economic Development Corporation who founded the Texas Border Infrastructure Coalition, says it’s time both federal governments invest in the region.

"We simply have not had the support to carry on trade between the United States, Canada and Mexico," he says.

Mexico’s border commissioner, Ernesto Ruffo, says financing should come from a slew of sources ranging from toll roads through trade corridors to a binational fund generated by government-backed bonds issued by states on both sides of the border. He estimates dlrs 20.8 billion is needed to bring infrastructure up to speed on the Mexican side alone.

"We need to focus on infrastructure to advance to the next stage," Ruffo says.

Ruffo sees a radically different region in the future. He wants current assembly plants to start moving farther south to Mexico’s more impoverished states and be replaced by higher-tech industries and manufacturing plants on the border, where the work force is more experienced.

Maria Rios, 17, who sews American clothes at a maquiladora in Matamoros, is among those preparing for such a change. Rios, who earns about dlrs 50 a week and lives in a cement hovel, recently started taking computer and English classes.

"I don’t just want to work my whole life sewing clothes," she says. "I want something better."

AP