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Health Policy and Planning; 17(1): 49-60
© Oxford University Press 2002

Primary health care vs. emergency medical assistance: a conceptual framework

WIM Van Damme1,2, WIM Van Lerberghe1,3 and Marleen Boelaert1

1 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium,
2 Médecins Sans Frontières, Phnom Penh, Cambodia and
3 Health Care Reform Office, Ministry of Public Health, Bangkok, Thailand

Primary health care (PHC) and emergency medical assistance (EMA) are discussed as two fundamentally different strategies of delivering health care. PHC is conceptualized as part of overall development, while EMA is delivered in disaster or emergency situations. The article contrasts the underlying paradigms, and the characteristics of care in PHC and EMA. It then analyzes the characteristics of PHC and EMA health services, their structure, management and support systems. In strategic aspects, it contrasts how managerial and financial sustainability are fundamentally different, and how the term accountability is used differently in development and disaster situations.

However, while PHC and EMA, development and disaster, are clear opposite poles, many field situations in the developing world are today somewhere in-between. In such non-development, non-emergency situations, the objectives and approach will have to vary and an adapted strategy combining characteristics from PHC and EMA will have to be developed.


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