Selective primary health care: Old wine in new bottles

Abstract

This paper comments on a previous paper on selective primary health care (PHC) written by Drs. Walsh and Warren. The PHC approach as developed under the guidance of the World Health Organization (WHO) represents the key health services/sector component of the basic needs strategy. This author finds that the lack of analytical rigor in the critical paper is a serious flaw. Another criticism is levelled against them with regard to established priorities for health care. In discussing feasibility of control the meaning implied is the technical possibility of controlling a disease through vaccine spraying or chemotherapy. To a health planner this appears quite differently. A vaccine is insignificant if the health care network is not in contact with the masses. Resource availability (finances trained workers etc.) and allocation are the context in which all of this must be considered. Once the diseases to be treated and prevented have been selected the next step is to devise interventions of reasonable cost and practicability. This does not take into account true considerations for those factors. Comprehensive PHC as understood by Walsh and Warren is probably not going to be available for everyone in the near future. However by implying that basic PHC systems are beyond the reach of low income countries is an error. Selective PHC is the authors maintain potentially the most cost-effective type of medical intervention and the authors recommend a mix of health care activities. This proposal is different in that it provides services for a certain group within the population (young children up to age 3 and women of childbearing age) while preventing or denying others. This in itself would be quite difficult to accomplish. This author maintains that it is virtually impossible to conceive of circumstances which would justify a fixed unit carrying out only a very narrow range of activities as proposed by Walsh and Warren. Clearly the authors are correct when they observe that flexibility is necessary; that certain types of care and treatment should be added when they become available or subtracted when they are not longer needed. The existing health care infrastructure which already exists in most countries is being ignored as is the possibility of its great expansion in this decade. Nor does the original paper address the nature of the wider development process. The priority activities advocated by Drs. Walsh and Warren are quite compatible; with the balanced set of PHC development; these may be essential for the successful extension of these high priority activities to the mass of low income country populations.