The district and support for primary health care: The management experience from large‐scale projects

DOIhttp://doi.org/10.1002/pad.4230060305
Date01 July 1986
AuthorDuane Smith,J. Patrick Vaughan
Published date01 July 1986
PUBLIC ADMINISTRATION AND DEVELOPMENT,
Vol.
6,
255-266
(1986)
The district and support
for
primary health care: the
management experience from large-scale projects
J.
PATRICK VAUGHAN
London
School
of
Hygiene
and
Tropical Medicine
DUANE SMITH
World
Health Organization
SUMMARY
With the implementation
of
primary health care policies the need
for
more effective
management support at the intermediate
or
district level has become apparent, but experience
is
poorly documented. This article reviews the management experience
of
large-scale district-
level projects in Ghana, India, Iran, Korea, Philippines, Thailand and Zaire. The lessons
point to a strong need to strengthen district-level management and
for
greater
decentralization. These in turn
will
require a review
of
the present organizational health
structures and the strengthening
of
national-level planning and management capacity.
INTRODUCTION
It is now more than
5
years since the Declaration
of
Alma-Ata
on
Primary Health
Care (PHC). In
a
recent review undertaken by the World Health Organization of
progress in
PHC
implementation in
70
countries, nearly two-thirds had officially
adopted the policy of Health for All. However, the problems are now becoming
apparent of moving from policy into planning and implementation (Vaughan and
Walt, 1984). One
of
the major problems is to secure good support for
PHC
at an
intermediate level as well as
at
the national, state and community levels (Conyers,
1981; Vaughan, Mills and Smith, 1984; Vaughan, Walt and Mills, 1985). The
development
of
this support is
a
management responsibility, and yet there is little
well-documented experience on how it should be done.
It is therefore relevant in considering the development
of
the district level to ask
what has been the experience and lessons
of
earlier projects: and what have been the
major management problems in enlarging small localized PHC projects to large-
scale programmes? What can we learn from these programmes about how to
strengthen district-level planning and management in future?
Dr.
Vaughan is Reader in Health Care Epidemiology in the Evaluation and Planning Centre
for
Health
Care at the London School
of
Hygiene and Tropical Medicine, London WClE 7HT.
Dr.
Smith is in the Division
of
Strengthening Health Services
of
the World Health Organization, Geneva.
027
1-2076/86/030255-12$06.00
01986
by
John Wiley
&
Sons, Ltd.

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