The Fairer Health Care ultimate goal is better health for all people. World Health Organization (WHO) has identified five key elements to realizing and achieving this goal: for instance, reducing social disparities and exclusion in health (universal-coverage reforms); systematizing and organizing health care services around people's expectations and needs (service delivery reforms); combining and integrating health into other different sectors (the public policy reforms);practicing and pursuing collaborative policy dialogue models (leadership reforms); and also increasing the participation of the stakeholders. Fairer Health Care is vital health care that is made accessible at a cost that a community or a country can afford, with processes and methods which are practical, socially acceptable and scientifically sound (Campling, 2005).
Fairer Health Care and Community Development
The Alma-Ata Declaration also emphasizes that all people should have right to use Better, Cheaper, and Fairer Health Care services and also to access to PHC, and that everyone should take part in it. The approach of Fairer Health Care takes in the following major components: community participation/involvement, equity, intersectorality, technology appropriateness and affordable costs (Greenhalgh, 2007). As-a-set-of-activities, PHC should include at the very least the health education for all people and the entire community on the nature and size of health problems and also on methods of controlling and preventing these problems.
Other important activities include the back-up or the promotion of adequate food supplies and right nutrition; basic hygiene and enough safe water; child and maternal health care, including immunization; family planning; appropriate treatment of injuries and common diseases; and the provision of some necessary drugs (Campling, 2005). As defined above, Fairer Health Care will do much in dealing with many of the pre-requisites for healthiness indicated earlier.
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The Fairer Health Care concept that is adopted at the Alma Ata Conference in the year 1978 is endorsed by NPPHCN and it forms the basis of NPPHCN definition of Fairer Health Care. A progressive PHC approach; challenges the community/society to deal with the socioeconomic causes of the poor health and creates provision for the basic health care needs. It encourages the empowerment of a community by ensuring that all individuals are fully able to handle and manage the resources which are available to them. It also provides comprehensive or complete quality health care as well as; preventive, promotive, curative, palliative and rehabilitative services (Andrews, 2008).
It demands accountable and concerned health worker practices. It prioritizes those people who are mostly disadvantaged by ensuring that the health care is equitable, accessible and affordable to all individuals. It recognizes the significance of provision of integrated services from the primary to tertiary levels of health care which are within a coherent or a consistent health system. Generally it promotes multi professional, inter-disciplinary and intersectoral collaborative joint effort development (Greenhalgh, 2007).
PHC seeks to extend the 1st level of the system of health from sick care to the health development. It seeks to promote and to protect the health of the defined communities and also to address people issues/problems and at an early age it populates health. The services of Fairer Health Care involve care continuity, education and health promotion, incorporation of prevention with sick-care, a population concern as-well-as individual health, community participation and the use of proper technology (Parker, 1999).
PHC incorporates primary care but has a wider focus through the provision of a comprehensive range of general services by multidisciplinary panels that include not only nurses and GPs but also allied or related health experts and other different health workers, for instance, multi-cultural and Indigenous health workers, promotion, health education and workers of community development as-well-as providing these health services for families and individuals, Fairer Health Care services also operated at the communities' level ( Parker, 1999). The approach for achieving or accomplishing the goal of Health for All came out in the year 1978 at a historic and remarkable conference in Alma-Ata in the earlier Soviet Union.
This conference was supported and sponsored by the (UNICEF) United Nation Children's Fund and (WHO) World Health Organization. Before Alma-Ata Conference, World Health Organization had identified 8 components common to thriving health programs (Beer, 2006). These code words Fairer Health Care (PHC) were chosen to describe the following 8 components in amalgamation: education in relation to common problems of health problems and what can be done to control and prevent them; child and maternal health care comprising of family planning; support of appropriate nutrition; immunization against some major transmittable diseases; basic sanitation; a sufficient supply of clean water; control and prevention of locally widespread diseases; and proper treatment for common injuries and diseases (Andrews, 2008). Fairer Health Care (PHC) emphasizes on prevention rather than the cure. PHC also relies on community involvement or participation, home self help and technology that individuals find appropriate, acceptable and affordable (Dickens, 1999).
Consequently at Alma-Ata earlier accepted strategies to medicine were metaphorically turned on their head. The curative medicine would later in the future take the 2nd place to prevention ( Parker, 1999). All countries' representatives that were in-attendance signed the Declaration of Alma-Ata and also pledged to go back home to begin channeling funds to PHC and to shift from the central control toward the regional control and the district control (Beer, 2006). These were radical changes that, if put into practice, would begin to encourage people to take-charge-of their health care. However such a spectacular shift in thoughts and action would need something that was not for all time forthcoming and accommodating political will.
An evaluation that was conducted in the year 1983 confirmed that, even where there is political, those accountable for a nation's mental, physical and social wellbeing did not have adequate spending power to make noteworthy improvements with no assistance (Greenhalgh, 2007). For that reason, in the year 1985 World Health Organization invited NGOs i.e. non-governmental organizations to help the governments to achieve the Alma-Ata goals. Several responded, mainly, by cooperating with the national governments in training the Fairer Health Care workers who were selected from their local communities (Dickens, 1999).
In the year 1989 in joint venture with numerous NGOs, Facts for Life, a brochure that was published by UNICEF, WHO, United Nations Educational, Scientific and Cultural Organization (UNESCO) and the United Nations Fund for Population Assistance (UNFPA), assembled/brought together crucial and very important information on family and child health that they resolute every family in the globe had a right to know (Beer, 2006). The booklet was thoroughly revised in the year 1993 in light of the latest research and now eight million copies in over one hundred and seventy five languages are being utilized in more than one hundred countries (Andrews, 2008). Facts for Life has turned out to be the basis for the efforts of health education by the national health services, for Non-Governmental Organization programs in Fairer Health Care and for the classes of adult literacy (Parker, 1999).
Facts for Life affirms that the womanhood multiple burdens are too great. Nonetheless, in many cultures, female and male roles are deeply and profoundly rooted in tradition and often they are perpetuated by both women and men attitudes. If all these roles are to alter, men and women must both concur that change is enviable and then they must together decide how responsibilities and duties can be redistributed (Parker, 1999). The significance of consultation on this particular topic/subject was highlighted by many male health experts who were interrogated after a medical conference that was held in Tanzania where the importance and the need for men to be more concerned and involved in protecting their children's health was emphasized. When we try to do this," they said, "our wives think we want to interfere with their work (Greenhalgh, 2007).
Fairer Health Care and Community Development
A community development strategy has been adopted in the out-reach work component of the Alexandra Health Centre in South Africa (Dickens, 1999). The significance of the local community organizations has been established and recognized and the Health Centre is not only seen as providing the technical answers/solutions but also as helping individuals to achieve improved and better conditions of living. This requires rigorous management, clear motivation and purposeful action by the health staff teams and also planning in-conjunction with the entire community.
PIP: Alexandra, a rural community in SA with 200,000 residents, is 15 KM from Johannesburg. The Alexandra Health Center and University Clinic is the key provider of comprehensive health care in a way that empowers and encourages the community; it is a health care model for similar local communities in the 3rd World (Andrews, 2008). The purposes of outreach are to increase health care accessibility, to improve the compliance or the conformity with the treatment for unremitting diseases and also to ensure the functioning of the preventive and the promotive health care programs (Beer, 2006). As the health services have enhanced, attendance from the bordering/neighboring areas is greater than before.
This outreach system makes sure that the focus remains on the Alexandra residents and the community's disadvantaged individuals such as the squatters, the disabled and the elderly. These services consist-of: community participation/involvement promotion, support of outreach services, community organizations, community education and health research on community services and outreach and information gathering for the health information system establishment (Andrews, 2008).
These outreach services cover the neonatal and maternal health, workers' health, child health, chronic and geriatric care and community-based education and rehabilitation. To meet all these requirements, a community based network of the health-extension staffs could be developed who are chosen, employed and trained by Alexandra Health Center. This training would cover PHC, resources of the community, education and communication techniques, and community based systems of information (Andrews, 2008). The staffs would be based in the health units and each covering two thousand families, from-which several outreach services could be afforded and provided. Their duties would be environmental supervision, home visiting and community education and organization. The Alexandra Health Center also offers assistance with monetary management and also offers the physiotherapists and doctor services for the Nokuthula Center for Children who are Mentally Handicapped (Greenhalgh, 2007).
This qualitative research aimed to explore PHC professionals' outlooks on the community development and to discover the barriers and opportunities associated with the using of this approach/strategy in practice. Community development participants training-especially health visitors-took-part in some small group-discussions before and after and also 6 months following that training course (Beer, 2006). Opportunities for making use of a community development strategy/approach were identified however they were restricted by the lack of interest from a few communities, lack of support and leadership in health visiting and also by the increasing medicalization of the health promotion.
There is a possible conflict between the community development ethos and the plan/aim of the national, policy driven public agenda (Greenhalgh, 2007). Proposals and recommendation are recommended to change the health visiting organization in order to aid in the adoption of the public health strategies/approaches including the community development. These amendments would enable the health visitors to use the help which is readily-available from the recently selected public-health practitioners, whose responsibility and role is to promote the public health practices in (PHC) Fairer Health Care (Beer, 2006).
Public health is very high on the United Kingdom's health care strategy agenda, and the nurses of the community are seen as been instrumental in helping in the reduction of health inequalities, in the promotion of social inclusion and in improving people's circumstances and lifestyles. Government policies put emphasis on the partnerships between communities and agencies and working with individuals in the community to reduce the health inequalities and improve health.
Community development been defined by Minkler, is a process that stresses-on working with people while defining their own goals, mobilizing their resources and also developing their action plans for addressing the problems which they have collectively and jointly identified. This is being promoted as a proper approach and strategy to addressing these problems/ issues (Shabecoff, 2001). The approach/strategy contrast with that of the traditional PHC team, which is mainly based on working with families and individuals, but it is in-tune with the health visiting principles, which involve looking for and stimulating health needs' awareness, influencing the health policies and also promoting the health enhancing activities.
The new primary-care groups: local-health groups in Wales are required to shape health services, assess the health needs/necessities, reduce the health inequalities, listen to views of the users and also work in partnership with the local agencies. This will definitely require a wide range of skills which a small number of Better, Cheaper, and Fairer Health Careexperts presently have. Few fund-holders under-took any health needs/necessities assessment or involved the patients in buying, and the government has given-out little financial infrastructure or managerial, conceptual for public involvement (Shabecoff, 2001).
Public gatherings, meetings or conferences are the only consultation mechanism mentioned in the white-paper, yet these are inadequate means of fully and genuinely engaging local communities in the health matters/ issues that matter to them, chiefly for the marginalized groups or areas. One way out is for the primary care to work with the projects of the community development, which have been dealing with these issues and problems for years.
Community development (CD) recognizes the economic, the social and the environmental causes of poor health and links-user involvement and the commissioning to advance/improve health and to reduce the health inequalities. These Communities can perhaps be geographical such as particular estates of housing or communities of awareness or interest, for instance the user groups ( Parker, 1999) The community development trained workers bring the local inhabitants together to identify and to support the already existing networks of the community, thus improving the health; they identify the health needs, and particularly those of marginalized areas or groups and also those suffering from health inequality; they work with other relevant and related agencies, including the community groups, to deal with the identified needs; to encourage conversation/dialogue with the commissioners to come up with more appropriate and accessible services (Campling, 2005).
Many examples of all of these activities exist. Researches indicate that community support through the social networks is very protective of individual's health (Shabecoff, 2001). High levels of density and trust of group membership are highly associated with the reduced mortality. On the other hand, lack of self esteem, lack of control and poor/ill social support greatly contribute to augmented morbidity. Needs appraisal that is mainly focused on the communities can identify the solutions as well as the problems.
In Torquay, concern regarding nutrition has brought about the setting-up of a cooperative of food managed by the local people who make cheap and healthy food available. Community development can also lessen social exclusion by making sure that marginalized areas and groups influence the health services.
In Bradford, this kind of an approach increased the up-take of breast and cervical screening amongst women from the ethnic minorities (Campling, 2005). The minority cultural/ethnic communities, the disabled people, the elderly people and adolescents have all been involved and are partakers in the process of commissioning in Newcastle, where a worker of community development, responsible to the community, brings community groups together with the purchasers and the providers to bring about change. Examples of the community development inter-agency activity comprise of the safety group's work in Torquay which resulted into policy changes in the housing department, the play areas and other different borough and the police services (Beer, 2006). Primary care groups need to realize and understand community development and also be open to alternative evaluation methods.
Techniques of community development can help primary care groups to develop processes of decision making that involve users truly. The lay member on the care group will become a figure that is isolated unless it is supported by an effective and vigorous infrastructure. An agency of community development, with a representative/agent appointed on to the board, is supposed to be established in each and every primary care group, maybe by expanding that already existing organization (Dickens, 1999).
By continuing the existing neighborhood community development and also drawing together the voluntary groups and the initiatives of a local authority, an agency could challenge and support planning by the primary care group (Dickens, 1999). Recommendations and information from the local people could directly go to the primary care group, at the same time this group could also ask representative lay outlooks or action on certain issues. This structure may possibly provide for some measure of responsibility and perhaps help the primary care group focus on the key social health determinants. It would facilitate the views of the users to be given proper respect and importance or weight in the process of planning.
In conclusion, broadening contribution in discussions of the Better, Cheaper, and Fairer Health Care strategy was a significant breakthrough. The signs of changes are building-up, global-in-scope, and extending across all sectors and levels. Many of all of these changes are linked directly to health, while some others have powerful possible effects on both health care and health. Fairer Health Care (PHC) needs to be adapted to changeable or varying circumstances at national and local levels. Any nation that establishes a firm basis for Fairer Health Care, provides for the needs and the necessities of its most needy and vulnerable populations and at one fell swoop, empowers its most deserted resource; women.
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