Selective primary health care. XXV. Management priorities.

Abstract

Provision of the greatest health benefits for the greatest number in developing countries requires setting priorities which will differ in each country according to its existing infrastructure. All programs are based on the foundation of immunization, control of diarrheal diseases, family planning and primary health centers. One of the major barriers to introduction of equitable health care in inadequate management, particularly at the provincial and local levels. In many countries solutions have been introduced with incomplete data, problem definition and monitoring. Typically health delivery systems of industrialized countries have been duplicated, emphasizing tertiary care facilities and curative treatment. The smallpox eradication campaign demonstrated the importance of surveillance, evaluation, management and the power of management. Major considerations in selection of priority programs are the major disease problems in terms of morbidity, mortality and cost, the existing health system, and skills needed. Successful programs have been remarkable for high literacy, particularly female literacy, and social organization acting beyond the individual. Development of an immunization infrastructure is one of the most important primary health care priorities, and forms the basis of the skills needed to supply other types of primary care. Besides traditional health problems, developing countries will need to deal with emerging issues brought on by smoking, alcohol, vehicle crashes and industrial exposure as they make the transition to development.