The PAHO-CENDES method.

The Pan American Health Organization (PAHO) and the Center for Devel opment Studies (CENDES) of the Central University of Venezuela Caracas collaborated in developing a methodology for national health planning. The logic involved calls for systematic determination of what the significant health problems will be in some future period and what resources will be available to deal with them. This technique starts with the problem of priorities. There are 2 views of the social importance of individual health: 1) that each persons life is of the same importance as any other or 2) that the life of certain persons is more important to the community than the life of others. In this method the 1st view is adopted. It also assumes resources should be concentrated on the disease or hazard to health that requires lowest expenditure per death prevented up to the point where the resources are no longer effective; then the next most effective problem should be atta cked and so on. Where differing regions have differing costs it is recommended that available national resources be allocated among regions in such a way as the ensure that existing health levels will be at least maintained during the period of the plan. This system seriously limits flexibility. Health professionals require long periods of training and a cardiologist is not interchangeable with a malariologist. These problems are acknowledged but are called matters of priorities to be set by others. The PAHO-CENDES Method uses 3 major steps: 1) diagnosis 2) determination of feasible alternatives in the local area and 3) preparation of regional and national plans. Areas do not necessarily correspond to existing administrative jurisdictions. The most highly sp ecialized services are planned at the national level. Details of the method are given. Methodological problems include the rigid definition of cure and the inability to deal with deaths from 2 or more causes. It has also been difficult to put health planning into effect from the local level upward thoughout Latin America. However it is 1 of the most thorough applications of systems analysis and represents a substantial step forward. It is continually being revised.