NoNonsense International Development by Maggie Black

Author:Maggie Black [Black, Maggie]
Language: eng
Format: epub
ISBN: 9781780262406
Publisher: New Internationalist

Alternative models and ‘barefoot’ approaches

If the export of Western models failed to benefit poor people economically, the same held true in the social sphere. Where 90 per cent of a country’s health budget was spent on a handful of high-tech hospitals dispensing medical care for the few, the health of 90 per cent of the country’s population was ignored.

Many examples of alternative models for health services came to prominence in the 1970s. China’s ‘barefoot doctors’, for example, who treated symptoms of common diseases, provided health education and referred cases they could not manage to those who could. A number of successful experiments were also undertaken by dedicated professionals in Bangladesh, Tanzania, Guatemala and elsewhere along similar decentralized lines. Their cumulated experience became the basis for WHO’s adoption of a strategy for ‘primary health care’ whereby village-based workers would help communities achieve ‘health for all’. At the heart of this model was public health advance: mother and child health services including safe childbirth, disease control and prevention, and education for health self-protection.

The ideology of those people-centric days was, at its extreme, very radical: some saw the democratization and demedicalization of healthcare as ends in themselves. Certainly, they represented a commitment to supporting people’s own abilities to define and meet their needs. Today, many of those concerned with health policy regard WHO as having backtracked on its commitment to the poor. It has been co-opted by Big Pharma, and dropped its emphasis on the expansion of primary-healthcare systems. Grand-slam approaches and disease campaigns are back in fashion. Médecins sans Frontières has become a more effective protagonist than WHO of ‘health for all’, as its more committed and effective response to the 2014 West Africa ebola crisis demonstrated.

Education had to undergo a similarly radical overhaul. Not only was there a huge appetite for learning all over the developing world, but even the leading advocates of economic growth as the sine qua non of social improvement recognize that the nation-building project is impossible without educational expansion. But should the major investment be in primary education for the masses, or secondary and tertiary education for a tiny elite? In the late decades of the 20th century, education also experienced its radical phase, with ‘barefoot’ teachers, reintroduction of local languages as the medium of instruction, non-formal programs for women who had never gone to school and children who had ‘dropped out’. Increased productivity and family wellbeing required that everyone – especially women – had a basic educational grounding: even the World Bank agreed with that.

These ideas, informed by a range of experiences in the South, came together in the ‘basic services strategy’. This envisaged the extension of basic healthcare, water supply, sanitation, nutrition services to untouched communities through the agency of community-based workers. The services would have to respond to the real needs and desires of communities since they would run them. The authorities would supervise, co-ordinate, provide technical back-up and adjust inputs appropriately.

The promise of the ‘basic services strategy’ was higher than its yield: many

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.