Selective primary health care: the counter revolution

doi:10.1016/0277-9536(88)90409-1

Social Science & Medicine

Volume 26, Issue 9, 1988, Pages 903-906

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Abstract

Primary health care in the WHO sense was triggered indirectly by the failure of the Malaria Eradication Programme. The response to this failure was an ideological change which considered that health services were not purely a way of delivering health care interventions to people but were something important to individuals and groups in their own right. Key changes of this idea called primary health care were linked to qualities such as power, ownership, equity and dignity. Such an ideological change involves the evolution of new forms to reflect the changes in content and some of these structures still require development.

The advocates of highly selected and specific health interventions plus themanagerial processes to implement them have ignored, or put on one side, the ideas which are at the core of what could be described as the primary health care revolution. They are in this sense counter revolutionaries.

References (7)

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Citation Excerpt :
A temporary reversal of this direction, following the 1978 Alma-Ata Declaration and WHO's espousal of PHC has been well-documented (Roemer, 1986; Cueto, 2004; Litsios, 2002, 2004; Birn 2014). In the standard narrative this was rapidly curbed by the international debt crisis, which enforced a return to vertical approaches of ‘selective primary health care’ based on limited, cost-effective interventions in child health (Newell, 1988). WHO's leadership was then superseded by the World Bank which yoked development lending for health services to structural adjustment conditionalities, resulting in a largely unsuccessful attempt to widen access through pluralistic, private sector development (Stein, 2008; Abbasi, 1999; Packard, 2016; Cueto et al., 2019).
Our contribution to this special issue examines the early history of international striving for universal health care, from the perspective of the World Health Organisation's (WHO's) Regional Office for Africa (AFRO). The aspiration was repeatedly reframed, from ‘strengthening health services’ in the 1948 constitution of the World Health Organisation (WHO), to ‘Health For All’ through primary health care (PHC) in the 1970s, to today's articulations of universal coverage and ‘health systems strengthening’. We aim to establish how AFRO supported member states in implementing these policies up to the mid-1980s, and with what degree of success. We also compare AFRO's experience to the established historiographical narrative of global health, as over-fixated on vertical interventions, save for the transitory impact of the PHC movement. Using the archives of WHO in Geneva and AFRO in Brazzaville, we first analyse AFRO's influence and capacity through quantitative financial data. The AFRO nations were net recipients of WHO resources, raising questions about their relative autonomy and voice in the organisation. We then examine AFRO's expenditure, showing that though circumscribed by funds with allocated purposes, there was nonetheless a significant proportion committed to services from the early 1960s, specifically capacity for planning and administration and the nursing, maternal and child health workforce. Counter to expectations though, there was no significant boost to these areas, nor to funding PHC projects, in the 1970s/early 1980s, when disease-specific interventions obtained a larger share. Qualitative sources show that despite its slender resources AFRO accomplished much with respect to training, capacity building and supporting innovative service-delivery, while insisting on African policy input into design and implementation. However country level system-wide planning in health was persistently vulnerable, and the bureaucratic capacity of post-colonial states often weak. Thus AFRO's overall impact was decisively bounded by the global structural inequalities in which it operated.
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Selective primary health care: the counter revolution

Abstract

Man Adapting

Organizational Study on Methods of Promoting the Development of Basic Health Services