Sierra LeoneSierra Leone

The use of teachers in The use of teachers in Primary Health Care Primary Health Care

EducationEducation

Introduction - 1Introduction - 1 IntroductionIntroduction ‘‘No child in the world will go to bed hungry by the No child in the world will go to bed hungry by the

year 2000.’ This was one of the closing year 2000.’ This was one of the closing statements of the Food Security Conference in statements of the Food Security Conference in Rome in 1974. According to the United Nations Rome in 1974. According to the United Nations Development Programme, hunger now prevails Development Programme, hunger now prevails among at least a quarter of the world’s among at least a quarter of the world’s inhabitants. Every day there are 30,000 – 40,000 inhabitants. Every day there are 30,000 – 40,000 child deaths in the world and most of these are child deaths in the world and most of these are from diseases related to poverty. This means that from diseases related to poverty. This means that there are 12 to 14 million-child deaths associated there are 12 to 14 million-child deaths associated with hunger each year.with hunger each year.

Introduction - 2Introduction - 2 The well-known phrase ‘Health for all by the year 2000’ was The well-known phrase ‘Health for all by the year 2000’ was

first heard at the United Nations Alma Ata conference in first heard at the United Nations Alma Ata conference in 1978. Alas, its aims were never realised and so as you read 1978. Alas, its aims were never realised and so as you read this Introduction it is time for us to examine both why the this Introduction it is time for us to examine both why the target was not reached and what can be done to try and target was not reached and what can be done to try and make some serious reductions in this tragic waste of human make some serious reductions in this tragic waste of human life. Such statements fall easily from the lips of politicians life. Such statements fall easily from the lips of politicians and planners but what is the reality against which they and planners but what is the reality against which they must be put in context?must be put in context?According to the World Bank almost 65% of the inhabitants According to the World Bank almost 65% of the inhabitants of Africa live in ‘absolute poverty’, a term used by the of Africa live in ‘absolute poverty’, a term used by the former World Bank President Robert MacNamara to former World Bank President Robert MacNamara to describe a condition of total deprivation of the minimum describe a condition of total deprivation of the minimum living conditions essential for human dignity.living conditions essential for human dignity.

Introduction - 3Introduction - 3 We are familiar with such terms as the ‘Debt We are familiar with such terms as the ‘Debt

Trap’ and other causes of morbidity and mortality Trap’ and other causes of morbidity and mortality amongst children and women – the most amongst children and women – the most vulnerable groups. This ‘pathology of poverty’ in vulnerable groups. This ‘pathology of poverty’ in the Third World is associated with increased the Third World is associated with increased scarcity of resources, more hunger, and scarcity of resources, more hunger, and increasing death rates. The poverty gap has increasing death rates. The poverty gap has increased by 30% over the past decade. We are increased by 30% over the past decade. We are also aware of the problems caused by aids, the also aware of the problems caused by aids, the enforced reductions in public expenditure on enforced reductions in public expenditure on health and welfare and the shrinking education health and welfare and the shrinking education budgets that many countries now battle with budgets that many countries now battle with

Introduction - 4Introduction - 4 So, how can teachers attempt to do something positive to So, how can teachers attempt to do something positive to

improve the quality of life of those they will teach and that improve the quality of life of those they will teach and that of their families and communities? Well, let’s look at two of their families and communities? Well, let’s look at two simple statements.simple statements.

there are more teachers that doctorsthere are more teachers that doctors there are more pupils than patientsthere are more pupils than patients Simple statements yes but they offer a base from which to Simple statements yes but they offer a base from which to

build programmes that allow those most at risk from build programmes that allow those most at risk from serious and life threatening disease to begin to do serious and life threatening disease to begin to do something positive to help them. In modern political terms something positive to help them. In modern political terms people need to be ‘empowered’ or offered the knowledge to people need to be ‘empowered’ or offered the knowledge to ‘enable’ them to begin an active campaign to improve the ‘enable’ them to begin an active campaign to improve the living conditions for the most vulnerable members of living conditions for the most vulnerable members of society.society.

Introduction - 5Introduction - 5 Let’s look again in more detail at the two statements. Let’s look again in more detail at the two statements. Teachers meet with the young and build a trusting Teachers meet with the young and build a trusting

relationship through which knowledge and its application relationship through which knowledge and its application are passed. Why not incorporate in normal are passed. Why not incorporate in normal timetables/curriculum’s simple advice on the major timetables/curriculum’s simple advice on the major diseases that cause so much of the poverty that is evident diseases that cause so much of the poverty that is evident in Africa? in Africa?

This can be done in interesting ways that encourage This can be done in interesting ways that encourage participation and a desire to spread the information. participation and a desire to spread the information. Lessons can centre on outward signs of possible illness, Lessons can centre on outward signs of possible illness, ways of reducing the risk of catching such diseases and ways of reducing the risk of catching such diseases and effective proposals for helping those who already have an effective proposals for helping those who already have an illness. Greater awareness may also reduce prejudice and illness. Greater awareness may also reduce prejudice and misunderstanding. Access to life saving information need misunderstanding. Access to life saving information need not be the privilege of those fortunate to live near to better-not be the privilege of those fortunate to live near to better-stocked medical centres.stocked medical centres.

Introduction - 6Introduction - 6 The second statement noted that more pupils The second statement noted that more pupils

exist than patients. So, once again here is a exist than patients. So, once again here is a perfect opportunity to allow the young to be perfect opportunity to allow the young to be pioneers within their own communities in the pioneers within their own communities in the spreading of health messages that offer a positive spreading of health messages that offer a positive input to communal life. None of this needs to be input to communal life. None of this needs to be sophisticated. Indeed, the more basic the sophisticated. Indeed, the more basic the message the greater the chance of acceptance. message the greater the chance of acceptance.

Young people can be ‘peer educators’ to their Young people can be ‘peer educators’ to their own age group and ‘information providers’ to own age group and ‘information providers’ to their wider community. Such programmes do not their wider community. Such programmes do not require vast sums of money and yet individuals require vast sums of money and yet individuals can be made to feel involved and valued.can be made to feel involved and valued.

Introduction - 7Introduction - 7 Evidence of the impact on both individual and Evidence of the impact on both individual and

community health standards can be gathered community health standards can be gathered from many different locations. An example is that from many different locations. An example is that of Nicaragua, where successive Structural of Nicaragua, where successive Structural Adjustment Programmes seriously reduced the Adjustment Programmes seriously reduced the fabric of the health and education facilities. A fabric of the health and education facilities. A more ‘upside down approach’, in which simple more ‘upside down approach’, in which simple primary health information was given to young primary health information was given to young people has now been introduced in some regions people has now been introduced in some regions and the levels of malnutrition and infant mortality and the levels of malnutrition and infant mortality is beginning to drop – though only by a little. In is beginning to drop – though only by a little. In India the ‘bottom upwards’ approach adopted in India the ‘bottom upwards’ approach adopted in Vellore, South India has also paid visible Vellore, South India has also paid visible dividends in increased child welfare and better dividends in increased child welfare and better treatment for women.treatment for women.

Introduction - 8Introduction - 8 In this course we will be concentrating on many In this course we will be concentrating on many

of the diseases most prevalent in West Africa and of the diseases most prevalent in West Africa and producing simple and effective teaching producing simple and effective teaching materials. We will be including materials on each materials. We will be including materials on each disease, community and individual reactions and disease, community and individual reactions and possible life style changes that could help in the possible life style changes that could help in the fight against the killer diseases. fight against the killer diseases.

Each disease will be given adequate coverage to Each disease will be given adequate coverage to allow teachers and others who work with the allow teachers and others who work with the young to offer positive, enabling instruction that young to offer positive, enabling instruction that will empower the next generation to make a will empower the next generation to make a significant contribution to the health of both significant contribution to the health of both themselves and their communities. themselves and their communities.

ObjectivesObjectives There are more teachers than doctors and more There are more teachers than doctors and more

students than patients, so we need to inform students than patients, so we need to inform young people of the dangers they face. Young young people of the dangers they face. Young people can then act as:people can then act as:

Peer educators and inform those not fortunate to Peer educators and inform those not fortunate to go to schoolgo to school

Community educators, so giving positive Community educators, so giving positive externalities and reducing the health problems externalities and reducing the health problems faced by their families and communities. faced by their families and communities.

Shapers of community reactions to those parts of Shapers of community reactions to those parts of life than can cause health problemslife than can cause health problems

As teachers we can ‘educate’ the young to have As teachers we can ‘educate’ the young to have long and lasting influences on their families and long and lasting influences on their families and communities.communities.

Basic Course StructureBasic Course Structure

Getting to know the bodyGetting to know the body Getting to know the environmentGetting to know the environment Serious diseases – symptoms, Serious diseases – symptoms,

reactions, preventative actions and reactions, preventative actions and helping those with these diseaseshelping those with these diseases

More minor illnesses and life style More minor illnesses and life style decisionsdecisions

Links to informationLinks to information

The manual – once preparedThe manual – once prepared An Introduction to the Manual of Teaching MaterialsAn Introduction to the Manual of Teaching Materials Alas, only a minority of the world’s population have direct Alas, only a minority of the world’s population have direct

access to basic medical assistance can be a worrying one – access to basic medical assistance can be a worrying one – indeed it may end in the need being totally ignored.indeed it may end in the need being totally ignored.

This manual is the result of several years work in various This manual is the result of several years work in various parts of the developing world. It represents a small, but parts of the developing world. It represents a small, but hopefully useful contribution to the level of health hopefully useful contribution to the level of health awareness afforded to the younger members of awareness afforded to the younger members of communities. By providing accurate, yet easily understood communities. By providing accurate, yet easily understood health information to young people, it is hoped that they health information to young people, it is hoped that they can act as effective messengers to both their peers and can act as effective messengers to both their peers and other members of the communities within which they live.other members of the communities within which they live.

Manual once prepared - 2Manual once prepared - 2 The language and style of presentation used is not The language and style of presentation used is not

technical, but is chosen to be of interest to young people. technical, but is chosen to be of interest to young people. Diagrams etc. have been selected to allow non-medical Diagrams etc. have been selected to allow non-medical personnel (especially teachers) to feel confident in personnel (especially teachers) to feel confident in discussing health issues with the young people for whom discussing health issues with the young people for whom they are responsible. Let us hope that better informed they are responsible. Let us hope that better informed young people will be less at risk from illness and will be young people will be less at risk from illness and will be capable of providing others with essential pieces of life-capable of providing others with essential pieces of life-style information. If this is achieved then individuals and style information. If this is achieved then individuals and communities will be less vulnerable and will be in the communities will be less vulnerable and will be in the position to engage in more meaningful dialogue with those position to engage in more meaningful dialogue with those in authority. For if these people who make the life the life in authority. For if these people who make the life the life enhancing decisions that directly affect the lives of those enhancing decisions that directly affect the lives of those for whom these materials are intended.for whom these materials are intended.

The manual once produced - 3The manual once produced - 3

Anyone is welcome to Anyone is welcome to re-print/translate as they wish any of re-print/translate as they wish any of the materials contained in the the materials contained in the manual. The format of this manual manual. The format of this manual allows for materials to be allows for materials to be incorporated as they become incorporated as they become available available

Working in the CommunityWorking in the Community

Community based projectsCommunity based projects platforms, platforms, notice boards, notice boards, maps, maps, education classes, education classes, keeping records, keeping records, developing a common health policydeveloping a common health policy

Working in the Community - 2Working in the Community - 2

Family-based projectsFamily-based projects covering standing watercovering standing water safe places to wash and bathesafe places to wash and bathe covering windowscovering windows burning rubbishburning rubbish

School based ProjectsSchool based Projects

In the classroomIn the classroomSchool-based projectslooking after siblings

dietsfarms

cleaningburning rubbishplacing of toilets

safe places to wash, draw water and bathe

School based ProjectsSchool based Projects

In-class projectsIn-class projects experimentsexperiments learning to help the disabledlearning to help the disabled using school as a community assetusing school as a community asset

Other ProjectsOther Projects

Other possible projectsOther possible projects keeping records of height and weightkeeping records of height and weight keeping health recordskeeping health records noting dates of clinicsnoting dates of clinics mapping local amenities and danger mapping local amenities and danger

spotsspots developing community reactions to developing community reactions to

problemsproblems

Other ProjectsOther Projects

Some other ideasSome other ideas gamesgames postersposters competitionscompetitions radio broadcastsradio broadcasts including local traditionsincluding local traditions diet based games (Sri Lanka)diet based games (Sri Lanka)

Where to goWhere to go

www. johnbirchall-economist.com/ www. johnbirchall-economist.com/ Primary Health CarePrimary Health Care

The teaching booklet that will The teaching booklet that will emerge post this sessionemerge post this session

Email: john_birchall@bsc.biblio.netEmail: john_birchall@bsc.biblio.net