El área de comunicación en niños de educación inicial

The world health community endorsed the goal of 'health for

all by the year 2000' in 1979. This milestone in global

health policy was to ensure the provision of 'health care

based on practical, scientifically sound and socially

acceptable methods and technology, made universally

available to the community through their full participation

and at a cost that the community and country can

afford in the spirit of self reliance and self

The primary health care concept was not new to PNG. For

many years the Aid Post Orderly had provided village level

curative health care to rural populations. Many developing

countries did not have this basic level health service. If

malaria control by this approach was to be successful then

it should work in PNG. What was needed was an extension of

the responsibility for health care to the people.

The differing patterns of malaria epidemiology from village

to village suggested that 'no subset of measures will have

universal application' and 'control measures should be

tailored to the local situation' (Charlwood 1984). For

malaria control this approach demanded a complete

reorganisation of concepts and strategies. The people were

to take charge of their own health, including malaria, and

the government health services would facilitate their

efforts through education, instruction and technical

support. What had been an entirely government administered

programme was to be reoriented so that the stimulus,

impetus and manpower would come from the community (Reilly

1986, Moir & Garner 1986).

The response to the primary health care approach was mixed.

It was difficult to disband the already monumental malaria

service with its one thousand employees. It was more

difficult to encourage provincial health and village

authorities to pick up the responsibility for malaria

control. We shall examine what progress has been made

Involvement of villagers in malaria control was not a new

concept in PNG. In 1954, before spraying with residual

insecticides commenced, rural people in the Trobriand

Islands (D'Entrecasteaux Islands) had demonstrated that, at

least in the short term, they were able to supervise their

own mosquito control programmes (Black 1954 a, 1955 b ) .

At the same time it was demonstrated that totaquine

(extracted from cinchona trees grown in the Highlands) was

not effective as a traditional suppressive of malaria but

it did demonstrate that the people in these islands could

take a regular prophylactic if necessary (Gunther JT 1974).

Black expressed reservations about the feasibility of

prophylaxis over a long period (Black 1956 c ) .

Very early in the war against malaria it was realised that

a programme of 'bonification' of villages would do more to

control malaria than house spraying and drugs;

'Integral bonification implied a three-fold policy of

hydraulic, agricultural and hygienic intervention with the

primary aim of reducing breeding sites for malaria'

(Gunther JT 1974). Christian had already demonstrated that

drainage of large areas would reduce breeding sites

(Christian 1969) and naturalistic methods would support

this approach. Gambusia affinis fish had already proven

useful (Harper et al 1947). Gunther repeatedly encouraged

an emphasis on bonification through health education rather

than in applying all efforts into residual spraying and

drug reinforcement. Health education was essential to the

such control from the people any intervention would have a

short lived effect (Carlaw & Saave 1963).

A prerequisite to integrating malaria control into village

level primary health care activities was their integration

into general health services (Saave 1964, Black 1974, Farid

1974) . Only in 1984 when malaria control became an

entirely provincial responsibility was the national malaria

service trimmed to a core of technical advisers.

The World Health Organisation formalised the primary health

approach to malaria control by stressing the importance of

a national commitment and by demonstrating that community

participation was indispensable (World Health Organisation

1978). Malaria control was an integral part of any

economic development programme and if government programmes

had failed in their attempts to achieve this then clearly

another approach should be tried. The basic premise was

that immediate decreases in mortality could be expected

from village-based treatment for malaria and that source

reduction, larvicides and oiling would achieve more in the

long run, be less expensive and would be on-going methods

administered at a village level.

As transmission of malaria in an evolving community was

changing, so the concept of the epidemiology of malaria

being a function of both biological and psychosocial

factors was born (McMahon 197 4 b ) . Human behaviour was

possibly a more important influence on attempts at malaria

An almost certain factor in the failure of the mass

campaigns in malaria eradication was the fact that the

integrity of such campaigns was determined by factors of an

administrative, social and political nature rather than by

technical aspects (Gonzales 1965). For treatment and

prophylaxis alone the costs may be outside the health

budget of many countries (Bruce-Chwatt 1979, Pampana 1969).

Village based treatment and source reduction remain the

cornerstones of the primary health care approach to malaria

control in PNG, with residual insecticide spraying as an

additional control measure in supportive villages.