Comprehensive vs Selective PHCs Approach

Health services, no matter how efficient, cannot change the condition of the marginalized people unless they are helped to become self-reliant and the root problems addressed…. People who are poor and illiterate are like uncut gems hidden under the dirt and stone. Given the opportunity, they can reach their full potential and live as responsible, sensitive human beings, possessing self-reliance and the liberty to shed those old customs and traditions that impede health and development.” Arole and Arole, 1994

I like this part about sharing with the people , in a place, the decision of health care and include them in designing  health programs , I think this will maximize the effect of the program and facilitate a lots of logistics, culture, and traditional challenges that may face health worker in that area.

Medicine needs to be demystified and knowledge shared freely with people so they can attain and maintain good health…. Hierarchical attitudes have to be replaced by a team spirit and equality. The realization that knowledge not only gives power, but that sharing knowledge also increases self- esteem is important in the development of a team spirit.”Arole and Arole, 1994

Some of Challenges that facing Alma Ata and primary health care: It is too broad and idealistic with an unrealistic time table-Turning most of health attention toward GOBI-FFF (growth monitoring, oral rehydration, breastfeeding, immunizations, food supplementation, female literacy, family planning) -  Easy to monitor and evaluate - Has indicators of success and reporting. Selective disease-specific approaches are the dominant form of global funding today -  Global Fund to Fight AIDS, Tuberculosis, and Malaria -  President’s Malaria Initiative.

 But widespread agreement that more emphasis on horizontal/ integrated/systems approaches also needed. How to combine both systems?  Is a question that has to rise, and how can we get most of advantages of each system and try to minimize the drawbacks?

Comprehensive/horizontal approaches are all inclusive and integrated packages of service that are more holistic in looking at the health issues which would allow for direct community participation and ownership of the interventions (more like a bottom up approach). As good as it seems it does not have the authority to provide the policy space required, and it requires technical expertise for guidance and for the more advanced level of services.

While for the selective/vertical is more of a top down approach which are initiated and implemented targeted at a specific health issue with largely technical experts being on control. It is target driven with less control in participation of affected populations. This approach has a strong experts opinion to it based on analytical deductions and with policy support. It is mostly external intervention to the receiving population and might not be sustainable if the implementers leave and also it does not build strong community capacity.

 

Therefore to have effective and efficient re-burst functional PHCs that would meet the principles of the Alma-Ata Declaration the two approaches must be co-delivered where their respective strengths will complement their weaknesses and there will be involvement of all necessary actors in achieving the desired health care needs of the population with a two-prong approach of comprehensive/horizontal, selective/vertical interventions.