Primary health care: why has water been neglected?

Since primary health care became ‘selective’ theneed for clean water sources has largely been neglected. Thispaper highlights both the economic and philosophical necessityto look again at the approach to primary health care. An observationalstudy from Nigeria is used to exemplify a community where aclean water source was the most urgent need, yet was ignored.Guinea worm infestation therefore caused serious disabilityin the community and resulted in a reduced uptake of the veryforms of ‘selective’ primary health care that havebeen favoured internationally - breastfeeding, immunizations,malaria treatment and oral rehydration therapy. In particular,the effect of such disability on women - who have prime responsibilityfor the health and welfare of their families - was seriouslyunderestimated, to the detriment of child health and survival.A clean, convenient water supply should be an essential componentof primary health