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From: Focus on health and dental care – Footsteps 42

Helping people make appropriate decisions about their own health needs

by Neil McDonald.

Two-thirds of the world’s healthcare professionals work in industrialised countries amongst one-third of the world’s people. This means that many poor people have little access to healthcare services. The situation is a challenge to both planners and health workers in low income countries.

The most common problems found in many countries are:

  • the restrictions faced by governments when planning and funding appropriate healthcare on a national basis for all of their citizens
  • the unwillingness of qualified health workers to move away from urban into rural areas
  • rural areas which therefore suffer from inadequate healthcare services with workers who are unsupervised, lack motivation and are poorly paid the difficulty of controlling or regulating the ‘unqualified’ group of health carers which develops alongside the inadequate government services
  • a lack of good information about healthcare – people are less able to make appropriate decisions about their own health needs
  • a superstitious view of the world which believes that illness (such as malaria or toothache) is the result of the gods’ displeasure or the work of evil spirits.

In the industrialised world people expect high standards in healthcare. The cost of paying for high quality healthcare is met partly by governments using income raised through tax, partly by employers and health insurance and partly by what individuals pay themselves. However, in low income countries governments raise less income from taxes and individuals are rarely able to pay a realistic contribution for their healthcare.

Planning for health services needs to consider carefully how much both health providers and users are able to pay for healthcare. Regional planning for more equal distribution of services is also vital – otherwise health services concentrate on urban areas (where people tend to have a higher income) and ignore the needs of people in rural areas.

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