5. Delivery of Primary Health Care 



The provision of reasonably accessible and 

 economical basic health, nutrition, and family planning 

 services for the world's poor deserves very high 

 priority. 



We propose that the United States encourage 

 expanded international support for efforts to 

 demonstrate effective approaches to providing these 

 services widely and at low cost. Such programs, to be 

 carried out in cooperation with countries that make the 

 domestic policy commitments deemed essential to 

 success, would emphasize preventive services (including 

 nutrition, family planning, and environmental 

 sanitation) , relatively simple technology, and 

 extensive use of community health workers and other 

 paraprofessionals, along with intensified training for 

 physicians in delivery of primary health services. 

 Many small-scale programs along these lines have worked 

 well, but, with such notable exceptions as those in the 

 People 1 s Republic of China and Cuba, few have been 

 effective on a large scale. Most of the trials have 

 something to teach, but systematic attempts to learn 

 from experience have been too infreguent. 



We recommend , therefore, that the United States (1) 

 offer to expand its cooperation in such demonstrations 

 in selected developing countries; (2) establish an 

 experimentally oriented small grant program, channeled 

 through U.S. universities and nongovernmental 

 organizations, to seek needed technological innovations 

 and to promote education, training, and community 

 health programs in developing countries; (3) enlarge 

 its complementary bilateral support of improved health 

 planning and management, including information and 

 evaluation systems; and (4) support international 

 research programs studying the relationships between 

 actual diets and physical growth, mental development, 

 fertility, and other key elements of human performance. 



Although the United States has not yet been able to 

 provide adeguate health care for all its people, and 

 although many doctors and health officials in 

 developing countries follow the high-technology, 

 hospital-centered, curative approach commonly found in 

 this country, it appears that the United States can 

 usefully contribute more to improved health delivery 

 worldwide. This country has a wide range of the 

 reguisite technologies and management skills, and 

 experience working in developing countries. It can 

 also benefit from insights generated in other countries 

 on how primary health care can be provided more 

 effectively to whole populations. 



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