PRIMARY HEALTH CARE WILL FAIL IF WE DO NOT CHANGE OUR APPROACH

Abstract

The implementation of primary health care seems seriously hampered because it is not properly handled by many of the international agencies. Initial concern is the haste with which primary health care projects are being established and executed. These projects are expected to improve the health status of the target group within 2-3 years. Almost everywhere health officials are trying to expand primary health care schemes as rapidly as possible and to provide a maximum of the population with village health workers, yet little attention is directed to the structure needed to support the village workers nor to the problems related to their training motivation and financial reward. There is also the tendency to ignore the complex interrelations between the socioeconomic, cultural, and political factors and health improvement in general. A better way of attaining permanent improvement in health is to build slowly, using the local results and positive experiences in primary health care to reinforce the awareness and political organizations of the poor so that they will have more power to demand a shift in money allocation in their favor from their governments. In most countries this is not likely to happen even after the year 2000, and the World Health Organization (WHO) should stop advertising "Health for All by the Year 2000" and call for slow and careful expansion of the primary health care policy. There are some negative aspects to the amount of money available for primary health care. Donors keen to help with primary health care may not see that it needs the assistance of all medical departments to operate effectively. Despite considerable financial investment in primary health care over the past few years, few countries have been able to change their health budgets from hospital-based services to primary health care. The priorities in the ministries of health still seem heavily biased toward the existing curative and urban-based health services. Through primary health care, predominantly Western values are introduced into the countries to be served by the projects. 1 such case is the emphasis on efficiency in establishing and running primary health care projects. The preoccupation with data collection in primary health care is another example of Western influence as is the tendency to plan, in as much detail as possible, the objectives to be met at each stage of a project. A less ambitious approach to a community health care proposal by the government of Giunea-Bissau with less defined objectives would have been preferable, but it is questionable whether the Western donor would have accepted such a "vague proposal.