Strengthening the backbone of primary health care

Abstract

This article discusses how to increase the effectiveness of district health systems, with particular reference to the setting of priorities and targets, the realization of various forms of joint action, and the improvement of management and other skills.

PIP: The Alma Ata committee emphasized the necessity of policies and programs which relate to better health services. However, the success of improving health status in developing countries has been limited by 1) the unrealistic expectations of wanting to show progress in a short time; 2) inadequate economic support; 3) the insensitivity of health personnel to local needs; and 4) the implementation of vertical programs for the convenience of the providers and not the benefit of users. In addition the district is identified in the context of an implementation unit of primary health care services in the community. This is advantageous to the community in the sense that 1) services are accessible to the community, 2) health services are administratively defined, 3) health services are located within the center of community activities, and 4) the community is small enough to provide services, yet large enough to have technical and managerial staff. District health services can be improved by 1) addressing disease priorities for prevention and control, 2) setting health objectives, coverage targets, and specific areas of improvements, 3) integrating vertical programs, intersectorial action and community participation, and 4) strengthening management needed to supervise the district primary health care. While the district is considered as the forefront unit of planning, organizing, and managing primary health care, it must not be considered in isolation, since guidance and management have to be provided by the government.