Of mud and alligators

• Published in: Health policy and planning 1986-12, Vol.1 (4), p.345-352
• Main Author: MAHLER, HALFDAN
• Format: Article
• Language: English
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/1.4.345

Each year Dr Mahler, Director-General of the World Health Organization, presents a report to member country delegates at the World Health Assembly. In his address this year, he likened WHO's attempts to promote primary health care (PHC) and Health for All by the Year 2000 to being in a swamp, ‘up to our necks in verbal mud, fighting all sorts of conceptual alligators’. Yet the aim is to clear the swamp. We reproduce here most of that address, not only for its lively images, but also because in it Dr Mahler takes on some of the conceptual and other criticisms of PHC, recapitulates what it is all about, casts a dear eye over how countries are faring in their implementation of PHC, and outlines some suggested areas for action in the coming years. Going back to first principles, he argues that PHC starts with people, their health problems, and their active involvement in solving those problems. It is that active involvement that distinguishes PHC from past health policies. It is not by chance that the very first element of PHC is educating people and communities on health matters, because for people to be intelligently involved in caring for their own health, they have to understand what leads to health and what endangers it. A crucial point is emphasized-that it is people themselves who decide what kind of care is required and not outsiders. In reviewing action programmes for PHC, Dr Mahler emphasizes the need for good organization and management, and calls for efforts to be concentrated on building up district infrastructures, with defined targets to galvanize people into action. He makes a number of suggestions for setting realistic targets and deciding what appropriate technologies exist that can be appropriately applied. The speech is a useful policy pointer on the road to Health for All by the Year 2000.