MOHIN^2DIA AND EASTIMOR

MOHIN^2DIA

The Indian constitution charges the states with "the raising of the level of nutrition and the standard of living of its people and the improvement of public health". However, many critics of India's National Health Policy, endorsed by Parliament in 1983, point out that the policy lacks specific measures to achieve broad stated goals. Particular problems include the failure to integrate health services with wider economic and social development, the lack of nutritional support and sanitation, and the poor participatory involvement at the local level.

The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983 health care expenditures varied greatly among the states and union territories. In the mid-1990s, health spending amounted to 6% of GDP, one of the highest levels among developing nations.

The fifth and sixth five-year plans included programs to assist delivery of preventive medicine and improve the health status of the rural population. Supplemental nutrition programs and increasing the supply of safe drinking water were high priorities. The sixth plan aimed at training more community health workers and increasing efforts to control communicable diseases. There were also efforts to improve regional imbalances in the distribution of health care resources.
Primary Services

Health care facilities and personnel increased substantially between the early 1950s and early 1980s, but because of fast population growth, the number of licensed medical practitioners had fallen between the late 1980s and 1981. In 1991 there were approximately ten hospital beds per 10,000 individuals.

Primary health centers are the cornerstone of the rural health care system. By 1991, India had about 22,400 primary health centers, 11,200 hospitals, and 27,400 dispensaries. These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centers and subcenters rely on trained paramedics to meet most of their needs. The main problems affecting the success of primary health centers are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. In addition, the integration of health services with family planning programs often causes the local population to perceive the primary health centers as hostile to their traditional preference for large families. Therefore, primary health centers often play an adversarial role in local efforts to implement national health policies.

Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centers.

EAST-TIMOR

East-Timor became independent on May, 20th 2002, and is at present on its way to recover after the destroying violence of 1999. There are improvements in economic area and governments- and health structures have been built, but the problems have not yet been solved. For instance, East-Timor needs support for the rebuilding of the infrastructure. The country is not receiving emergency aid anymore and the situation yet proves not to be stable enough for development cooperation. The health care is yet difficult to access and badly organized. There is a large shortage of doctors and technical expertise.

Health Care Development
The Ministry of Health urged HealthNet TPO and Cordaid to contribute to the rebuilding of the health care systems in East-Timor. The first joint programme of HealthNet TPO and Cordaid started in 2002. The most important objectives were the capacity building of the health care workers of the Dili National hospital, the development of the ´General Practitioner Plus´- programme and the set up of counseling and test service for HIV/Aids.
Furthermore HealthNet TPO contributed to the development of sustainable elementary health care facilities in the Liquica and Bobonaro districts and supplied the hospital in Maliana of clinical and administrative personnel. Since 2003 Cordaid handed over fully the activities in East-Timor to HealthNet TPO.

Disease Control
Malaria is one of the most important causes of death in East-Timor and stands, besides the human suffering it impairs, the more far-reaching development of the country in the way. The Ministry of Health asked HealthNet TPO to conduct two research studies concerning the reduction of malaria in East-Timor: a study into the effectiveness of mosquito nets sprayed with insecticide and a study into durable methods of distribution and applicability of these nets at national level. The strategies which Healthnet TPO developed for the social marketing of mosquito nets are incorporated in the existing healt