Dear Readers,

With the realization that with Western type health services, based mainly on hospitals, health for all can never be reached in the foreseeable future, new concepts had to be developed. Primary health care was the answer to the pressing problem of providing minimum health care to the largest possible portion of the population particularly in remote rural areas. This concept is based on the principle that the rural community selects a volunteer who receives training to take care of the most common illnesses and is able to advise on the prevention of disease. Considerable progress has been made. But as this concept involves a change of attitude in the whole community towards self-reliance in health matters, long-term success cannot be achieved within a short period of time. This is a concept which requires patience and persistence. The basic tasks of the primary health worker are relatively simple, as the most common diseases are easy to prevent or treat. In diarrhoea a simple water-salt solution given by mouth is usually an adequate treatment. Proper well construction may be another simple solution to many health problems. The time/y treatment of ma/aria or early recognition of pneumonia may safe many lives.

The primary health worker can also be a useful agent for the promotion of family planning. The population growth in many developing countries particularly in Africa is so high that all other development efforts are made null and void if to measures are taken to curb the population growth which outstrips economic and social development.

Community-based health services have to be sensitive to the needs of the community and be aware d the fact that traditional healers still play a major role in health care. Traditional midwives who receive additional training in sound obstetric practice provide an excellent example of the combination of modem and traditional medicine. Efforts should be made to expand this dialogue wherever possible.

The remarkable acceptance and successes of the primary health care concept have in part contributed to a tendency to overlook the conventional health services consisting of health centres, and district and provincial hospitals.

The primary health worker's credibility can only be maintained d an adequately functioning referral system is available. Therefore development planners must not neglect this important aspect of the health sector. The provision of orthopaedic services is but one example for the provision of a more sophisticated type of medical care which may not be life-saving but is in great demand by the population. The most difficult task of the health planner is to find the right balance between simple primary health services and the components of a more sophisticated refferal level.

Rolf Korte