Health risks from poor sanitation, insufficient and unsafe water supplies, poor personal and food hygiene, inadequate garbage disposal, indoor air pollution and crowded and inferior housing are associated with nearly 30% of the global burden of disease.
This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities.
Gonoshasthaya Kendra (GK) was set up by Dr Zafrullah Chowdhury as a People's Health Centre in Bangladesh after the liberation war in 1972. In 1983 it set up Gono Pharmaceutical, with a factory employing 400, to supply essential drugs at low cost. It now supplies 15% of all Bangladesh's drugs and at 60% of their cost from multinational. Half the profits are reinvested in GK social projects. In 1993 it is expanding into education and nutrition work and setting up employment-generating projects, which employing up to 160 paramedics trained in preventative medicine. Chowdhury has been coming under pressure from the new regime and from the Western-orientated Bangladeshi Medical Association, who want to remove him. At the same time, the government is being pressurized to change its drugs policy by foreign drug companies.
Governments should consider adopting enabling and facilitating strategies to promote participation of communities in meeting their own needs in addition to providing direct support to the provision of health care services. A major focus should be the preparation of community-based health and health-related workers to assume an active role in community health education with emphasis on team work, social mobilization and the support of other development workers. National programmes should cover district health systems in urban, peri-urban and rural areas; the delivery of health programmes at the district level, and the development and support of referral services.