L48 Anthro 3283 Chapter Notes - Chapter 4: Barefoot Doctor, Schistosomiasis, Global Health
RGH Chapter 4
Primary Healthcare and Selective Primary Health Care
• The primary health care movement (PHC) started in 1970s; driven by Cold War
superpowers
• Soviet Union wanted state-led health programs, U.S. promoted market-based programs
• Era of decolonization; liberation struggles in 3rd world and visions of self-determination
from developed countries
• WHO’s malaria eradication campaign (1955-1969) failed; eradication of smallpox (1967-
1979)
• Rural doctors in India, integrate local practices and drew from community participation
• Cooperative Medical System, or “barefoot doctor” movement, in China demonstrated the
strengths of community-based medicine; combined Western and local medical traditions
such as Chinese acupuncture and herbal medicine practices
o Efforts to control parasitic diseases, such as malaria, lymphatic filariasis and
schistosomiasis, achieved impressive results and contributed to significant rise in
average life expectancy from 35 yrs. to 68 yrs. From 1952 and 1982
• Indian and Chinese programs relied on grassroots participation, cost less than concurrent
top-down health initiatives
o Successes sometimes exaggerated by proponents of horizontal interventions
o Romanticized
o Bottom- up
• Halfdan Mahler – (1923) founder of primary health care movement
o “social justice” a “holy phrase”
o impact on international health policy in the 1970s
o part of many WHO tuberculosis projects and a Red Cross tuberculosis programs
(1950s)
o elected WHO general in 1973-1988
o “health for all by 2000” slogan of PHC movement
o wanted to find middle ground between Soviet and U.S models for healthcare
o didn’t want conference for PHC, but Russia and China suggested it
• Alma-Ata Conference; September 6-12, 1978
o Landmark event in history of global health
o 3,000 reps from 134 countries and 67 intl. organizations made commitment to
achieving universal PHC by year 2000
• Declaration of Alma-Ata
o Introduces concept of “appropriate technology” to describe medical and public
health tools that are readily deployable in resource-poor settings
o Critique of “medical elitism” – calls for increased community participation in
health care delivery as well as integration of Western and traditional medical
practices
o Frames health as an avenue for social and economic development
▪ Would improve education and nutrition, boosting the workforce; tool for
development
• Declaration’s definition of PHC
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o Education concerning prevailing health problems and the methods of preventing
and controlling them
o Promotion of food supply and proper nutrition
o Adequate supply of safe water and basic sanitation
o Maternal and child health care, including family planning
o Immunization against the major infectious diseases
o Prevention and control of locally endemic diseases
o Appropriate treatment of common diseases and injuries
o Provision of essential drugs
• U.S willing to sign it; support from U.S. seen as a victory for advocates in intl. health
equity; reaffirmed notion of health care as a human right
• Conference generated support for PHC among policy makers
• Bold vision for Alma-Ata; failed for many reasons
o Didn’t specify who would pay for or implement PHC scale-up worldwide; signers
pledged support w/o a commitment to implementation
▪ Affluent countries would transfer funds to developing countries for PHC
o 1980s brought a sovereign debt crisis that left many developing countries unable
to provide comprehensive social services and dried up intl. development aid
• Selective Primary Health Care (SPHC) – Julia Walsh and Kenneth Warren; major
critiques of PHC and offered a different approach; thought Alma-Ata scope makes it
unattainable b/c of costs and people needed
o Sought to identify a package of health care services that would offer a high return
in lives saved per dollar spent; introduced as a strategy to complement Alma-Ata
o Cost-effectiveness framework
• GOBI
o Growth monitoring
o Oral rehydration therapy
o Breastfeeding
o Immunizations
o Offered a low-cost, high-impact platform for intl. health
o Interventions easy to monitor and measure
• Critics of GOBI said it excluded leading causes of death; led to question of whether
boosting basic health services was enough; vertical vs. horizontal debate
• WHO continued to support Alma-Ata; Rockefeller Foundation dedicated $20 million to
SPHC; World Bank supported SPHC
• UNICEF – James Grant (1980-1995) supported GOBI and SPHC; sought to deliver
disease-specific technical fixes; fought for “child survival revolution” that would cut the
number of child deaths in half by raising immunization rates in developing countries to
80%
o 1990- UNICEF announced met its goal of 80% immunizations
The Rise of Neoliberalism
• Hayek and Friedman argued that free markets distribute society’s resources in an optimal
way and to view with skepticism the efficiency of most forms of government intervention
o In opposition to Keynes – promoted role for state in macroeconomic stabilization,
market failure, and social welfare
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