PHA-Exchange> Self-help: What future role in health care for low and middle-income countries?

[claudio at hcmc.netnam.vn]

 from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----

Self-help: What future role in health care for low and middle-income
countries?

K. R Nayar, Centre of Social Medicine and Community Health, School of
Social Sciences,

Jawaharlal, Nehru University, New Delhi, India.

Catherine Kyobutungi, Oliver Razum, Department of Tropical Hygiene and
Public Health, Heidelberg University, 
Heidelberg, Germany

International Journal for Equity in Health 2004, 3:1 (published 15 April
2004)

 Available online as PDF file [33p.] at:
http://www.equityhealthj.com/content/pdf/1475-9276-3-1.pdf
<http://www.equityhealthj.com/content/pdf/1475-9276-3-1.pdf>  

 ".........In the debate on 'Third options' for health care delivery in
low- and middle-income countries it is proposed that self-help should
play a larger role. Self-help is expected to contribute towards
improving population health outcomes and reducing government health care
expenditure. We review scope and limitations of self-help groups in
Europe and South Asia and assess their potential role in health care
within the context of health sector reform. 

 Self-help groups are voluntary unions of peers, formed for mutual
assistance in accomplishing a health-related purpose. In Europe,
self-help groups developed out of dissatisfaction with a de-personalised
health care system. They successfully complement existing social and
health services but cannot be instrumentalized to improve health
outcomes while reducing health expenditure. In South Asia, with its
hierarchical society, instrumental approaches towards self-help prevail
in Non-governmental Organizations and government. 

The utility of this approach is limited as self-help groups are unlikely
to be sustainable and effective when steered from outside. Self-help
groups are typical for individualistic societies with developed health
care systems - they are less suitable for hierarchical societies with
unmet demand for regulated health care. We conclude that self-help
groups can help to achieve some degree of synergy between health care
providers and users but cannot be prescribed to partially replace
government health services in low-income countries, thereby reducing
health care expenditure and ensuring equity in health care....."


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