Sri Lanka’s Health Unit Program: A Model of “Selective” Primary Health Care

Abstract

hirty years ago vigorous debates on primary health care articulated at least two main approaches to health promotion in developing countries. The Alma-Ata Declaration of the World Health Organization (WHO) kicked off the debate in 1978 by urging all nations to promote health through primary health care. Reaffirming the 1946 WHO charter that recognized health as a “state of complete physical, mental and social well-being,” the Declaration recommended a comprehensive primary health care program, which included at least the following key sectors: “education to inform prevailing health problems and measures to control them, food security and improved nutrition, supply of clean water and sanitary services, maternal and child care services including family planning, immunization against communicable diseases, the control of locally endemic disease, and the supply of essential drugs for critical health problems.” In allocating resources to these key sectors of the primary health care, the Declaration recommended, countries must ensure “equality,” “affordability” and “community participation.” An alternative to this approach was promoted mainly by the representatives of the United States Agency for International Development, the Rockefeller Foundation and the World Bank who argued that comprehensive primary health care would be prohibitively costly to implement for most nations. One of the