Selectivity within primary health care

While great strides have been made in improving socioeconomic conditions in the developing world, prospects for health for all remain remote. Resources are few, and difficult decisions must be made concerning the priorities for their use. This paper addresses several topics involved in making these choices including the methods for determining priorities and ensuring effectiveness of resource use. First, prioritizing. Information is needed concerning the prevalence, mortality, morbidity, feasibility and cost of control for each disease of importance in the area under consideration. Second, use of technology. In discussion of health care some have denigrated the concentration many programs have placed on specific methods and technologies. Nevertheless, technological advances, while some have had detrimental results, have often led to improved living conditions; for example, improved seed and fertilizer use, improved water pumps, family planning efforts. These technologies required a larger investment in management, financial and communication systems. Health interventions are frequently more various and complex than these and need a similar support system for impact. However there are many shortcomings in health services; the paper looks at some of these learnt through experience, and concludes that the lack of impact on health of large scale health programs that have provided selective interventions is probably related to an inadequate recognition of the importance of community and political involvement and of the necessary social, cultural, financial, management and administrative underpinnings.