Strategies for child survival: program vs. process.

This article discusses the origin of the concept of primary health care (PHC) and compares and contrasts it with the concept of selective primary health care (SPHC) as it relates to programs devoted to improving child health. PHC came to encapsulate a health policy that emphasized basic health services particulary for the poor and focused attention on the relationship of health improvements to socioeconomic factors, which incorporated such things as education, nutrition, employment, and overall standards of living. SPHC narrowed the focus of health to a limited number of cost-effective medical/technological interventions that were believed to improve health rapidly and dramatically. Health planners developing child survival strategies must choose which approach to follow. Those who emphasize the importance of process do not reject the value of specific medical interventions, just as those who follow specific programs recognize the importance of considering the broader processes that determine health. However, entry points, work methods, and goals of the 2 approaches are very different. Whether the choice is conscious or unconscious, the one which is taken will have wide implications for the allocation of money, material, and manpower.