Primary Health Care in Practice: Is It Effective?
Primary health care is accepted as the model for delivering basic health care to low income populations in developing countries. Using El Salvador as a case study, the paper draws on three data sets and a qualitative survey to assess health care access and utilization across public and private sector options (including NGOs). Multivariate analysis is used to estimate the quantitative determinants of health seeking behavior. Physical and financial access is generally good. Households do not value the community health workers, and prefer high cost private care, even the poorest families, because of the lower waiting times and higher probability of successful treatment. Similarly, higher level public facilities—health centers and hospitals—are preferred because they are less costly in terms of time as they offer "one stop shopping" and do not require multiple visits, and treatment success is higher than among health posts, health units or community health workers. These results combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending.
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- Akbar Zaidi, S., 1994. "Planning in the health sector: For whom, by whom?," Social Science & Medicine, Elsevier, vol. 39(9), pages 1385-1393, November.
- Woelk, Godfrey B., 1994. "Primary health care in Zimbabwe: Can it survive?: An exploration of the political and historical developments affecting the implementation of PHC," Social Science & Medicine, Elsevier, vol. 39(8), pages 1027-1035, October.
- Lewis, Maureen A. & La Forgia, Gerald M. & Sulvetta, Margaret B., 1996. "Measuring public hospital costs: Empirical evidence from the Dominican Republic," Social Science & Medicine, Elsevier, vol. 43(2), pages 221-234, July.
- Rifkin, Susan B. & Walt, Gill, 1986. "Why health improves: Defining the issues concerning 'comprehensive primary health care' and 'selective primary health care'," Social Science & Medicine, Elsevier, vol. 23(6), pages 559-566, January.
- Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
- Sherraden, Margaret Sherrard & Wallace, Steven P., 1992. "Innovation in primary care: Community health services in Mexico and the United States," Social Science & Medicine, Elsevier, vol. 35(12), pages 1433-1443, December.
- Robinson, Sheila A. & Larsen, Donald E., 1990. "The relative influence of the community and the health system on work performance: A case study of community health workers in Colombia," Social Science & Medicine, Elsevier, vol. 30(10), pages 1041-1048, January.
- Walsh, Julia A., 1988. "Selectivity within primary health care," Social Science & Medicine, Elsevier, vol. 26(9), pages 899-902, January.
- Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
- Lewis, Maureen & Eskeland, Gunnar S. & Traa-Valerezo, Ximena, 1999. "Challenging El Salvador's rural health care strategy," Policy Research Working Paper Series 2164, The World Bank.
- Stock-Iwamoto, Christel & Korte, Rolf, 1993. "Primary health workers in North East Brazil," Social Science & Medicine, Elsevier, vol. 36(6), pages 775-782, March.
- Bentley, Chris, 1989. "Primary health care in Northwestern Somalia: A case study," Social Science & Medicine, Elsevier, vol. 28(10), pages 1019-1030, January.
- Alderman, H. & Gertler, P., 1989. "The Substitutability Of Public And Private Health Care For The Treatment Of Children In Pakistan," Papers 57, World Bank - Living Standards Measurement.
- Kloos, Helmut, 1990. "Utilization of selected hospitals, health centres and health stations in Central, Southern and Western Ethiopia," Social Science & Medicine, Elsevier, vol. 31(2), pages 101-114, January.
- Stanton, Bonita & Wouters, Annemarie, 1992. "Guidelines for pragmatic assessment for health planning in developing countries," Health Policy, Elsevier, vol. 21(3), pages 187-209, July.
- Stone, Linda, 1992. "Cultural influences in community participation in health," Social Science & Medicine, Elsevier, vol. 35(4), pages 409-417, August.
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