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The Political Economy of Primary Care and “Health by the People”: An Historical Explanation

Published online by Cambridge University Press:  13 August 2021

Oscar Gish
Oscar Gish*
Affiliation:
University of Michigan
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Extract

During the last several years “primary care” has come to the fore as the “new” priority in health care. In September, 1978 the World Health Organization and UNICEF jointly sponsored the first International Conference on Primary Health Care. The following general principles were put forward in 1975 by the 28th World Health Assembly as the basis of successful primary care efforts.

  1. 1. Primary health care should be shaped around the life patterns of the population it should serve and should meet the needs of the community.

  2. 2. Primary health care should be an integral part of the national health system and other echelons of services should be designed in support of the needs of the peripheral level, especially as this pertains to technical supply, supervisory, and referral support.

Type
Research Article
Information
African Issues , Volume 9 , Issue 3 , Fall 1979 , pp. 6 - 13
Copyright
Copyright © African Studies Association 1979 

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References

Notes

1. For example: Ivan lllich’s Medical Nemesis, Pantheon Books, New York, 1976.

2. Industrialized socialist countries (the “Second World”) will not be dealt with, partly because the issues there are quite different, but mainly because the priority importance of primary health care has always been recognized both in theory and practice in these countries.

3. The expression has become widely known through the World Health Organization book of the same title, edited by K. Newell, Geneva, 1975.

4. For example, see Rodney, W., How Europe Underdeveloped Africa, Howard University Press, Washington, D.C. 1974 Google Scholar.

5. In fact, at least in some cases, the introduction of medical missionaries even preceded the coming of the flag. For example, the famous explorer Dr. Livingstone (“I presume”) was a medical doctor.

6. In older, now usually expanded regional and district hospitals in Africa the former European ward is now often reserved (on a non-segregated basis) for “Grade I” patients.

7. Hostile not especially because of so-called tropical diseases, but the very poor socio-economic conditions of the mass of people and the related low sanitary standards, which allowed (and continued to allow) these diseases to flourish.

8. As President Nyerere of Tanzania constantly reminds his planners.

9. For more on this, in the Indian context, see Banerji, D., “Social and Cultural Foundations of Health Serrvices Systems,” Economic and Political Weekly, Special Number, August, 1974 Google Scholar.

10. Roemer, M. I., “Organized Ambulatory Health Service in Inter-national Perspective,” International Journal of Health Services, Vol. 1, No. 1, 1971 CrossRefGoogle Scholar.

11. Fendali, N.R.E., “Medical Planning and the Training of Personnel in Kenya,” Journal of Tropical Medicine and Hygiene, Vol. 68, No. 1, January 1965 Google Scholar.

12. King, M., Medical Care in Developing Countries, Oxford University Press, 1966 Google Scholar.

13. Gish, O., Planning the Health Sector, The Tanzanian Experience, Helm, Croom, London, 1975 Google Scholar.

14. Of course, this is also true to a very considerable degree of medical schools in the industrialized countries.

15. No federal level ministry of health even existed in the U. S. until the early 1950s, and in many key respects it is still not one that can be compared to those in other parts of the world.

16. Schumacher, E. F., Small is Beautiful, Harper and Row, 1973 Google Scholar.

17. Seers, D., “The Meaning of Development,” International Development Review, Vol. XI, No. 4, December 1969 Google Scholar.

18. I know, I am one of them.

19. As in, Djukanovich, V. and Mach, E. P., Alternative Approaches to Meeting Basic Health Needs in Developing Countries, WHO, Geneva, 1975 Google Scholar.

20. As Tanzania’s President Nyerere puts it; the country is “aspiring to achieve socialism.”

21. This expression was coined in 1974 by a group (of which I was part) working at the Institute of Development Studies, University of Sussex.