The Case for Integrated Primary Health Care

[above data collection in Agincourt]

With the high hopes this blog will provide a useful forum for discussion and reflection - I henceforth declare this the first (hopefully not the last) "research perspectives in Global Health Seminar" post.

Using the scaled up delivery of HIV treatment, the authors of this article argue for the transformation of primary health care in rural Africa from a system characterized by the episodic care of infectious disease to one that manages the care of chronic illnesses. This argument is based on the notion that as mortality and morbidity due to non-communicable diseases rises and as more people receive anti-retroviral therapy, the more people will develop complications from cancer and cardiovascular disease.

I'm not convinced the mortality data from Agincourt supports the suggestion that a "substantial health transition" from communicable to non-communicable illness is underway. The numbers: between 1992 and 2005 all cause risk of death increased by 87 percent; infectious disease risk of death increased by 598% and non-communicable disease risk of death increased by 15% (with a confidence interval that includes the possibility of no increase). This is not to minimize the importance of managing non-infectious chronic illness (which is especially important when you take a long-term view), but just to take the devil's advocate position that their argument - to overhaul primary health systems in resource constrained settings - seems stretched based on the evidence.

Thoughts, reactions, comments?

Disclaimer: The views expressed herein are do not necessarily represent those held officially by IHME, or of its funder - el patron Gates, or its other funder the University of Washington, or of our bosses, supervisors or program officers. This collective (aka PBFs) make no representation concerning and does not guarantee the source, originality, accuracy, completeness or reliability of any statement, information, data, finding, interpretation, advice, opinion, or view presented. In other words - don't trust anything we say.