Selective primary health care: is efficient sufficient?

Developing countries are increasingly using economic evaluation methods to assess and plan their health services. Inappropriate application of these methods may lead to serious errors in developing primary health care strategies. In 'Selective Primary Health Care', Julia Walsh and Kenneth Warren present a logical approach to health planning based on cost-effectiveness techniques. Their paper is a timely example of the risks of using simple technical criteria to plan solution to complex public health problems. Cost-effectiveness is not a sufficient criterion for planning primary health care. Related issues are discussed in these comments. As an alternative, a multiple-objective approach is suggested.