Education And Debate

Community development and its impact on health: South Asian experience

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7443.830 (Published 01 April 2004) Cite this as: BMJ 2004;328:830
  1. S M Moazzem Hossain ([email protected]), project officer1,
  2. Abbas Bhuiya, senior scientist and head of SBSP2,
  3. Alia Rahman Khan, economics graduate3,
  4. Iyorlumun Uhaa, regional health and nutrition adviser4
  1. 1 MCHC Section, Unicef, Saudi Pak Tower, Blue Area, Islamabad, Pakistan
  2. 2 International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Bangladesh
  3. 3 Mount Holyoke College, MA, USA
  4. 4 Unicef Regional Office for South Asia, Kathmundu, Nepal
  1. Correspondence to: S M Moazzem Hossain

    Most South Asian governments have concentrated on emulating a Western style of healthcare service, with the result that an elite few are overmedicalised whereas the majority are neglected. However, community participation in the development of local health services could provide a solution

    Despite a remarkable improvement during recent decades in many countries' overall health and nutrition statistics and macro-economic indicators,1 some 10.8 million children aged under 5 years still die annually worldwide, of which 34% occur in South Asia alone.2 It is too simplistic to relate improvements in economic indicators with better health because this does not take account of inequality, change in focus of public health priorities, and, most importantly, the involvement of the community in improving health. This article discusses some of the most prominent examples in South Asia of involvement of the community in planning, managing, and evaluating health projects. However, showing a direct relation between community development and improved health remains a challenge.

    Community development and health: where is the link?

    Community development is becoming one of the most popular subjects in the context of public health interventions. Although an accurate definition of community development is problematic, a reasonable description would be the empowerment of a community to obtain self reliance and control over the factors that affect their health. Unfortunately, South Asia, so richly endowed with natural and human resources, has suffered for centuries from poverty and consequent ill health. It has, however, a rich heritage of community initiatives such as the establishment of education facilities, religious institutions, and orphanages and the construction of roads. It is unfortunate that health has remained the responsibility of governments, outside agencies, and, of course, the private sector (both formal and informal) and the provision of medical services has become big business.3

    Most of the public and private health services in South Asia have …

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