Primary health care and the consequences of a strategy of denial: inefficient and uneconomical management of health problems due to a far-reaching omission of clients' world view, self image and psyche from the context of therapy

In spite of high prevalence rates, non-somatic health problems remain largely neglected in Third World First line health services. Deficits in staff qualification and motivation, clients' lack of readiness to perceive their problems as psychogenic, and "superstitious" beliefs as to their causation, material constraints, and the inapplicability of Western psychotherapeutic techniques in non-Western cultures are quoted as possible explanations. We assess their validity and potential consequences for the quality of service delivery; a different approach towards the training of staff, aiming at the integration of attention to psychological problems into everyday service provision, is discussed.