I.2. FRAMEWORK OF THE CONCEPT
The conceptual model below on the participation of the
population in the framework of health system integration as sub-system of the
local council socio - economic system has served as reference [1].
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This diagram of management and animation shows that from
resources (relatively) limited and with considerable problems, a rational
management of health is a must. This means an efficient and effective
management.
Among available resources, there is the use of human
potential, which is indispensable in the increase of efficiency and
effectiveness of the treatment management. Health is not a general good in
itself; it only makes sens when seen as a contribution to human promotion. As
shown in the first diagram :
(a) Is the objective of health service and direct
contribution to development; (a) does not have any sense if:
(b) does not develop itself in parallel to it.
(c) Is the health service contribution by a non specific way
to development.
(d) Is the responsibility of a number of services among
which health service must be part.
However, for various reasons, the study of this interface did
not lay prior emphasis on research activities on health system.
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Obstacles
Met
Methods to
use
Long term
objectives
Global aim
(d)
Figure 1: Management diagram:
global approach of health problems in the
Importance of problems HIV/AIDS -
M alnutrition - Transmissible diseases
Lack of opportunities
leading to a fatalistic attitude
Lack of resources Qualified personnel - finances-
furniture infrastructure - etc.
MEDICAL AND
HEALTH ANIMATION
M ANAGEM ENT Optimal use of resources
(Human resources)
(c)
GLOBAL SOCIAL A NIM ATION
&
SOCIO
ECONOM IC
DEVELOPMENT
Rise of the living standard
HEALTH
(b)
(b)
(a)
HUMAN
PROMOTION
Studies on the integration of population « health »
preoccupations in a huge complete package where other socio-economic structures
interact with the health action [1] have described how from problems met at the
level of the interface health service / population one can initialize a
dialogue with other existing socio-economic structures to
»coordinate» the inter sector action. The relation of the medical and
health animation with social animation (c) and socio-economic development (d)
can only express itself by «the integration» of the health system in
a whole complete package (figure 1) [1].
Other concepts range health and well -being in an ecologic
approach based on the principle that they are two intimately linked elements
and that they are determined by multiple conditions that interact on one
another (people's way of life, their social milieu the same as their
environment) [2].
In addition, studies on the analysis of various treatment systems
describe various models of integration system and how they can be coordinated
[3].
In reference to primary health care [4] and to health district
[5] [3] [6] as defined by the WHO, the participation of the populations is
erected as a pillar of health services delivery. The health centre is
considered as the element of the district health service whose specificity in
primary health care is to be the point of interaction between the service and a
defined community to which it delivers global health care, that is, complete,
continuous and integrated1 [5] [7].
Many studies also place the importance of participation in the
policy and practices for the promotion of health because it enables communities
to identify problems, propose solutions and favour change [8].
With the advent of AIDS pandemic, the youths are highly
exposed to the risk of contracting HIV. They are in the heart of this pandemic.
Their participation to HIV prevention programmes has been identified as being
an essential feature for the success of programmes that have recognized them
[9]. The participation of the youths to questions in which they are involved is
a right stipulated in the Convention of Rights of Children (CRC) [10].
I.3. DESCRIPTION OF THE CONTEXT
2
The pilot experience was developed in Bangui, the capital city
of the Central African Republic with an estimated population of 670,000
inhabitants divided up into eight districts. The third district covers an area
of 510 hectares with an estimated population of 134, 000 inhabitants among
which 53, 000 young people of 10 to 24 years old (40%). It is divided into two
groupings and twenty-nine quarters with eight main ethnic groups. The
socio-educative infrastructure comprises eight primary schools (among which
five are public), four Islamic
1 Comprehensive (whole) health care (globalité): illnesses
are considered in their total dimension (including social and economic
dimensions).
Continuity of health care: treatments are organized to follow
service users' right from the beginning to the end of their illness or their
risky episode as well as to follow the whole health needs of the community.
Integrated health care: promotion, prevention and education
activities are complementary to curative activities and they are integrated to
socio-economic development.
2 Data provided by the third district council of Bangui
schools for the study of the holy Quran, two secondary schools
(all of them public), two youth clubs, nine health centres (among which two are
public), an HIV voluntary testing centre, a sector for social action comprising
eight nursery schools (among which two are public), four catholic parishes,
twenty -two protestant parishes, six mosques, a police station, a gendarmerie
(French police station), a post and telecommunication service, a taxation
service, a « Crédit Mutuel de Centrafrique » desk, and two
playgrounds.
3
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Figure 2 : The administrative map of
the city of
Bangui
Figure 3 : The administrative map of
the third
district of Bangui
II. GLOBAL APPROACH OF PROBLEMS IN THE PREVENTION OF
RISK AND VULNERABILITY TO HIV/AIDS OF YOUTH IN THE THIRD DISTRICT OF BANGUI:
OBJECTIVES AND PROCESS
II.1.OBJECTIVES
Three main objectives have been defined in the framework of this
pilot experience:
1. to study the organisation-management conditions and
methods of the comprehensive responsibility (integrated, continuous and whole)
of youth risk and vulnerability related to STI/HIV/AIDS with their full and
active participation;
2. to exploit collected data for documentation ;
3. to provide to authorities in charge (of youth education)with
useful information for the generalisation of the model in the whole country.
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