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Hospitals and Primary Health Care

Hospitals and Primary Health Care

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Published by Vievie Zaenal

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Published by: Vievie Zaenal on Dec 21, 2012
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Hospitalsand PrimaryHealth Care
An International Study
 
From the International Hospital Federation
 
worldwide
health care leadership
visionar
ebook 
by Rufino L. Macagba, MD, MPH
A report on world-wide survey on theRole of Hospitals in Primary Health CareSponsored by theInternational Hospital Federationand funded by the W.K. Kellogg Foundation of USAEdited by Melissa Hardie, HA, SRN, PhDInternational Hospital Federation126 Albert Street postage London NW1 7NXEngland
 
 
 
 
Involved in PHC?pages 6 - 8 Description of International
 
Study
 
pages 9 -12 Survey Responses
 
 
 
pages 24 -89 1.Dr Carlos Luis ValverdeHospital, Costa Rica
 
Bangladesh
 
College and associated
 
Hospitals, New Delhi, India
 
Sudan5.SSA Hospital, 
 
Netzacualcoyotl, Mexico
 
6.North Central BronxHospital, New York City,
 
Surabaya, Indonesia
 
Beer Sheva, Israel9.Gonoshystha Kendra,
 
Bangladesh
 
Bangkok, Thailand
 
Bihar, India13.Serabu Hospital, Sierra
 
Philippines
 
pages 90 -96 About the IHFpages 97 -98About the Authorpage 99 
Introduction
By its constitution, the aim of the International Hospital Federation (IHF) is topromote improvements in the planning and management not just of hospitals alone,but of health services in general. However, it has to be admitted that in the pastmany hospitals have not been actively involved either in the formulation of PHCstrategies or in their implementation, but the scene is now changing, and changingrapidly.Many IHF members live and work in big cities and in 1975 the IHF started to promotesurveys in a number of the world's largest cities to help identify some of the mainobstacles hindering the improvement of standards of health and health services.Another objective of these surveys was to identify and publicise some of the morenoteworthy initiatives that were being taken to overcome these obstacles. Thesurveys showed that in almost every city deficiencies in PHC were recognised asbeing the most critical problem -but at the same time there were reported a numberof very imaginative and effective ways in which hospitals were promoting, supportingor providing PHC.Hospitals, like human beings are likely to respond more positively to encouragementto build on what is being done well than to criticism about what is being done badly.On this basis, the IHF felt that it could usefully try to gather from its memberassociations and hospitals examples of noteworthy innovations and developments inhospital/PHC relationships, in urban and rural areas alike, following the principlessuccessfully demonstrated in the IHF project on Good Practices in Mental Healththat started in 1977 and still continues.A number of pilot studies in the late 70's produced promising results, and it was as aresult of these that an approach was made to the W.K. Kellogg Foundation of USAfor financial support to extend the study on a wider scale. This approach brought agenerous response and led to the appointment of Dr Rufino Macagba to undertakethe project, which is reported in these pages. With active encouragement andsupport of the World Health Organization and its Regional Offices, Dr Macagba wasable to identify and contact many hospitals all over the world that are activelyinvolved in PHC, and it is of course their efforts that form the basis for this report.It would be fair to say that although the project has shown that more hospitals aremore deeply involved in PHC than many people expected, it is equally clear thatmore hospitals could do more. The project will have achieved its objective if itencourages those hospitals that are doing well to do even better and stimulatesthose that are doing nothing to do something.Miles HardieDirector-General, I H F
HealthDevelopment
 
International
 
Hospitals & Primary Health Care
 
 
Introductionpage 2 
 
 
Involved in PHC?pages 6 - 8 Description of International
 
Study
 
pages 9 -12 Survey Responses
 
 
 
pages 24 -89 
 
1.Dr Carlos Luis ValverdeHospital, Costa Rica
 
Bangladesh
 
College and associated
 
Sudan5.SSA Hospital, 
 
Netzacualcoyotl, Mexico
 
6.North Central BronxHospital, New York City,
 
Surabaya, Indonesia
 
8.Soroka Medical Centre,Beer Sheva, Israel
 
Bangladesh
 
Bangkok, Thailand
 
Bihar, India
 
Leone14.Silliman Medical Centre,Philippines
 
pages 90 -96 About the IHFpages 97 -98About the Authorpage 99 
Forward
Over the last twenty years there has been increasing dissatisfaction about therelevance and effectiveness of national health systems in both the developing andthe industrialised countries. Many people have been seriously questioning the highlysophisticated -and, it follows, expensive -medical technology, which is widespreadthroughout the system and particularly in the hospitals. Is it having a real impact inrelation to its cost? Many have given voice to an awareness of the need forcompatibility between the services provided by the conventional health deliverysystems and the most prevalent health needs of the majority of the population.In the industrialised countries the increasing costs of health care had reached a levelwhich no health system -governmental or private -could pay for without falling intobankruptcy; at the same time, people were realising with increasing clarity that theywere fast becoming passive objects under a medical care system far beyond theirunderstanding and which they could neither participate in nor control. People weretiring of figuring as numbers on computerised lists, considered as "cases" and not ashuman beings. Any sense of responsibility for their own health was progressivelyreceding in the minds of individuals, the family and the community.At the same time, in the developing countries people complained that largesegments of the national population were not even being granted health care as abasic human right. It is not unusual in developing countries to find between 40% and60% of the population without access to any form of permanent health care, whilst inthe capital city problems just like those found in the industrialized countries were rifeand in flagrant contrast to the neglected populations living mainly in the rural areas,the small urban communities and the poverty-stricken belts of the big cities.Many aspects of the health system were questioned. Was there no way to put intopractice the old aphorism that "prevention is better than cure"? Were hospitals(enclosed within their own walls and treating advanced stages or sequelae ofdiseases that could be well prevented outside their walls) the only way of providingan effective _health care? Were physicians the only human resources to be used inall cases, or was there, in fact, a real range of health care activities that could besafely delegated to other professionals, other non-professional health workers andeven members of the family, if not the patient themselves? Could other activities bepromoted outside the health care delivery system that would contribute, perhaps withmore impact in certain cases, to the positive health status of the population?Such activities would be, for example, the provision of clean and safe water; propersanitation; good nutrition, and even activities concerned with such factors as bettereducation, improved income, proper physical exercise, health habits, etc. Were allthe technological developments applied to health care of the same value, equally justified and of the same effectiveness in all societies, or were there seriouslimitations in their use -financial, economic, cultural, etc? How many of thetechnological innovations were either "cosmetic" or of very limited, marginaleffectiveness, out of proportion to their high cost and fast technical obsolescence?
HealthDevelopment
 
International
 
Hospitals & Primary Health Care

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