The art of conflict resolution

The year 1978 marked an important turning point in the field of public health. No, the fact that it also happens to be the year I was born has nothing to do with that. While my mum was changing my nappies back in Holland, somewhere in the former USSR some of the world's public health leaders were gathered at a major international conference to produce what was to be known as the "Alma Ata Declaration". In a nutshell, this declaration urged all governments to work towards "health for all" by setting up and strengthening systems of primary health care.

Now why am I telling you all this? The fact is that ever since then a debate has been going on between proponents of this primary care based strategy and people who believe in the strength of so-called vertical approaches. To understand what is meant by that, picture for instance a dedicated polio immunization campaign or a malaria eradication programme. Such approaches are dedicated to only one purpose; they have their own health care workers, their own funding, their own priorities. There are some obvious advantages. Vertical programmes tend to be much simpler to manage, there is a clear link between action and effect and somebody can take the credit. The trouble is that having a number of these isolated pillars of care in a country can become very inefficient and drain the general health services of resources. Furthermore, the priorities of all these programmes may not be in line with national ones, particularly when external donors are involved.

And so the debate has continued for the past 30 years. The strange thing about this debate is that it seems to be a lot of rhetorics and emotion but very little evidence. So, the reason I have been working my a*#e off lately is that this week a number of bigwigs in the field are gathering to discuss how we can move beyond this deadlock and start having a more productive dialogue. My job was to help supply the evidence and analyse which approaches have been most successful under particular conditions. As you can imagine it's a fairly high profile piece of work and I am very pleased to have been able to chip in. I really hope to get my hands on more assignments like this. I just hope that the deadlines can be a bit more ... healthy.