This is an essay I have written for a Coursera Course at the University of Copenhagen on Global Health
The MDGs currently are:
• Eradicating extreme poverty and hunger
• Achieving universal primary education
• Reducing child mortality rates
• Improving maternal health
• Ensuring environmental sustainability
• Developing a global partnership for development[i]
The above may appear to be quite separate matters to be tackled as a complex and difficult checklist. But they are able to be tackled together, and this is a very effective, whole system, high quality and financially competent way to manage these matters.
The Alma-Ata Conference agreed: health, … is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.[ii]
Dr Carl Taylor wrote: “Simply put, community oriented primary care is the merger of front line clinical medicine with public health.”[iii]
The first sub-goal
Is to create a good enough understanding of the issues faced by individual communities, neighbourhoods, sub regions and regions.
I propose that our nation commits to the following plan, that all communities, villages, towns and cities have assessed and discussed their position in relation to the MDGs; their issues, strengths, weaknesses, opportunities, threats, resources and barriers; and have agreed action plans with appropriate local regional national and international stakeholders.
They understand where they are from, where they are now, and where they wish to be. [iv] All local communities would be collecting relevant data about themselves – Where there is no Doctor has a relevant example of what is needed.[v] Participatory Rural Appraisal and similar initiatives are further examples of how communities may collect information about themselves and then decide together what action to take when.[vi]
The second sub goal
Is for the communities to be beginning to implement their agreed objectives. Depending on what type of community it is, this would include training, managing and resourcing community health workers[vii], managing water quality for example through Community Led Total Sanitation[viii], (this will have immediate effects on issues like Polio[ix]) and enabling high quality sustainable agriculture through methods like permaculture[x]. Organisations like BRAC are highly skilled in these matters.[xi]
The third sub goal
Is to improve the quality of governance. Future Generations notes:
“Communities need help from officials, who can adjust policies and regulations to facilitate cooperation among factions and channel external resources. Communities also need help from experts who can build capacity by training, introduce new ideas, and help monitor change.”
“When officials and experts show some humility, community enthusiasm becomes contagious. A feedback loop creates new expectations and standards for everyone. As one change supports another, social pressure builds, and those who do not cooperate are generally bypassed or overrun by the community’s momentum. This momentum will eventually redefine the entire community’s collective future.” xiv
Experience has shown these methods to be highly popular, effective and economic. They have a long tradition, for example with Bruntland.[xii] There has recently been significant focus on austerity and related matters, but these matters of the health of the public are the bedrock of everything else.[xiii]
We are able to enable continuing improvements in the health and well being of all our people by all parties working together to resolve these issues co-operatively. This is a staged process, building on already existing best practice and replicating this geographically with neighbouring communities. The main difference when and where there is a complex emergency these processes need to be implemented faster.Xv