|Education for Health (WHO, 1988, 274 p.)|
|Chapter 3: Planning for health education in primary health care|
We have seen the different steps that are involved in planning health education activities in primary health care. You will have noticed that, at each step, the health worker uses health education approaches that facilitate and reinforce the involvement of communities in health development. Through that involvement, you can make sure that the technology used is appropriate.
Using appropriate technology
Appropriate technology is an important factor for the success of primary health care. The word 'technology', as employed here, means an association of methods, techniques, and equipment which, together with the people using them, can contribute significantly to solving a health problem.
'Appropriate' technology means that, besides being scientifically sound, the technology is also acceptable to those who apply it and to those for whom it is used. This implies that technology should be in keeping with the local culture. It must be capable of being adapted and further developed if necessary.
In addition, the technology should be easily understood and applied by community health workers, and even by members of the community; although different forms of technology are appropriate at different stages of development, simplicity is always desirable. The most productive approach for ensuring that appropriate technology is available is to start with the problem and then to seek, or if necessary develop, technology that is relevant to local conditions and resources.
Involving the people in health care
The report of a WHO Expert Committee on New Approaches to Health Education in Primary Health Care' states that:
'to involve people and to enable them to formulate their own health care objectives, the health care providers will have to:
(a) provide opportunities for people to learn how to identify and analyse health and health-related problems, and how to set their own targets;
(b) make health and health-related information easily accessible to the community, including information on practical, effective, safe, and economical ways of attaining good health and of coping with disease and disability;
(c) indicate to the people alternative solutions for solving the health and health-related problems they have identified;
(d) create awareness of the importance of effective communication in fostering mutual understanding and support between the people and the health care providers;
(e) translate the targets set by the people into simple, understandable, realistic, and acceptable goals which the communities can then monitor; and
(f) help people to learn how to set priorities among the different health problems they have identified and to understand the need to refer to relevant policies in doing so, e.g., that priority should be given to the deprived sections of the community and to certain diseases on the basis of the degree of their contagiousness, susceptibility to treatment, etc.'
The report adds:
'It is essential that communities have a clear understanding of their role in the implementation of strategies for solving health problems. Here, health education should facilitate the dialogue with the people through culturally and socially acceptable forms of communication.'
Developing a partnership with the community
The subject of the Technical Discussions held in May 1983 on the occasion of the Thirty-sixth World Health Assembly was 'New policies for health education in primary health care'. More than 300 delegates to the Assembly took part. They discussed the need to develop a real partnership between health workers and the community at every stage of health planning, from identifying problems, through facilitating and reinforcing health action, to evaluating results. There should be a constant dialogue and interaction between the community and the health workers.
People may 'feel' many health and related problems, but they may not be able to express them clearly. There may be other major problems that they do not see. The health worker should encourage and guide the community in self-study so that the community can better understand its problems, identify local resources to solve them, and call on outside help when needed.
As action to solve a problem is developed, the health worker will assist the community in examining whether its efforts are worthwhile and effective. Are the desired changes occurring in the community? Have obstacles to progress arisen? Are the chosen technologies and strategies appropriate? In other words, the health worker should involve the community in a constant cycle of planning, action, and evaluation. By encouraging involvement and continuous self-examination, the health worker will be educating the community about the planning process. This makes future self help efforts possible.
Coordinating levels of planning
Coordination is an important job in health education. We need to provide a link between people and the various resource agencies and to foster communication between the people and the agencies. We should also encourage communication among the agencies themselves so that they will make the most effective use of their resources in assisting the community. We must also be aware that this assistance will come from different levels district, regional, state, and national.
This chart shows how a real partnership develops between health workers and the community through the various stages of identifying problems then facilitating and reinforcing health action.
This chart was developed in connection with the Technical Discussions on 'New policies for health education in primary health care' at the Thirty-sixth World Health Assembly in May 1983.
Primary health care is a national concern, not just a local one. Ministries and agencies at the central level are also planning for the effective delivery of primary health care services. It is necessary for the community to be aware of these central planning efforts so that it may benefit from the resources. An example of a central function would be the supply of essential drugs to all communities. Another important central function of direct relevance to health education is the planning of mass media (radio, television, etc.) programmes on priority health needs.
The community and health workers together must make sure that their needs for essential drugs, basic transportation, educational media, and other resources are constantly communicated to the central planning authorities. Likewise the central planners must always be in touch with local communities to hear their needs and thereby be in a better position to plan for primary health care.