Special Health Problems of Island Developing and other Specially Disadvantaged Countries

Special Health Problems of Island Developing and other Specially Disadvantaged Countries

Report of a Meeting of Experts, London, 21–25 January 1980 You do not have access to this content

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Commonwealth Secretariat
01 Feb 1981
9781848592995 (PDF)

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This is the report of an expert group, convened to focus on the special health problems of island developing and other specially disadvantaged countries. The members of the expert group were invited to examine the problems and to make recommendations as to how they should most effectively be tackled, by individual governments, by regional groups of countries and by the Commonwealth Secretariat and other agencies, within available resources.

This report includes a list of the conclusions reached, a summary of the discussions, an introductory paper prepared by the Secretariat, papers prepared by participants who led the discussion on particular topics, and other papers contributed by participants.
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  • Introduction

    The number of Commonwealth developing countries which are islands or which suffer particular disadvantages as a result of their small size, their remoteness from major centres and their limited resources is large. Because of their relative proverty and shortages of trained personnel, they are especially at risk in the face of disease epidemics and natural disasters.

  • List of Conclusions

    For most island developing and other specially disadvantaged countries, there is a need to determine the use of manpower in primary health care programmes in close relation to the locally-defined tasks required for the provision of basic health services for their entire populations.

  • General Review

    The meeting began by making a general review, in the light of the introductory paper prepared by the Commonwealth Secretariat (see p 53), of the special health problems facing small developing countries. It was accepted that these were not merely a small-scale version of the problems of larger countries but often had special characteristics of their own.

  • Health Manpower Planning

    The presentation on the subject of health manpower planning, with particular reference to small states, was made by Dr. Richard A. Smith, author of the discussion paper Realistic manpower planning for primary health care; practical considerations (see p61).

  • Travel and Communication

    The subject of travel and communication difficulties experienced by the small states was introduced by Professor E. R. Walrond, author of the discussion paper Travel and communications: their relation to health problems in small states (see p.75).

  • Demographic and Health Data

    The discussion on the problems of small states concerning demographic and health data was introduced by Professor Lindsay Davidson, whose Report on a visit to study health care delivery in a number of Western Pacific islands is included in the documents section of this report (see p.79).

  • Natural Disasters and Other Emergencies

    The meeting discussed disaster and emergency preparedness in the light of relevant section of the Secretariat's introductory paper (see p.53). This pointed out that the effects of natural disasters on island developing and other specially disadvantaged countries were often severe. The response to emergencies tended to fall below the already limited capacity of such countries to deal with them, because of inadequate planning, lack of coordination of resources and paucity of properly-tabulated information on essential measures relating to health.

  • Specialist Services

    The meeting considered the position of the smaller countries in relation to the provision of specialist services. It was accepted that few small countries could be self-sufficient in tertiary health services. Some efforts by donor governments to assist such countries by providing them with expatriate specialists were seen as having had a distorting effect on the health care system, and also as giving rise to an unwelcome feeling of dependence.

  • Pharmaceuticals

    Problems encountered by small countries concerning the procurement, storage, distribution and dispensing of medicinal drugs were discussed by the meeting. It was pointed out that in some countries there was little treatment with drugs outside hospitals, because of the high cost of imported drugs, and that where some drugs were available these were often used inappropriately. At present most of the information doctors received about drugs came from the companies which sold them.

  • Strengthening National and Regional Institutions

    The discussion on strengthening national and regional institutions to enable them to deal more effectively with the special health problems of small countries was introduced by Professor Kenneth Newell, author of the paper Some special health problems of island developing and some other specially disadvantaged countries (see p.93).

  • Regional and International Cooperation

    The meeting discussed the advantages of regional collaboration as a means of supplementing the limited resources of island developing and other small disadvantaged countries. The need for an effective organisational framework was emphasised in the Commonwealth Secretariat's introductory paper which, while accepting that the details had to be worked out in individual regions, pointed out that agreement at the highest level of decision-making on the machinery for collaboration was required.

  • Distribution of Report

    It should be suggested to ministries of health and regional health agencies that relevant recommendations of the meeting might be placed on the national and regional health agenda as an item meriting continuing attention.

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    • Special Health Problems: Island Developing and Other Specially Disadvantaged Countries

      In the communiqué issued after their meeting in Lusaka in August 1979, Commonwealth Heads of Government “welcomed the opportunity to discuss the special disadvantages that beset the growing number of smaller member countries, particularly the island developing countries and certain other specially disadvantaged member countries. They agreed that in order to offset the disadvantages of small size, isolation and scarce resources which severely limit the capacity of such countries to achieve their development objectives or to pursue their national interests in a wider international context, special measures of support were required”.

    • Realistic Manpower Planning for Primary Health Care: Practical Considerations

      There are a number of ways to look at health manpower planning. Some plans are developed for publication to attract resources from donors, others for practical implementation. This discussion will deal with practical planning for implementable health manpower development programmes appropriate to specific health care needs and adapted to the contexts of specific national health care systems.

    • Travel and Communications: Their Relation to Health Problems in Small States

      Many of the new countries in the Commonwealth are small states, small in terms of population and in many instances in land mass and identified resources. Many, like those in the Caribbean, are separated by sea although grouped together. Within these states mountainous terrain, forests or other ecological factors, along with the underdeveloped state of roadways, make internal communications difficult.

    • Report on a Visit to Study Health Care Delivery in a Number of Western Pacific Islands

      I am most grateful to the World Health Organisation for the opportunity to undertake this survey and to all those in the various countries who gave me of their time and for their patient answering of all the questions I asked of them.

    • Some Special Health Problems of Island Developing and Some Other Specially Disadvantaged Countries

      I gratefully acknowledge the assistance of the Sandoz Foundation in making funds available to me to collect information from and consult with governments in the Pacific, South East Asia, the Caribbean and elsewhere, and to consult with the World Health Organisation, the Commonwealth Secretariat and the Christian Medical Commission. This paper is based upon material from these sources and I am most grateful for the interest and the responses to my enquiries from these multiple authorities.

    • Managerial Training for Middle-Level Health Administrative Personnel

      As we approach the end of this first month in the penultimate decade of the twentieth century, it is altogether fitting that we are meeting to consider the special health problems of smaller states and to discuss methods which can be utilised to alleviate or resolve those problems. Criticism, as many of you are aware, has been expressed in a number of quarters regarding the 1978 Declaration of Alma Ata which states, inter alia, that “a main social target of governments…should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.” Without entering into that debate, it appears most unlikely that smaller states will achieve this “main social target” by the beginning of the next century unless special attantion is given to their unique problems.

    • A Comprehensive Hospital Service for Caribbean Territories

      The territories of the English speaking Caribbean extend from Belize in the west and to Guyana in the east.

    • A Proposal for Assistance With Specialist Medical Services for the Small Status of the Commonwealth Caribbean

      Health services in the small stales of the Commonwealth Caribbean are widely recognised to be grossly inadequate at all levels. There are shortages of personnel and equipment. Whilst the major efforts to assist these states are properly directed towards social and preventive medicine, and to providing an effective primary care service, these services cannot be appreciated by the affected populations unless an adequate secondary care service is also provided.

    • Special Health Problems of Small States

      Small states the world over, endowed with limited natural and trained human resources, are faced with special problems in their efforts to raise living standards and improve the quality of life of their peoples.

    • Health Development Problems of Small States: The Design of Appropriate Health Delivery Systems for the Islands of the Pacific and Indian Oceans

      A health delivery system for small countries is proposed which is largely government-financed, without discouraging a modest private sector. It is proposed to be based on only a comparatively small central administrative core with progressive decentralisation and with the strength as far as possible at the periphery. Peripheral health workers of comparatively short training and modest educational standards, with community support and involvement, are the basis for the service at rural and peripheral urban level.

    • Participants and Secretariat
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