Primary health care led NHS: learning from developing countries. Many lessons.

Over the past 30 years a wide range of developing countries have successfully developed a model of primary health care promoted by the World Health Organization (WHO). It differs fundamentally from the primary care system in the United Kingdom which relies more on technical and curative care than the community-oriented approach. In the 1950s and 1960s many developing countries faced a daunting task. A different model of care emerged which recognized that the health of populations was determined by factors other than medical care and that these factors could be controlled by communities themselves through collaboration with agriculture water sanitation and education in a spirit of self reliance. By the 1970s WHO had formulated this model and declared at Alma Ata that Health for All was achievable through primary health care by 2000. The Wests reaction to this model was to support it in developing countries by giving aid but to reject it for the Wests own countries. The medical model was powerful and its proponents argued that populations would become healthier with more doctors and hospitals. The Wests second reaction was political. Socialist countries such as China Cuba and Tanzania had fully adopted primary health care and the concepts of community participation. Such reforms resulted in dramatic improvements in health status in many countries. After the introduction of barefoot doctors for example in China mortality among children under five fell from more than 175 per 1000 live births to under 49. With the end of the Cold War the receding threat of socialist expansionism British and other Western governments are now discovering the wider determinants of health and the strength of community involvement. Some of the WHOs initiatives that have been so successful in developing countries such as Health for All use of health targets and community empowerment are now being pursued in Britain.