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

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7475.1183-a (Published 11 November 2004) Cite this as: BMJ 2004;329:1183
  1. Masamine Jimba (mjimba{at}m.u-tokyo.ac.jp), assistant professor,
  2. Susumu Wakai, professor
  1. Department of International Community Health, Graduate School of Medicine, University of Tokyo, 113-0033 Tokyo, Japan

    EDITOR—In many developing countries policy makers and donor agencies tend to emphasise creating a robust system rather than empowering communities. For them, it is much easier to tackle the system as it does not complain or talk back, whereas it is hard to deal with people, who do not always behave as expected.

    Thus an imbalance between system and community occurs. As the power of systems grows, the power of community declines, and as control magnifies, consent fades.1 As standardisation is implemented, creativity disappears—to build a healthful society both system and community are needed.1

    To improve the balance between system and community in rural Nepal, we conducted the school and community health project from 1992 to 2004. For example, we trained traditional healers in Western medicine to strengthen their roles in primary health care. Later, their relationships with the government health workers were much improved.2 In the same communities we conducted literacy programmes for adult women—an entry point for community empowerment.3 These women then helped in government health activities.


    • Competing interests None declared.


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