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  • Title: [Planning human of resources in health: a necessity to attain Health for All in the year 2000].
    Author: Suarez RM, Del Riego A, Rojas O, Gonzalez M.
    Journal: Cienc Soc; 1989; 14(1):39-50. PubMed ID: 12342849.
    Abstract:
    This report assesses human resource needs in the Dominican Republic in light of the goal of health for all by the year 2000. The economic crisis that has deepened in the Dominican Republic since 1984 is aggravated by steps taken to pay off the external debt, including reduced public spending for health, education, and transportation. Per capita health expenditures declined from US $10.73 in 1983 to $4.48 in 1986, a 58% decline. The infant mortality rate is estimated at 75/1000 for upper socioeconomic strata to 83/1000 for lower strata. The proportion of children hospitalized with malnutrition declined from 1977-86, but the number of severe cases increased. The proportion of low birthweight infants more than doubled between 1977-86 from 6.2% to 14.3%. The lack of an adequate system of health statistics hampers analysis of health data, but the progressive deterioration of living conditions appears to have had a negative impact on health. The number of universities providing health education increased from only 1 in 1965 to 15 in 1983. Beginning in 1980, the proportion of medical students began to decline because of the severe economic crisis and high unemployment rates of medical graduates. The object of study in all current programs in illness, based on a biological and individual focus, ignoring the process of disease and its social and historic determinants. Little weight is given to epidemiology, prevention, scientific methods of investigation, or related areas. Most of the teachers were trained abroad and the curricular materials are almost exclusively foreign. Most learning is passive and occurs in classrooms. Most practices are demonstrations and hospital work is the only contact with the phenomena of health and illness. The current training program prepares personnel with fragmented knowledge, limited technical skills, and an orientation toward clinical practices and the terminal end of the health-disease continuum. Moreover, all medical schools accept students for essentially economic reasons or because of demand by potential students; there is not effective mechanism for balancing supply and demand of health workers. Existing health personnel are poorly distributed between the public and private sectors, geographically, and within specialties. Steps to take in preparing human resources to achieve health for all through primary health care include reorienting the type of manpower trained and the curriculum, redistributing existing personnel, strengthening programs of practical work for advanced medical students, and encouraging community participation and demand for quality health care.
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