The Trouble With Developing a Framework for Primary Healthcare Delivery in Poor Countries

Long-term approaches are difficult but necessary to solve the problem. Short-cut approaches are all a road to perdition.

Most discussions about healthcare delivery start by celebrating the impressive gains made in tackling infections, and reductions in maternal and childhood mortality (even though we remain behind several countries with comparable economies). There is also a general agreement, reinforced by reports of the Global Burden of Disease Study, that future threats to population health and economy will come from the rapidly growing burden of chronic non-communicable disorders. We also agree that addressing the challenges presented by these conditions requires a qualitative change in the way healthcare is delivered.

Communicable diseases announce their presence by making an individual fall ill, which makes her want to seek medical care. In contrast, non-communicable disorders generally do not produce symptoms until major complications involving important organs – like heart attack, stroke, kidney failure or blindness – develop, which is generally too late. Non-communicable disorders like high blood pressure, diabetes and kidney disease may be discovered either during a routine health check or when she undergoes evaluation for an unrelated condition.

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