Over the last twenty years there has been increasing dissatisfaction about therelevance and effectiveness of national health systems in both the developing andthe industrialised countries. Many people have been seriously questioning the highlysophisticated -and, it follows, expensive -medical technology, which is widespreadthroughout the system and particularly in the hospitals. Is it having a real impact inrelation to its cost? Many have given voice to an awareness of the need forcompatibility between the services provided by the conventional health deliverysystems and the most prevalent health needs of the majority of the population.In the industrialised countries the increasing costs of health care had reached a levelwhich no health system -governmental or private -could pay for without falling intobankruptcy; at the same time, people were realising with increasing clarity that theywere fast becoming passive objects under a medical care system far beyond theirunderstanding and which they could neither participate in nor control. People weretiring of figuring as numbers on computerised lists, considered as "cases" and not ashuman beings. Any sense of responsibility for their own health was progressivelyreceding in the minds of individuals, the family and the community.At the same time, in the developing countries people complained that largesegments of the national population were not even being granted health care as abasic human right. It is not unusual in developing countries to find between 40% and60% of the population without access to any form of permanent health care, whilst inthe capital city problems just like those found in the industrialized countries were rifeand in flagrant contrast to the neglected populations living mainly in the rural areas,the small urban communities and the poverty-stricken belts of the big cities.Many aspects of the health system were questioned. Was there no way to put intopractice the old aphorism that "prevention is better than cure"? Were hospitals(enclosed within their own walls and treating advanced stages or sequelae ofdiseases that could be well prevented outside their walls) the only way of providingan effective _health care? Were physicians the only human resources to be used inall cases, or was there, in fact, a real range of health care activities that could besafely delegated to other professionals, other non-professional health workers andeven members of the family, if not the patient themselves? Could other activities bepromoted outside the health care delivery system that would contribute, perhaps withmore impact in certain cases, to the positive health status of the population?Such activities would be, for example, the provision of clean and safe water; propersanitation; good nutrition, and even activities concerned with such factors as bettereducation, improved income, proper physical exercise, health habits, etc. Were allthe technological developments applied to health care of the same value, equally justified and of the same effectiveness in all societies, or were there seriouslimitations in their use -financial, economic, cultural, etc? How many of thetechnological innovations were either "cosmetic" or of very limited, marginaleffectiveness, out of proportion to their high cost and fast technical obsolescence?
Hospitals & Primary Health Care