African conditions and circumstances present specific challenges to health service providers. These conditions have implications for primary health care (PHC), including problems of communication (geographical, educational and cultural), maldistribution of health manpower, political unrest and wars. Local PHC services must compete with the prestige of and faith in the hospitals. Manpower training should be stressed at all levels of education of all medical and paramedical personnel. The status of PHC in the Republic of South Africa is now well recognized, and provision of the required services has a high priority.
PIP: To promote and protect the health of individuals and communities in Africa at the primary health care (PHC) level, strategy must be translated into action. Discussion focuses on the assistance that possibly can be given to PHC through health and related systems. Health development councils and networks have been proposed and are being tried in several African countries as structures for attacking health problems at their roots. The Health Act of 1977 provides for community participation by creating a number of subcommittees on which the public can serve. Community involvement is cost effective. An involved public enables the transfer and management of certain patients from the hospital into the community. Care groups can be a viable link between communities and the authorities. Policy statements for PHC must be supported by appropriate plans. Voluntary involvement is not always sufficient. Certain forms of "gentle persuasion" must then be exerted. For example, health legislation should support education, and for many years immunization for tuberculosis, polio, and smallpox have been mandatory by law. Compulsory notification of diseases does not require sophisticated supervision, yet it is vital for the planning and evaluation of PHC. A variety of health responsibilities must be shared by different health authorities: teaching hospitals and PHC units; psychiatric hospitals and PHC units; employers and health authorities; and health authorities and private enterprise. In some African countries, a wide gap exists between PHC services and hospitals, and there is a discrepancy in the money allocated for hospitals and for extrainstitutional services. At this time patients in Africa must themselves take the initiative in order to obtain health care. This system should be replaced by active outreach programs that bring promotive, preventive, and curative health care to the entire population. In Africa, people are realizing that well situated community health centers (CHCs) reduce the need for hsopital beds. The day hospital and large CHCs are gaining more and more suppport as ideal facilities for delivering PHC, especially in urban areas. Traditional doctors and midwives continue to pay a significant role in Africa, even in urban areas, and they should be regarded as members of the extended health team. In most African nations the State remains the major funding source for PHC. More funding should come from the private sector within the country or from international sources.