84

Health System Support for Primary Health Care B. Klezkowski et al. Public Health Papers, 80 World Health Organization, Geneva, 1984, 104 p.

In 1978 the Alma-Ata declaration recognized primary health care as the major key to reach the main goal adopted by the Member States of WHO in 1977 “Health for all by the year 2000”. To implement these objectives research is necessary to be followed by exchange of research data and experience between countries and between health system managers at all levels. To stimulate this exchange “Health system support for primary health care” was selected as the subject of the Technical Discussions held on the occasion of the 34th World Health Assembly in May 198 1, of which this publica- tion is a reflection.

The scope is wide; it encompasses support systems for primary health care delivery throughout the world. The support which is presumably needed from the total health care system to the primary health care system is headed under three major categories: - Promotion of primary health care (policy and priorities, intersectoral support,

legislation, community support) - Development of primary health care (planning and programming, manpower

development, organization and financing) - Functioning of primary health care

This publication is important because it highlights the interdependency of the different segments in society of which an integrated coordination is required in order to have a well balanced health system oriented towards primary health care. The discussion starts from quite an “idealistic” viewpoint of society which should be largely restructured in order to permit a smooth operation of primary health care. Emphasis is put on an appropriate working environment and a “genuine” committed community. However, one wonders if starting from existing situations with a gradual development of the required steps at sectoral and intersectoral level which foster primary health would not have been a more realistic approach.

It is also questionable whether it is possible to discuss support systems for primary health care on a worldwide base both for developed and developing countries, at a much too high level of generalization.

This publication is important for those involved in management and policy-making in health services systems and for those committed to the development of primary health care. A critical analysis of each of the issues mentioned is recommended in order to detect appropriate structures and strategies furthering a well balanced primary health care system with effective systems support and without the creation of addition- al red tape.

Mia Defever, Ph.D. Leuven University

School of Public Health Leuven, Belgium

* * * * *