Reinventing primary health care: the need for systems integration.

摘要

The world has come a long way since the Alma Ata Declaration 30 years ago. However, achievements have fallen short of expectations. This is therefore the time to launch a renewed effort to strengthen health systems as the fundamental strategy for integrating primary health care.The origins of the idea of primary care probably date back to the Dawson Report, published in the UK in 1920. This report introduced the notion of three levels of care-primary health centres, secondary health centres, and teaching hospitals-which is still the basis of the pyramidal regionalisation of health services that prevails nowadays. The famous feldshers and the polyclinics of the former Soviet Union could also be regarded as part of the initial impetus to the primary health care tradition.23 In developing countries, the South African Pholela health centre model, which integrated curative and preventive health services in a community-based project, was launched in the early 1940s.In 1946, the Bhore Committee of India recommended the establishment of primary health centres to offer integrated preventive, curative, and rehabilitation services to rural populations. Barefoot doctors in China were also inspired by these experiences, as was the work of Maurice King in Uganda. Other important antecedents of primary health care were the missions of the Christian Medical Commission, created in the late 1960s. According to Cueto, it was in the journal of this organisation that the term primary health care was first used, although Longlett and colleagues had previously coined the term community-oriented primary health care. In the 1960s and 1970s, primary health care took off, mainly through the work of pioneers such as Kerr White, Jack Bryant, and Carl Taylor, who had influence both in academia and international organisations. The culminating moment. was the link of primary health care to the goal of Health for All through the historical declaration adopted in Alma Ata in 1978.