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Year : 2019  |  Volume : 8  |  Issue : 6  |  Page : 2165  

Comprehensive primary health care, not any vertical program needed for UHC

General Practitioner, Raiganj, Uttar Dinajpur, West Bengal, India

Date of Submission03-May-2019
Date of Decision14-Jun-2019
Date of Acceptance15-Jun-2019
Date of Web Publication26-Jun-2019

Correspondence Address:
Dr. Jayanta Bhattacharya
General Practitioner, Raiganj, Uttar Dinajpur - 733 134, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_361_19

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How to cite this article:
Bhattacharya J. Comprehensive primary health care, not any vertical program needed for UHC. J Family Med Prim Care 2019;8:2165

How to cite this URL:
Bhattacharya J. Comprehensive primary health care, not any vertical program needed for UHC. J Family Med Prim Care [serial online] 2019 [cited 2021 Jul 24];8:2165. Available from: https://www.jfmpc.com/text.asp?2019/8/6/2165/261434


In his intriguing editorial, Raman Kumar has raised three important issues – (1) “Immediately after independence, India pushed aside the recommendations of the Bhore committee, which was for implantation of comprehensive primary healthcare. Instead, we opted for the path of selective primary care modeled on vertical disease–based programs under the guidance of international development agencies”, (2) “Superspecialty care, fragmented public health programs, and quackery have become three pillars of the Indian health system”, and (3) “Will the Indian economy be able to sustain the double burden of UHC and the vertical programs?”[1]

To emphasize, barring the period of the historical Alma-Ata Conference (1978) big corporate players of the world have always pursued the path of technology-intensive vertical care programs. Since 1960s and even before, medicine and health/healthcare have become the focus to make it a commodity of open market and private insurance. 2 Nobel Laureate economists—F. A. Hayek and Kenneth Arrow—categorically advocated for such state policies. To Hayek, “there is little doubt that the growth of health insurance is a desirable development… Beveridge scheme and the whole British National Health Service has no relation to reality.”[2] Arrow specifically emphasized that “the subject is the medical-care industry, not health.”[3] He even gave subtitle of one chapter as “A Survey of the Special Characteristics of the Medical-Care Market”.

In the post-WWII era, concern for technological development has dominated not only the economies of the industrial nations but also their relationships among themselves and particularly, with the less developed countries. Technologies were only effective when they were themselves an integral part of the development of the society to which they were transferred. The Alma-Ata Declaration stressed – (1) people's participation in policy-making, (2) technological benefits to be transmitted to the remotest people, and (3) preferring resource mobilization and detente over armament.

Following Alma-Ata, John Knowles, CEO of the Rockefeller Foundation, along with World Bank and USAID, organized a conference at Bellagio in April, 1979, under the title “Health and Population in Development”. One of the papers presented here was later published in the New England Journal of Medicine.[4] Authors argued for the development of limited primary care programs, concentrating exclusively disease control and advocating for a return to vertical health program.

New era of “medical-industrial” complex began. People's voice was subdued. Big players like IMF, World Bank and giant pharmaceutical houses began to stride for vertical health program,[5] a global business of around 7 trillion dollars.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kumar R. Universal health coverage – Time to dismantle vertical public health programs in India. J Family Med Prim Care 2019;8:1295-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
Hayek FA. The Constitution of Liberty. University of Chicago Press; 1960. p. 421-2.  Back to cited text no. 2
Arrow K. Uncertainty and welfare economics of medical care. Am Econ Rev 1963;53:941-73.  Back to cited text no. 3
Walsh J, Warren K. Selective primary health care: An interim strategy for disease control in developing countries. NEJM1979;301:967-74.  Back to cited text no. 4
Cueto M. The origins of primary health care and selective primary health care. Am J Public Health 2004;94:1864-74.  Back to cited text no. 5


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