Will primary health care efforts be allowed to succeed?

It is suggested that the consequences of following Primary Health Care (PHC) principles as guidelines for health care development must of necessity lead to socio-economic and political restructuring in most countries. We are well aware that health status is determined more by the social and economic situation of population groups than by curative health services. The holistic approach of primary health care includes a concern with such factors. PHC, if it is to succeed, must ultimately lead to a reduction in the greater benefit for the few to the greater benefit for the many. This will receive strong opposition. The situation of a PHC programme in Guatemala is presented as a case of PHC efforts which were succeeding being violently opposed. This is compared with PHC development efforts in Tanzania where, unlike Guatemala, there has been a conscious effort at restructuring the society and where national development policies are in tune with PHC principles. The future of PHC in Tanzania will depend more on whether or not the organization and management of selection, training and implementation processes, and the minimal available resources, will lead to success, than on whether or not it will be allowed to succeed. It is concluded that the situation in most countries comes closer to that of Guatemala than of Tanzania and that many people and institutions in hierarchial, non-egalitarian societies will spend a great deal of energy to prevent PHC programmes from succeeding. This forces us to consider the promotion of PHC in a much more serious manner than we might wish.