Primary health care, selective or comprehensive, which way to go?

Abstract

Objective: To critically review the advantages and disadvantages of selective versus comprehensive Primary Health Care (PHC) approaches as a strategy towards improving health in the developing world.

Data sources: Review of literature on PHC.

Data selection: Relevant papers from western and developing world literature.

Data extraction: Search of Pub-Med, WHO/UNICEF reports, and relevant publications on PHC.

Data synthesis: Examination of principles behind PHC and practical experiences in PHC in the developing world.

Conclusions: Selective PHC programs have improved specific aspects of health, frequently at the expense of other health sectors, but fail to address an individual's health in holistic manner, or the health infrastructure of countries. Selective PHC programs tend to focus only on a small subset of the community. Comprehensive PHC is expensive to implement, however addresses health of individuals more holistically, addresses both preventive and curative health care, and promotes health infrastructure development and community involvement, thereby providing more sustainable improvement of health in the whole community.