PRIMARY HEALTH CARE: AN OVERVIEW
DEBABAR BANERJI
Guest Lecture for National Seminar on Health For All in the New Millenium, NIHFW, February 24-26, 2003. (Professor Emeritus, Centre of Social Medicine and Community Health, Jawaharlal Nehru University)

A WATERSHED IN PUBLIC HEALTH
The concept of Primary Health Care (PHC), which was approved by the World Health Assembly in 1977 and endorsed at the International Conference on Primary Health Care at Alma Ata in 1978, marks a watershed in the discipline of public health.

It had virtually turned the discipline up side down, as it were; technology, administrative practices were subordinated to the needs of the people. Halfdan Mahler, the then Director-General of WHO, had rightly labelled it as a revolution. He had also acknowledged that the work done in India had substantially contributed to the development of the concept of PHC.

The concept of Primary Health Care has to be distinguished from the concept of a Primary Health Centre in India. Failure to do so has very often led to trivialisation of the concept of Primary Health Care. The ideas behind setting up Primary Health Centres can be considered as a component of the concept of Primary Health Care.

Reference to the term, primary health care, is made in the Director-General' s report to the 53rd meeting of the WHO Executive Board as early as in January 1975, proclaiming that `primary health care services at the community level is seen as the only way in which the health services can develop rapidly and effectively'. He had enunciated seven guiding principles for this purpose:

1. to shape PHC `around the life pattern of the population';
2. for involvement of the local population;
3. for `maximum reliance on the available community resources', while remaining within cost limitations;
4. for an `integrated approach to preventive, curative and promotive services for both community and for the individual';
5. for all interventions to be undertaken `at the most peripheral practicable level of the health services by the worker most simply trained for this activity';
6. for other echelons of services to be designed in support of the needs of the peripheral level; and,
7. for PHC services to be `fully integrated with the services of the other sectors involved in community development'.

By the time of the Alma Ata Conference on PHC had taken its now well known form, it was seen as the `key to attaining' the target of health for all by the year 2000 (HFA-2000/PHC). Only the outstanding elements of the Declaration are being presented below:

I The Conference strongly reaffirms that health is a fundamental human right and that the attainment of the highest level of human health is the most important social goal and whose realization requires action in many other social and economic sectors in addition to the health sector.

II The existing gross inequality in health status of the people particularly, between developed and developing countries and as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

III. Economic and social development is of basic importance to the fullest attainment of health