From the bench to the field: control of parasitic infections within primary health care.

During the last decade there has been a great increase in the number of countries that have endorsed the primary health care (PHC) policy at national level, set up national guidelines for it and launched its large-scale implementation. In addition, there have been many important developments with regard to appropriate, cost-effective technologies, training concepts and approaches to securing community participation. These achievements have produced numerous encouraging results. However, although the control of parasitic infections integrated into PHC systems has often been initially successful, these achievements could often not be sustained. Using case studies, mainly concerning schistosomiasis, as examples, control technologies and their applicability within PHC are discussed at three levels; the identification of public health priorities, the community-based implementation of control and the process of evaluation and monitoring. There is a great potential for the integration of a substantial part of control activities, particularly morbidity control, into PHC, provided that the aims and sequences of control activities are well matched with the felt needs of the communities concerned. This implies that the biomedical researcher, the epidemiologist and the health planner need to consider the indigenous health perspectives of the affected community. For example, recent progress in the laboratory in the development of vaccines against parasites needs to be complemented by field studies that continuously validate, standardize and assess the applicability of the proposed measures. This kind of interplay will form the basis for participatory approaches in health planning and make it possible for control activities to be integrated into existing PHC structures and to respond to the needs of the communities concerned.