The identification of health needs, or the determination of priorities, generally follows the application of epidemiological principles used to select the main problems requiring solution. These problems are commonly expressed in terms of prevalence, incidence, severity and vulnerability of health damage.
However, the definition and selection of priorities are, in essence, value judgments that result from the interaction of the political and professional ideologies of those participating in the decision-making process, as well as the historical and cultural patterns that condition the situation in each country.
Only those needs that manage to be channeled through the political machinery actually generate true demand. As a result, some low-priority needs that are of interest to population groups with greater influence over the decision-making process may generate strong political demand, while other needs perceived as important by less influential groups may never become a true demand on the health system. For this reason, community participation is essential in primary care.
In developing countries, deficiencies are frequently observed in the training of health professionals with respect to the real needs of the population. This is due to the strong influence that centers of medical knowledge in more developed countries have on corresponding academic programs.
Consequently, the interpretation of one’s own reality in terms of needs may lead to dangerous distortions. On the one hand, although it is important to recognize the undeniable value of medical treatment for disease, growing concern arises when the increasingly urgent demand for medical services threatens to push existing resources beyond their capacity.
On the other hand, the application of ecological and social concepts to the study of human diseases indicates that enormous progress could be achieved if the general environmental factors involved in the manifestation of diseases in different human groups could be identified and controlled.
In this sense, it has been observed that certain circumstances are related to health in a very general way. These include the urban or rural environment, marital status, economic situation and type of occupation.
Each of these factors simultaneously predicts an increased risk of a group of diseases, whether infectious or not, and regardless of the organ system they affect. Thus arises the convenience of organizing health services as programmatic sets rather than as isolated interventions aimed at controlling specific problems.
In practice, this process is facilitated when the needs and characteristics of well-defined population groups are examined together and, afterward, the configuration of programs that may have the greatest impact on their health problems is decided.
The application of the risk approach to the study of mothers’ and children’s health needs has facilitated the identification of those factors most closely related to indicators of health level. Information on the distribution of these risk factors in the population facilitates decision-making in two main directions: the design of approaches and techniques for controlling risk factors, and the selection of alternatives for organizing service delivery at different degrees of complexity according to the levels of risk detected.
Scientific and Technological System
When the World Health Assembly identified as the main social goal of the WHO and its Member States “to achieve for all citizens of the world, by the year 2000, a level of health that would allow them to lead a socially and economically productive life,” the search intensified for “practical, scientifically based and socially acceptable methods and technologies” so that primary care could be within reach of all individuals in the community.
The most effective way to ensure that technology has an appropriate basis is to take the problem as the starting point and then select or create, if necessary, a technology that corresponds to the local situation and resources.
In most countries, the scientific and technological system is made up of a variety of sectors, institutions, groups and individuals, including the health infrastructure itself. The different elements of the system participate in different ways in carrying out general functions that may be summarized as follows:
· Identification of technologies, available in the country or abroad, to address health problems.
· Promotion and execution of research for the development of technology and health sciences.
· Adaptation of available technology to achieve maximum use of what is appropriate and relevant to the country’s needs and demands.
