Improving health services in developing countries with new types of public and allied health personnel.

Allied health manpower in developing countries should be able to serve the specific needs of these countries in solving malnutrition diarrheal disease and other health problems. Disease patterns tend to evolve in stages with each stage requiring a special type of health manpower: 1) the 1st stage where infectious diseases are linked to poverty malnutrition and poor personal hygiene for which personnel trained to improve health through providing safe water supplies improving sanitation and immunizing the population are needed; 2) in the 2nd stages diseases such as cancer arthritis and cardiac diseases exist requiring extensive technology such as is available in the US; and 3) the 3rd stage relates to an awareness of health hazards (caused by the environment by the lifestyle dysfunctions of the society and an emphasis on health promotion) and implies a responsibility for ones own health by the individual; this is a difficult stage to apply to developing countries since the ability to bring about change assumes literacy on the part of the population which is not always the case. Since most developing countries need to cause change in the 1st stage more public health personnel such as sanitarians and generalist workers are needed. Training of these personnel should include on-the-job education; traditionally trained US allied health professionals are not always equipped to deal with health problems in developing countries. Health educators should look to the lessons learned by the US in the allied health movement: 1) the system of control that national membership organizations have over schooling and the job environment has contributed to an increased cost of health care delivery unnecessary prolonged curricula overspecialization extreme protectionism for membership and inappropriate fractionalization of health care delivery; 2) the emphasis on prolonged curricula sometimes causes the student to lose sight of the supposed direct relationship between training and actual needs of the community 3) requiring degrees before health training was not necessary; and 4) look to more realistic student selection criteria related to the demands of the job rather than of the education program to avoid job turnover. Funding should be found for training a new type of allied health professional that would combine preparation for public and allied health; in addition US schools should extend their medical equipment repair programs to include students from other countries. The production of health personnel appropriately trained to deal with problems and situations specific for developing countries could be a breakthrough in upgrading these countries health status.