Editor—Women and children continue to die needlessly in developing countries. We know the causes but seem powerless to prevent their deaths. Constraints within health systems are blocking improvements, and we don't know enough about how to strengthen and sustain them without external investment. Individuals and communities have their own priorities for health, and a global solution for disease and poverty is impossible to prescribe.
A village was asked by an aid agency what its priorities for development aid would be, the answer presumed to be a health centre, school, or irrigation system. When the villagers replied that they wanted a football pitch, the agency withdrew its offer. The villagers built their own football pitch, and this engendered such a feeling of community spirit that they built their own health centre the next year without outside help.
During famine we concentrate on nutritional supplementation for children under 5 years old, yet I have been challenged by villagers who argue that the older children should have priority as they have already survived the difficult years of early childhood and are now contributing to their family's potential.
Listening to communities and allowing them to decide on their priorities avoids inappropriate aid. Programmes may require only modest outside support. A recent study in Nepal reports significant improvements in maternal and neonatal mortality rates by establishing women's groups with a facilitator.1 The process was similar to that used in the child-to-child initiative in the United Kingdom, in which children determine their priorities, plan and implement action, and then review results, all with the help of a facilitator. This approach has also been successful with child refugees.2
Community programmes using the simple techniques described by Werner and Bower are easily adapted to other settings whether the objective is a reduction in poverty, morbidity, or illiteracy.3
Figure 1.
Credit: STEFAN BOWERS/PANOS
Female literacy rates are an important predictor of child survival.4 What is not well understood is the mechanism by which female literacy exerts such an influence. It has far more significance than simply being able to read instructions on a medicine packet. Literate women tend to earn more and are better at accessing health and other services for economic development.5
Health for All by the Year 2000 failed to meet its goals in many countries. Those that have improved the health of their women and children in the past 40 years have achieved it by developing health services in parallel with improvements in economic measures, education, and social infrastructure. Aid therefore needs to be widely targeted and supplied in response to priorities that are determined locally.
Competing interests: None declared.
References
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