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WONCA WORKING PARTY ON RURAL PRACTICE

Health for all Rural People: THE DURBAN DECLARATION
Adopted at 2nd World Rural Health Congress,
Durban South Africa 1997

Preamble

We, the rural health professionals of the world, meeting in Durban at the 2nd World Rural Health Congress propose a global initiative for the advancement of the health of the world's rural people. We wish to work in partnership to overcome the inequities facing rural areas.

We recognise the significant contributions and progress by a few countries and organisations but express our profound concern and dismay at the continued neglect of the people of the world who live in rural areas. We are deeply saddened that in many parts of the world the majority of rural people live in absolute poverty without the benefits of education or health care, with dire consequences on the health of these people.

The rural people in these continents have a very low life expectancy, and suffer high infant and maternal mortality rates. Half of all children are underweight, and most go to bed with hungry stomachs. Infectious diseases, malaria and tuberculosis, and now HIV infection, devastate the lives of these poor people. The future looks bleak. Income disparity continues to widen within nations, between nations and most seriously between rural people and urban people.

The failure of the program, 'Health for All by the Year 2000', underlines the failure of national governments and international institutions to give sufficiently high priority to overcoming rural poverty and poor health.

We now present our positive vision of the way forward.

Principles

We reaffirm our support for a global campaign to achieve "Health for All'.

We recognise that alleviation of poverty is fundamental to any endeavour to improve the lot of rural people.

We emphasise that nutrition, clean water and efficient sewage disposal, a safe environment, immunisation of children, adequate housing, education are the highest priority.

We note that governments of poor countries have few resources at their disposal and are unable to sustain the burden of foreign debt, the declining terms of trade and the impact of structural adjustment programmes. Nevertheless we insist on good governance, elimination of nepotism and corruption, and steps to reduce grave inequalities in the distribution of income and wealth within these poor countries.

We emphasise the responsibilities of rich countries to contribute the promised 1% of GNP to aid, to curtail their trade in arms, to cancel debts owed to them by the poorest countries, and to support more equitable forms of trade globally.

We note that the restructuring of global institutions is underway, and emphasise the importance of a more clearly defined role for the United Nations and its agencies and global non-governmental organisations, to work for the elimination of global poverty.

A Call for Action

Participants at this World Rural Health Congress call for a renewed 'Health for All' initiative.

We call on the WHO, UNICEF, development banks such as the World Bank and other regional development banks, and national governments to work with the local communities, as well as doctors, nurses, and other health workers actually working in the poorer areas of the world, to make a success of the 'Health for All" initiative this time.

We ask for a combined effort to redress the historical inequities facing rural and disadvantaged communities.

We recommend that targets be set in stages until the Year 2020 to substantially reduce all aspects of global poverty - social, cultural, economic, educational, nutritional and health

We, the conference participants, recommend that the rural health workforce commits itself to work at a local, regional, national and international level with governments and other agencies towards this goal by:

  1. ensuring appropriate delivery of public health measures
  2. development of multidisciplinary multisectoral teams with a community orientated approach
  3. ensuring a mix of primary health care, public health, clinical and community development approaches that is appropriate to each community
  4. ensuring appropriate training of adequate numbers of rural doctors and other health professionals and promote the reorientation of universities to provide such training
  5. ensure continued educational support of health professionals in rural areas
  6. to sustain and enhance the provision of rural health care by the provision of incentives and appropriate conditions for rural doctors and other health professionals
  7. the provision of adequate resources and facilities for rural health care

Since the great majority of the poor people of the world live in rural areas, we pledge ourselves to this Global Initiative to Achieve Health for All Rural People by the Year 2020.

We make this declaration, here in Durban, South Africa, on 17 September 1997 and signed below on our behalf.

Signed by and on behalf of
The Second World Rural Health Congress Conference Committee Supported by the President of WONCA & the Health Minister of South Africa

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