E-DRUG: Politics of PHC and child survival

[David Gilbert <dgilbert@kehf.org.uk>]

E-drug: Politics of PHC and child survival
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Dear e-druggers

Found this on another e-mail discussion group. Hope it's useful (it's 
quite long).

Best wishes

David Gilbert

Date:    Sat, 20 Jun 1998 18:46:56 -0700
From:    Claudio Schuftan <aviva@NETNAM.ORG.VN>
Subject: Book review, Hlth Pol + Plg 13(1): 103-104,1998

                              BOOK REVIEW

                       QUESTIONING THE SOLUTION
        The Politics of Primary Health Care and Child Survival
         with an in-depth Critique of Oral Rehydration Therapy
                                  by
                    David Werner and David Sanders
           with Jason Weston, Steve Babb and Bill Rodriguez

A Healthwrights Paperback,  1997,  207 pp., available from Health
Wrights, 964 Hamilton Ave, Palo Alto, CA 94301, USA, $30 airmail postage
paid.

Here is a new book whose time had come; a book that succeeds in painting
the big picture of the  the health situation in the 1990s worldwide.
The book is a true wake up call to all of us.

The book  is written based on the authors' long respective field
experience.

The book makes a passionate call for rectifying what is terribly wrong
with PHC in the mid nineties.  It calls for  sterengthening
international solidarity among the like-minded progressive health
practitioners. The book makes one question what one is doing and to take
a stand.  Each of its 21 chapters is full of data  carefully woven into
a lucid argument that is convincing and compelling.

We are sternly warned of the current global regressive trend in the
health status of the growing number of the poor and are alerted to the
unfulfilled promises of PHC and  the Child Survival Revolution. 'Magic
bullet' technologies ultimately have only brought about some survival,
but 'survival at what cost?'...
The futility of safety net approaches/damage control measures to resolve
deep rooted health problems is masterfully exposed.

The authors criticize the prioritization of product over process and
make an  in depth critique of  oral rehydration therapy (ORT).  The book
basically objects to the pharmaceuticalization of this simple solution.

What really ultimately determines the health status of  poor people are
wider social equity issues that can only be addressed by embracing the
political dimensions of the problem.  Solutions are not about health
per-se, but about triggering organized popular demands for an overall
fairer treatment in society.

The role of international pharmaceutical houses,  the IMF and the World
Bank are reviewed in this regard. The latter is seen as excesively
intruding into Third World health care policy-making, leaving WHO a weak
second.
The global roles of WHO and UNICEF are also scrutinized. Both agencies
are shown to have addressed the basic causes of of ill-health in the
world , but also of implementing measures that ultimately avoid tackling
them; they are made accountable for the non-sustainability of the
measures they promote. They are thus written off by the authors as
potential leaders in the struggle for (needed) social change.

PHC has been replaced by what really is a disempowered compliance by
people together with a dose of blaming the victim.  A whole rhetoric has
risen to justify the absence of a shift from a humanitarian to a  more
political agenda.
The interventions introduced simply do not simultaneously emphasize
actions to address the root causes.  Inequity and poverty cannot just be
accepted as inalterable facts. The authors assert that the alleviation
of poverty is actually a precondition to health improvements.
Therefore,  they posit that PHC -as conceived in Alma Ata- has never
really failed; it just has never been tried!

The ultimate challenge is to find workable solutions.  No road map is
offered.  But different attempts to find a way are convincingly shown.
We need to create opportunities for popular pressure to demand the
social transformations needed to counter the regressive social trends we
are seeing.  We must move away from calls for narrow-focused
'cost-effective' interventions that do not challenge the status-quo.

At the heart of the conclusions of the book is a call for a  Child
Quality of Life Revolution in which children will not only survive, but
will be healthy in the fullest sense of wellbeing.

All in all, this is a one-of-a-kind book.  It is not without flaws,
though. Nevertheless, even people politically unsympathetic to the
book's political line will find it worth reading.  Students will find
endless inspiration.  Some addresses to join groups that are working
along the lines advocated by the book are given.

Claudio Schuftan, MD.
I. P. O. Box 369 - Hanoi, Vietnam
Fax: (84-4) 8260 780
Email: aviva@netnam.org.vn
(Claudio Schuftan)

-- 


David Gilbert
Promoting Action on Clinical Effectiveness (PACE)
King's Fund
11 - 13 Cavendish Square
London, W1M OAN.
Tel: 0171 307 2661
Fax: 0171 307 2810
 
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