A health district as the operational unit for primary health care.

Abstract

Commentary is provided on the usefulness of the health district as the organizational hub for implementation of primary health care (PHC) objectives. The recommendation is based on experiences in developing countries, and the awareness that PHC has been constrained by political, economic, social, and bureaucratic factors. A district government area is defined as a clearly defined administrative unit under the aegis of the central government and is responsible for local management. At the district level, the geographic and demographic area is small enough for managing problems and solutions and large enough to have professionally qualified staff. Community participation, intersectoral action, affordable appropriate technology, equity and social justice, and major components of PHC can all be implemented at the district level. Community initiatives can be incorporated into district programs. District health teams have access to District Health Officers, who encourage and support directly and indirectly health-related community initiatives. External cooperation agencies have been active in developing and strengthening local and district government. The 8 basic components of the Alma Ata Declaration on PHC can be realized at the district level. The district level also provides the ideal opportunity to encourage cooperation between people, their governments, and external agencies and to develop a strong national health system.