Learning from low income countries: what are the lessons?: Communities improve health systems

doi:10.1136/bmj.329.7475.1183-a

BMJ 2004;329:1183 (13 November), doi:10.1136/bmj.329.7475.1183-a

Letter

Learning from low income countries: what are the lessons?

Communities improve health systems

The first 150 words of the full text of this article appear below.

EDITOR—In many developing countries policy makers anddonor agencies tend to emphasise creating a robust system ratherthan empowering communities. For them, it is much easier totackle the system as it does not complain or talk back, whereasit is hard to deal with people, who do not always behave asexpected.

Thus an imbalance between system and community occurs. As thepower of systems grows, the power of community declines, andas control magnifies, consent fades.¹ As standardisation isimplemented, creativity disappears—to build a healthfulsociety both system and community are needed.¹

To improve the balance between system and community in ruralNepal, we conducted the school and community health projectfrom 1992 to 2004. For example, we trained traditional healersin Western medicine to strengthen their roles in primary healthcare. Later, their relationships with the government healthworkers were much improved.² In the same . . . [Full text of this article]

Masamine Jimba, assistant professor

mjimba@m.u-tokyo.ac.jp

Susumu Wakai, professor

Department of International Community Health, Graduate School of Medicine, University of Tokyo, 113-0033 Tokyo, Japan