Local institutional development for primary health care

An initial section describes local institutional options (local offices of a national agency, elected local government, self-help groups, cooperative and service organizations, and private providers) which can be used in promoting PHC and notes that a network of local institutions is preferable to a single entity. After discussing the need to enlist prudently the support of indigenous health practitioners, especially women, in PHC delivery, the relation of key PHC issues - access to health care, recurrent costs, preventive versus curative programs, cost/benefit perceptions, and public versus private goods and services - to local institutional alternatives is analyzed. A final section discusses the process of establishing local institutional networks, including the need for an institutional base, use of paraprofessionals, the comparative advantages of local institutions, and the stages of health care development. It is concluded that local institutions are essential to make PHC recipients participants in their own health improvement. Appended are 11 case studies of local institutional development found particularly instructive by the authors and a 57-item bibliography (1969-84).