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I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care.
These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.
DURING THE PAST FEW decades, the concept of primary health care has had a significant influence on health workers in many less-developed countries. However, there is little understanding of the origins of the term. Even less is known of the transition to another version of primary health care, best known as selective primary health care. In this article, I trace these origins and the interaction between 4 crucial factors for international health programs: the context in which they appeared, the actors (personal and institutional leaders), the targets that were set, and the techniques proposed. I use contemporary publications, archival information, and a few interviews to locate the beginnings of these concepts. I emphasize the role played by the World Health Organization (WHO) and UNICEF in primary health care and selective primary health care. The examples are mainly drawn from Latin America. The work is complementary to recent studies on the origin of primary health care.1
BACKGROUND AND CONTEXT
During the final decades of the Cold War (the late 1960s and early 1970s) the US was embroiled in a crisis of its own world hegemony-it was in this political context that the concept of primary health care emerged. By then, the so-called vertical health approach used in malaria eradication by US agencies and the WHO since the late 1950s were being criticized. New proposals for health and development appeared, such as John Bryant's book Health and the Developing World (also published in Mexico in 1971), in which he questioned the transplantation of the hospital-based health care system to developing countries and the lack of emphasis on prevention. According to Bryant, "Large numbers of the world's people, perhaps more than...