Abstract

PIP: Primary health care (PHC), despite its potential, has not always been easy to implement with stable communities in developing countries. This discussion explores some of the additional obstacles encountered in refugee camps and settlements and identifies possible ways of overcoming or avoiding a number of these potential obstructions in order to facilitate the implementation of PHC in this setting. It focuses on prevention, equitable distribution, appropriateness, community participation, and intersectoral cooperation. Prevention calls for a longterm orientation to the refugees' problems, despite the uncertainties. In general, host governments, nongovernmental organizations (NGOs), and intergovernmental agencies, including the UN High Commissioner for Refugees (UNHCR), have tended to take a short-term view and concentrate on the emergency aspects of refugee medical care. This orientation has been generated, among other things, by an inadequate conceptualization of the problems, by pressures to become involved in high visibility aid, and by the vested interests of some groups in perpetuating the myth that the refugees' problems essentially require emergency assistance. If prevention is to be effectively implemented, it is necessary for the longterm nature of refugee problems to be accepted. It also is necessary to ensure that all people involved with service provision are adequately selected, trained, and briefed and that the needs of the refugees take precedence over those of the fund raisers and politicians. Some aspects of accessibility may actually be improved in refugee camps as a result of large numbers of people, who previously were dispersed in rural areas, being forced to live close together in a confined space. Yet, there are a number of factors which may give rise to differential and decreased accessibility, including: the availability of resources may be affected at a national level by the decisions of host governments, intergovernmental, and nongovernmental organizations, in terms of their geographical distribution and their allocation between different sectors and activities; and the refugees' access is sometimes resrricted to a number of resources which, under normal circumstances, are important for their health. The involvement of the community in determining priorities, planning, and implementing their own health care is arguably the most radical, politically sensitive, and problematic aspect of PHC. The community participation of refugees is likely to be as difficult as it is essential. Needed is commitment to their involvement. This requires imaginative approaches on the part of groups now responsible for providing health care and appreciation that the refugees have much to offer in the way of skills and abilities. Solutions to the current problems of health care call for several fundamental changes. Changes are required in the way that the issues are currently conceptualized, away from the predominantly emergency aid orientation towards a more developmental approach.