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ORGANIZING PRIMARY HEALTH CARE IN A SYSTEMS APPROACH TO PUBLIC HEALTH

The provision of primary health care to the rural and urban populations in the developing and developed countries in recent years has “unexpectedly” come to the fore among other widely discussed medico-biological, organizational and social problems of contemporary public health. These problems have attracted the attention of public health managers, the medical and academic communities, politicians and statesmen and the public at large in many countries; as well as international organizations and first and foremost, the WHO, UNICEF, international societies, associations and academies. Quite a number of books, reports and reviews have already been published on these questions, and there have been various conferences, symposiums and meetings devoted to them. The number of such conferences began to increase rapidly after the World Health Assembly passed a resolution to hold in Alma Ata (USSR) in September, 1978, an International Conference on Primary Health Care to exchange experience on the development of primary health care within the framework of comprehensive national health systems and services, especially as regards the aspects of planning and evaluation. It is also of primary importance that the World Health Organization, upon the proposal of the Director-General, Dr. H. Mahler, has set the goal“Health for All by the Year 2000,” thereby fixing a deadline for attaining one of the foremost objectives that was defined in the WHO constitution at its inception more than 30 years ago, but whose attainment is still far away. Yet, the overall situation has radically changed: the demands of the public at large in all counrries for properly guaranteed rights for each and every person and for the whole population for the protection and promotion of health and have become even more acute and thus a political necessity. This trend is connected with the apparent realization of the growing social, economic, political and international significance of the problems of public health not only in the socialist and developing countries, but also in the countries of the so-called “Western World,” where questions of public health were “traditionally” viewed through the prism of interrelationships between private practitioners and their patients. It has become quite apparent that private medicine cannot meet the continuously growing requirements of the population in health protection and promotion even given the most substantial state and private subsidies, and that radical reforms are needed in this area. Such reforms logically should begin with resolving the problems of primary health care. At the same time, one cannot but note that in numerous publications and statements made during discussions concerning the primary health care concept, and the principles of its provision, there has been much confusion, misunderstanding, emotionalism, naive wishing, and at times, simply wishful thinking, as well as involuntary