Selective / Primary Health Care

The Declaration of Alma-Ata¹ takes on a new meaning, once you become aware of the games they play.

First off, the claim that it's decentralised is... not quite true, even though ‘the people’ are essentially expected to take care of themselves -

'requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care...'

But operational decentralisation isn’t the whole story. The full list of services considered essential include -

‘education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;‘

Education is centralised, as is promotion, vaccines, provision of essential drugs, and advice on family planning - which really is part of education.

Treatment of common diseases and injuries is decentralised (per above), as is - presumably - maternal and child healthcare.

The one that sticks out is ‘prevention and control of locally endemic diseases‘. Reason being that it can’t be fully decentralised, but rather must be controlled from top down, if used to essentially protect outside communities. Consequently, this would be a case of ‘decentralised to the lowest appropriate level’, which we also see mentioned in the Convention on Biological Diversity’s ‘Ecosystem Approach’; key being - who decides to what level to delegate?

Another item of interest is that apart from maternal and child, no such as general healthcare is considered essential. Either way, let’s recap -

• Centralised: education, promotion, vaccines, drugs.

• Delegated: prevention and control of locally endemic diseases;  

• Decentralised: treatment, healthcare.

And the centralised responsibilities of education and promotion can then be further reduced to information, and vaccines and drugs in short entail pharmaceuticals. And the delegated responsibilities comes down to epidemic containment strategies.