The Silver Lining
However, despite the heavy odds, the situation is not as grim as it appears. Some innovative community-based health initiatives witnessed in the last few years give reasons for hope. For instance, the Primary Health Care Project in the remote regions of Indonesia. The aim of this project, implemented in the remote regions of Sumatra and Kalimantan, was to develop a sustainable health infrastructure by training medical staff, coordinators, village cadres, midwives and those working for TB programmes; provision of ongoing guidance and education in this area; and provision of vehicle, medicines and funds.
Group activities were conducted at the grassroots level to update information and skills. Health clubs, consisting of students and teachers were set up with a view to improve health awareness among the youth. Interaction was facilitated with key persons in the village. As a result of the project, communities in remote areas developed increased awareness on regular health care and disease prevention, particularly for pregnant women and children. They now appreciate the importance of regular paediatric and gynaecological check-ups, and immunization. Personal hygiene has improved and child mortality has declined significantly. Village health cadres are more capable of identifying sick children and preventing diseases, particularly diarrhoea. Participation from the community has increased and there is a drive towards self-reliance. There is an increased networking between health centres, catholic health units and school parishes, to educate the youth on health. The project has pioneered a process towards positive changes.

No Smoking Islands
Outstanding examples of inter–sectoral collaboration and close linkages between NGOs, community groups and the government have been observed in many countries. For instance, in Maldives, collaboration between youth groups, island development committees (IDCs) and health workers led to the declaration of two islands as ‘No Smoking Islands’.
It was in 1942 that the Maldives had first sought to promote a tobacco-free environment. Laws controlling tobacco import use were enforced. But very little was done to inform the public about the hazards of tobacco used as cigarette, bidis, cigars and chewing tobacco. In 1994, Maldives spent a total of US$4.3 million on tobacco imports. Despite advocacy initiatives by the President of Maldives and the government’s control efforts, smoking rates in the country continued to increase.
Convinced of the benefits of a ‘no-smoking’ environment, the youth of Madifushi island initiated a campaign to make their island a ‘no-smoke’ zone. Later, they sought the help of the IDC and the campaign gradually became a joint community effort. The activities were funded by the Ministry of Health, WHO and the IDC.
Community leaders were motivated to support the tobacco ban on the island and groups were formed to facilitate interactions with individual smokers. These groups also provided a forum for discussing the ill-effects of tobacco and encouraged people to make informed choices.
Tobacco in all forms was burnt by the IDC at a ceremony to officially mark the declaration of Madifushi as a ‘no-smoking’ island. Billboards at the harbour proudly proclaimed the same and cautioned the visitors to refrain from smoking while on the island. This example was followed by another island, Haa Alif Berinmadhoo. This experiment proved that individual decisions combined with legislative action can bring about the desired changes.

AIDS Prevention in Sri Lanka
The role of religion in the prevention and control of AIDS has received considerable attention in recent years especially in countries where cultural values are strongly influenced by religion. In Sri Lanka, the predominantly Buddhist culture has had a tremendous influence on the society and it continues to shape the way people look at human relations and sexual matters. With the emergence of AIDS and the increased incidence of Sexually Transmitted Diseases (STDs), it became necessary for various groups to discuss the subject of sex and sexuality more openly to find ways to combating these diseases.
Sarvodaya developed a methodology to involve Buddhist monks in AIDS prevention and control at community level by evolving "the Buddhist approach to AIDS Prevention in Sri Lanka". The project succeeded in breaking the resistance by using the Buddhist teachings and developing a training module. Over 15 hundred Buddhist monks from five districts were trained with the help of this module. Educational materials on AIDS based on Buddhist teachings were also developed. Sarvodaya plans to initiate a temple-based culturally appropriate, scientifically planned, AIDS prevention programme through the leadership of the training Buddhist months.

In more ways than one, the people-centred health initiatives in the South East Asian region have provided an alternative, and in many cases a supplement to bureaucracy-ridden health programmes.

They have addressed the health needs of the poor who did not have access to other health care programmes and are therefore like a silver lining in the otherwise dismal health scenario in the region. These initiatives are characterized by a culturally appropriate, community-based approach. Dynamic leadership, malleable strategies, effective planning, local resource mobilization and need-based upscaling of programmes are other ingredients responsible for their success.
For health promotion to cope with the changing situation in the region, more effective strategies need to be developed not only in terms of programme formulation and implementation but also in the area of public policy so that health can be placed at the centre of development. There is also a need for empowering communities by developing their socio-economic support systems which may lead to narrowing of the existing gaps. Partnerships and networks which put the health of communities at the forefront are also the need of the hour. Decentralization of activities, adequate resource allocation as well as re-orientation of health services to make them more responsive to the needs of the communities are other critical areas of action.

[top] [index]