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Introduction
C urative care is o ne co m p o nent o f health p ro gram m es. It is im p o rtant to rem em ber
that
th e o th er co m p o nents also need to be d evelo p ed . T h ese co m p o nents includ e
p ro gram m es fo cusing o n: p alliative care ( includ ing p ain co ntro l) , p sych o lo gical
sup p o rt, p reventio n ( includ ing th e E xp and ed P ro gram m e o f Im m uniz atio n ( E P I) ,
m aternal-child health etc.), nutritio n, w ater, hygiene and sanitatio n.
I - The objectives of curative care programmes
– At an individual level: to cure the p atient o f d isease and to m inim iz e o r p revent the
co nsequences fo r th e ind ivid ual and th o se in clo se co ntact ( i.e. p reventing
transm issio n w hen p o ssible).
– At a population level: to red uce the m o rtality and the co nsequences o f m o rbid ity o f the
m o st p revalent and im p o rtant d iseases in the p o p ulatio n.
– For certain endemic diseases (tuberculo sis, lep ro sy, tryp ano so m iasis etc.): curative care
can red uce transm issio n if a large eno ugh p ro p o rtio n o f the p o p ulatio n is treated .
Often, this o bjective is o nly achieved thro ugh sp ecific co ntro l p ro gram m es w hich are
no t extensively d iscussed in this m anual.
II - Strategy
W h en d efining a strategy fo r a m ed ical interventio n, m ed ical d ecisio n m ak ers m ust
tak e into acco unt the p rio rity d iseases: tho se w ith the highest frequency and m o rtality.
P rio rity d iseases vary w ith co ntext (co nflict, natural d isasters, etc.) and geo grap hical
regio n. N everth eless, th ere is a relatively stand ard ep id em io lo gical p ro file w ith
quantitative variatio ns. A n initial assessm ent, bo th qualitative (d isease d istributio n)
and if p o ssible quantitative (m o rtality, incid ence, p revalence and case fatality), is still
necessary. T h is evaluatio n id entifies th e m o st co m m o n d iseases (d iarrho ea, m easles,
acute resp irato ry tract infectio ns, m alaria, w o und s etc.) and th e p o p ulatio n gro up s
exp o sed and at risk (child ren und er 5 years, p regnant w o m en).
T hese d iseases and p o p ulatio ns co nstitute the p rio rity „targets‟ o f a p ro gram m e.
F o r reh abilitatio n p ro gram m es and p ro gram m es to sup p o rt p re- existing h ealth
structures, d etailed info rm atio n is so m etim es available fro m th e health structures o r
fro m th e M inistry o f H ealth . T h e evaluatio n co nsists o f assessing th e info rm atio n
available and filling in any m issing d ata.
In very iso lated co ntexts o r w hen there is p o p ulatio n d isp lacem ent, no info rm atio n is
available and it is alw ays necessary to d o a co m p lete assessm ent.
Once the p rio rity d iseases are id entified and health p o licy, m eans and reso urces (list o f
essential d rugs, M inistry o f H ealth p ro to co ls, staff and level o f training, health services,
functio ning p ro gram m es etc.) are k no w n, p ro gram m es can be d efined and initiated .
T his m anual and the m anual, Essential drugs – practical guidelines, are to o ls to help in th e
d efinitio n and im p lem entatio n (p ro to co ls, training, retraining) o f curative p ro gram m es.
8
Introduction
C urative care is o ne co m p o nent o f health p ro gram m es. It is im p o rtant to rem em ber
that
th e o th er co m p o nents also need to be d evelo p ed . T h ese co m p o nents includ e
p ro gram m es fo cusing o n: p alliative care ( includ ing p ain co ntro l) , p sych o lo gical
sup p o rt, p reventio n ( includ ing th e E xp and ed P ro gram m e o f Im m uniz atio n ( E P I) ,
m aternal-child health etc.), nutritio n, w ater, hygiene and sanitatio n.
I - The objectives of curative care programmes
– At an individual level: to cure the p atient o f d isease and to m inim iz e o r p revent the
co nsequences fo r th e ind ivid ual and th o se in clo se co ntact ( i.e. p reventing
transm issio n w hen p o ssible).
– At a population level: to red uce the m o rtality and the co nsequences o f m o rbid ity o f the
m o st p revalent and im p o rtant d iseases in the p o p ulatio n.
– For certain endemic diseases (tuberculo sis, lep ro sy, tryp ano so m iasis etc.): curative care
can red uce transm issio n if a large eno ugh p ro p o rtio n o f the p o p ulatio n is treated .
Often, this o bjective is o nly achieved thro ugh sp ecific co ntro l p ro gram m es w hich are
no t extensively d iscussed in this m anual.
II - Strategy
W h en d efining a strategy fo r a m ed ical interventio n, m ed ical d ecisio n m ak ers m ust
tak e into acco unt the p rio rity d iseases: tho se w ith the highest frequency and m o rtality.
P rio rity d iseases vary w ith co ntext (co nflict, natural d isasters, etc.) and geo grap hical
regio n. N everth eless, th ere is a relatively stand ard ep id em io lo gical p ro file w ith
quantitative variatio ns. A n initial assessm ent, bo th qualitative (d isease d istributio n)
and if p o ssible quantitative (m o rtality, incid ence, p revalence and case fatality), is still
necessary. T h is evaluatio n id entifies th e m o st co m m o n d iseases (d iarrho ea, m easles,
acute resp irato ry tract infectio ns, m alaria, w o und s etc.) and th e p o p ulatio n gro up s
exp o sed and at risk (child ren und er 5 years, p regnant w o m en).
T hese d iseases and p o p ulatio ns co nstitute the p rio rity „targets‟ o f a p ro gram m e.
F o r reh abilitatio n p ro gram m es and p ro gram m es to sup p o rt p re- existing h ealth
structures, d etailed info rm atio n is so m etim es available fro m th e health structures o r
fro m th e M inistry o f H ealth . T h e evaluatio n co nsists o f assessing th e info rm atio n
available and filling in any m issing d ata.
In very iso lated co ntexts o r w hen there is p o p ulatio n d isp lacem ent, no info rm atio n is
available and it is alw ays necessary to d o a co m p lete assessm ent.
Once the p rio rity d iseases are id entified and health p o licy, m eans and reso urces (list o f
essential d rugs, M inistry o f H ealth p ro to co ls, staff and level o f training, health services,
functio ning p ro gram m es etc.) are k no w n, p ro gram m es can be d efined and initiated .
T his m anual and the m anual, Essential drugs – practical guidelines, are to o ls to help in th e
d efinitio n and im p lem entatio n (p ro to co ls, training, retraining) o f curative p ro gram m es.
8
