Myths and misconceptions in primary health care: lessons from experience

Primary health care (PHC) is neither new nor cheap. It is a step forward in the consistent commitment of the public health movement over the past century and a half to seek out and redress the wrongs of society, paying particular attention to those most in need. PHC is not 2nd class medicine; it is not simpler but rather more complex. Selective PHC and primary medical care are significant parts of PHC but not the whole. PHC is essentially a combination of task-oriented basic health services and process-oriented community development. The former is a community-desired service, the latter less so. Community participation and community self-help in health care is more productive if based on an informed community, rather than otherwise, and is open to abuse. Health education and health legislation are the trusted tools of health advancement. Medical schools and other institutions of higher learning have a significant, if not vital, role to play in research education, evaluation, and services. They also have a coordinating role to promote PHC team effort. The selection and preparation of voluntary health workers and paid auxiliaries is at least as difficult as that for professional health workers. The preparation of their teachers is a sadly neglected aspect, without which there is little hope of any major progress in improving the image of PHC. Traditional practitioners could and should have an important role in promoting modern PHC since it is simply an update of their traditional role. Data and information systems require revision to meet the needs of local communities rather than those of central intelligence.