Sunday, September 6, 2009

Primary care in developing countries

While this blog focuses on health and the dysfunctional health care system in the U.S., it's worth noting that many other countries have problems providing their citizens with good primary care. Last year, the World Health Organization released a report, titled "Primary Health Care: Now More Than Ever," that discussed the central role of universal access to primary care in improving the health of people in industrialized and developing nations. One of my previous posts mentioned a conversation I had with health officials from Kazakhstan about their efforts to train more primary care physicians. But what should one do in places where doctors are, and always will be, scarce? In the December 2008 issue of National Geographic, Tina Rosenberg describes how Jamkhed, a remarkable public health program operating in rural India, has trained teams of illiterate health workers to provide a remarkable degree of basic prenatal and primary care services in impoverished rural areas. Rosenberg writes:

"Even doctors who do treat villagers ... rarely spend time teaching them about nutrition, breast-feeding, hygiene, and using home remedies such as oral rehydration solutions. They don't help villages acquire clean water and sanitation systems or improve their farming practices—ways to eliminate the root causes of disease. They don't work to dispel myths that keep people sick. They don't combat the discrimination against women and low-caste people that is toxic to good health. ... 'Doctors promote medical care because that's where the money is,' says [health worker] Raj Arole. 'We promote health.'"

Promoting medical care instead of promoting health is the problem in America, too. While the National Health Service Corps, a program that provides financial incentives for health professionals to practice in medically underserved areas, is chronically underfunded, fire fighters and emergency medical technicians have become the de facto primary care providers to the poor. That's why, in the absence of health reform, the "developing country" title of this post applies to the U.S. as well as it does to places like India and Kazakhstan.