Is there a middle way? Categorical programs for PHC

Abstract

Comprehensive primary health care and selective primary health care are often unnecessarily considered mutually exclusive positions. It is frequently assumed that as they are defined the frameworks of each are different and that acceptance of 1 approach precludes the acceptance of the other. A problem-oriented approach is suggested as a middle way. This approach takes a middle ground by defining a series of tasks or strategies that are focused and manageable. Although individual government institutions such as health ministries necessarily operate in only 1 sector taking a problem--solving approach does not necessarily imply that the strategy will be a top-down effort. This may be appropriate in some circumstances where the intervention. The tasks may just as well include the establishment of community organizations to assure autonomous management of specific activities and inevitably must include information education and communication programs where personal behavioral change is essential for effective implementation as for example with educational activities. The point is that a categorical program that is poblem-oriented sets out some specific goals and tasks with designated endpoints to be reached. Relating inputs to outputs and to impact is permitted. The family planning movement could be considered a categorical program that clearly stands somewhere between what is defined as comprehensive primary care and selective primary care.