Intended for healthcare professionals

Education And Debate Health needs assessment

Assessing health needs in developing countries

BMJ 1998; 316 doi: (Published 13 June 1998) Cite this as: BMJ 1998;316:1819
  1. John Wright (, consultant in epidemiology and public health medicineb,
  2. John Walley, senior lecturer in international public healthb
  1. a, bNuffield Institute for Health, University of Leeds, Leeds LS2 9PL
  1. Correspondence to: Dr Wright

    This is the last in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively

    In most developing countries, the evolution of health services has been dominated by Western models of health care. These have rarely taken into account how local people explain illness, seek advice, or use traditional healing methods. The emphasis has been on hospitals and curative care rather than on trying to address local health needs equitably and effectively. Since the Alma Ata declaration on primary health care, more attention has been given to increasing coverage of basic services and preventing common diseases. However, the bias in resource allocation towards secondary care and urban areas remains.

    Summary points

    Timely and accurate information is essential if health services in developing countries are to meet the needs of their populations

    Routine health information can provide an epidemiologically based assessment of ill health and identify what health services are needed

    Community appraisals can provide valuable insight into patients' needs as well as empowering communities

    Emergency health needs are similar whatever the disaster. Community involvement, good surveillance, and foresight are important

    The global burden of disease can be represented by disability adjusted life years; these can help to identify international health needs

    Health needs are changing and new challenges from chronic diseases and HIV infection must be faced. Better coverage of preventive and essential healthcare services has led to greater emphasis on improving the quality of health care and ensuring that the most efficient use is made of scarce resources. For example, infant mortality has fallen dramatically in the past two decades through interventions such as oral rehydration for diarrhoea and immunisation programmes. With fewer children dying there has been greater emphasis on the need to tackle the causes of infant …

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