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LETTERS: Paul Eunson Learning from low income countries: what are the lessons?: Communities should decide priorities BMJ 2004; 329: 1183 [Full text]

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Learning from low income countries - What are the priorities?

Karthikeyan Paranthaman   (7 December 2004)

Learning from low income countries - What are the priorities? 7 December 2004
Karthikeyan Paranthaman, Senior House Officer in Neurology The Walton Centre for Neurology & Neurosurgery, Liverpool - L9 7LJ Send response to journal: Re: Learning from low income countries - What are the priorities?	The article by Eunson highlights the complexities of setting priorities in the distribution and allocation of resources in the community level by external agencies. It also raises an important question - Are communities capable of deciding priorities in low-income countries? In communities that lack good leadership and have low literacy rates, sometimes it may be necessary for external agencies to set the priorities in the interest in public health. In certain instances, it may be unwise to give the entire responsibility to the community. In order to give communities the power and responsibility to set priorities, as a first step, they should be educated about the need for the specific public health interventions. Once they are made aware of the benefits of health intervention programmes, the next most important goal should be to enlist their support and cooperation in achieving the health objectives. Another important point to understand is that most of the public health interventions in low income countries is focussed mainly upon disease control and eradication. Although this is the most practical and effective approach in the short term, unfortunately it is not the ideal solution for long-term health needs. Emphasis on personal hygiene, healthy lifestyle and health promotion at an individual level would lead to greater improvement in the overall health status of low income communities. The only way to achieve this objective is by increasing the spending on education to increase the overall literacy rate. Literate individuals and communities are more capable of making the right decisions to promote health than the less literate. A strong political will to improve adult literacy in the general population would augment the effectiveness of all public health interventions. In this perspective, allocation on education should also be considered as a major public health priority. Instead of focussing entirely on health allocation, public health experts and health planners should also influence the policy makers to redouble the efforts to improve the overall literacy status of the community. This strategy would allow communities and individuals to take responsibility for their own health and therefore bring greater benefits to the community. Competing interests: None declared