Primary health care in the Pacific

It is widely accepted that a Primary Health Care (PHC) response needs to be separately designed for each individual country, but less emphasis has been given to the need to consider different objectives under different circumtances. During the 1970s and 1980s the island States of the Pacific are facing their era of major movement towards political independence and self-sufficiency, which includes the need to redesign their health systems to fit their priorities and to match their particular geographic, demographic and cultural qualities. The priority problems do not appear to include a fight against poverty or a redistribution of resources in a manner which takes a special account of variations in wealth or socio-economic class. Instead, the next decades may have to mean a quite desperate effort to replace a very high external aid component in their budgets with comparable local resources, and the design of health systems for country units which may be as small as 35,000-50,000 and which are composed of widely dispersed populations living in small groups cut off from each other by sea. Even countries with resources and a reasonable health status cannot remain unchanged and the Pacific is a good model to consider what could be done in health terms in countries which are not poor, but which are unlikely ever to be rich. While the island States of the Pacific may be considered to be at present largely unsuccessful in applying international PHC principles, they already have a high health status ranking. The case is presented for them to take more positive PHC steps in the future. In the immediate future the national economic problems must be dominant, but there are technical health system possibilities which could assist them to minimise the inequities due to population dispersion and possibilities for regional collaborative action which would help to overcome the disadvantages of being a small State.