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( By J.-J. Guilbert )

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Chapter 1: Priority health problems and educational objectives - The educational planning spiral



The object of education is not to shape citizens to the uses of society, but to produce citizens able to shape a better society.

The educational planning spiral


Programme reform has been a source of concern for many years to those training health personnel and the alarm has often been sounded. However, the strength of the traditions impeding necessary reforms has been such that it has not been possible to avoid serious disturbance in many universities throughout the world, always caused by a reaction in face of the apparent diehard conservatism of the system.

It would, however, be negative and dangerous merely to accuse of incompetence those at present in positions of teaching responsibility. They should be offered help.

Societies change and have always been changing, but until the present century their evolution was relatively slow and adaptation to change was possible without unduly violent disorders.

The form of teaching has remained unchanged for centuries. The university has wrapped itself in its privileges and remained deaf to the cry from without. The needs of society, the practical side of the matter, have been left to chance, whereas specific features of the situation in each country are changing ever more rapidly. Hitherto, unfortunately, little or no account has been taken of those features and the training of health personnel has followed traditional systems. What is required now is to make sure that educational programmes are relevant.

There can be no question of continuing to copy the models of the past or, in the case of developing countries, foreign models.

The educational system leading to the development of health personnel, at all levels, must be re-examined within the context of the needs of the country concerned1

1 Those who are interested in a more detailed analysis of needs, organization of health services, and the definition of tasks and functions than it is possible to give in this Handbook should consult specialized texts on these aspects (see Bibliography, p. 7.01).

There are a few health sciences institutions in different parts of the world that have not only succeeded in introducing significant changes over the past two decades but have also amply demonstrated that the effort has been worth while. No educational system can be effective unless its purposes are clearly defined. The members of the health team must be trained specifically for the tasks they will have to perform, taking into account the circumstances under which they will work.

The sum total of these tasks, or professional profile, can only be defined in accordance with a plan in which the nature of the services to be provided is specified, priorities are allotted, the staff needed to provide these services determined, etc.

Professional training programmes must then be tailored to meet these needs.

There is room for some degree of optimism in this sphere, for no financial assistance is needed for a move in the right direction. All that is needed is a resource distributed more or less equally around the world: mental ability. The management of that resource is the art of organizing talent and of coping intelligently with change.

Defining the professional tasks of health personnel to be trained, the very basis of the educational objectives of training centres, is of crucial importance.

Thus an educational programme, instead of being the result of a non-selective accumulation of knowledge built up over the centuries, must be shaped selectively in terms of the goal to be achieved. If that goal is modified in the course of time, the programme must also be modified accordingly.

Definition of professional tasks must proceed from a study of needs, take account of available resources and indicate clearly and precisely what various categories of personnel will be called upon to do during their professional careers in a given type of health service.

The first step is to map reality.