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Building the infrastructure for primary health care: An overview of vertical and integrated approaches

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  • Smith, Duane L.
  • Bryant, John H.

Abstract

In the past four decades there has been a succession of different approaches to the development of infrastructure for the delivery of health services. There have been striking similarities among these approaches in both direction and timing in many different countries, particularly in the developing world. While the general trend has been strongly in the direction of a more comprehensive, integrated health infrastructure, there have been important regressions from this path. It is suggested that the recent attention given to the delivery of 'selective' packages of interventions has often diverted energy and resources from the essential task of developing comprehensive, efficient and effective health services. This paper begins with an historical review of trends in the development of health services infrastructure in recent decades. It proceeds to analyse the implications for the organization of health services and for resource allocation when the health services infrastructure is viewed as part of a health system based on primary health care. Finally, we maintain that district health systems based on primary health care provide an excellent practical model for health development, including an appropriate health system infrastructure. Within this model the concerns with accelerating the application of known and effective technologies and the concerns with strengthening of community involvement and intersectoral action for health are both accommodated. The district health system provides a realistic setting for dialogue and planning involving both professionals and non-professionals concerned with health and social development.

Suggested Citation

  • Smith, Duane L. & Bryant, John H., 1988. "Building the infrastructure for primary health care: An overview of vertical and integrated approaches," Social Science & Medicine, Elsevier, vol. 26(9), pages 909-917, January.
  • Handle: RePEc:eee:socmed:v:26:y:1988:i:9:p:909-917
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    Cited by:

    1. Brown, Malcolm C. & Crampton, Peter, 1997. "New Zealand policy strategies concerning the funding of general practitioner care," Health Policy, Elsevier, vol. 41(2), pages 87-104, August.
    2. Jeppsson, Anders & Birungi, Harriet & Ostergren, Per-Olof & Hagstrom, Bo, 2005. "The global-local dilemma of a Ministry of Health: Experiences from Uganda," Health Policy, Elsevier, vol. 72(3), pages 311-320, June.
    3. Valeria Oliveira-Cruz & Christoph Kurowski & Anne Mills, 2003. "Delivery of priority health services: searching for synergies within the vertical versus horizontal debate," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(1), pages 67-86.
    4. Marc Bonenberger & Moses Aikins & Patricia Akweongo & Xavier Bosch-Capblanch & Kaspar Wyss, 2015. "What Do District Health Managers in Ghana Use Their Working Time for? A Case Study of Three Districts," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-15, June.

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