Priority for primary health care: its development and problems

Abstract

National health policies of many countries stress priority for primary health care (PHC). This emphasis has arisen as a reaction to large expenditures on hospitals and sophisticated technology in major cities of developing countries, while vast rural populations have been virtually ignored. The paradox developed from colonial and neo-colonial emulation of European and North American medical models. In 1978, an international conference of WHO/UNICEF at Alma-Ata, USSR defined the meaning of PHC, along with several principles of organization and equity under which it should be provided. To reach rural people with PHC, thousands of community health workers have been prepared and stationed in villages. Their training, however, is very brief and, with weak supervision, their performance has been disappointing. To achieve the WHO goal of "Health for All" through PHC requires greatly expanded education of public health leaders, who can supervise and inspire community personnel.

PIP: The goal of "health for all by the year 2000" emerged in response to the vast health problems of rural populations in developing countries and the pattern of inappropriate reliance on expensive, sophisticated medical technology imported from developed countries. Primary health care was stressed as an alternative approach to meeting basic needs in developing countries. Primary health care requires maximum community participation in the planning and control of services and the involvement of all related sectors of national socioeconomic development. The use of briefly trained community health workers was identified as a sound strategy for getting health services to rural populations and brought community people closer to the operations of the whole health care system. However, the guidance and supervision of these village workers has been inadequate. The volume of utilization of community health worker services by the population is very low, and these workers tend to spend their time on the symptomatic treatment of sick patients rather than on preventive activities. The attitude of community health workers is generally apathetic, and they appear to be superficial and hasty in their work. These shortcomings can be related to a serious lack of supervision of community-level services by the next higher administrative echelon. District and provincial medical officers rarely visit community health posts. This lack of leadership leads community health workers to be poorly motivated for primary health care functions beyond the treatment of basic ailments. To acquire the health management skills necessary for the guidance and supervision of community health workers, medical or health personnel must be trained in the philosophy and practices of public health.