The urban bias in health facilities in Pakistan.

In this paper we examine the urban bias in the health facilities in Pakistan. Although urban areas in Pakistan contain less than 30% of the population, the health facilities are grossly over-represented here. We have argued that the evolution of the health sector has taken place under the broader dynamics of the economy and society in Pakistan. Opting for a capitalist path of growth, with its inherent class contradictions, the health sector has grown in response to the needs of the bourgeois (predominantly urban) classes. The two factors which we feel are responsible for this urban bias are the type of medical education in Pakistan, and the role of the Government. The pattern of medical education is one which is a replica of the developed countries resulting in a demand for the 'latest' and the 'best' in medical care. The result is an urban-biased, hospital-oriented, curative-care model. The Government of Pakistan has also enhanced this urban-bias by investing heavily in urban-centred health facilities, often at the expense of the larger rural population. We have argued that it is the class structure under capitalism which gives rise to an urban bias. Policies are made by the ruling class, and allocations within and outside the health sector are made not on need, but on political expediency and on the ability to pay. To alter this maldistribution of resources, it is the class structure in Pakistan which will have to be attacked.

Hygiene, health education and collaborative health practices in Nepal.

PIP: Health education in Nepal, according to the Long Term Health Plan (1975- 1990) emphasizes an integrated, intersectorial approach, committed to providing minimum health care to the maximum number of people. Nepal has about 16 million people, 90% of them rural, growing at over 2.7% yearly, with a rising growth rate, a 12.2% infant mortality rate, a 50% child mortality rate, and life expectancies of 46 for men and 42.5 for women. 2 health projects based on community volunteers are described: the urban Bhaktapur Development Project and the rural Jumla Project. The Bhaktapur Project employs Community Health Leaders, Village Health Workers, and Panchayat Based Health Workers to provide basic health care and health education, emphasizing prevention. These workers visit households daily, and teach sanitation, latrine construction, water supply development, first aid, detect deficiency diseases, and refer people to clinics. The Jumla Project supplies a densely populated but inaccessible mountainous region where food supplies have to be airlifted, the per capita income averages $140, firewood must be brought from may kilometers away, and local streams are used for drinking water, livestock, bathing and latrines. In the 1st 2 years of the project, 11 pit latrines and 2 gravity fed water systems were constructed. Now latrines are being built all over the region with materials supplied by the International Human Assistance Programme.^ieng