• disease control;
  • primary health care;
  • health policy;
  • systems approach;
  • health district;
  • users participation


The effectiveness of disease control by mobile teams decreased when countries became independent. Early case-finding and continuity of care require permanently accessible health care facilities where rationalization by professionals and participation of the users are well balanced. The Primary Health Care concept, a plea for this equilibrium, has been discredited by different types of misapplication. Correctly functioning and accessible first line health services, completed by a referral level, are a precondition for effective participation of the users. Where ‘ideal health districts’ cannot be realized, a form of steady exchanges between generalists and the specialists of the referral level has lead to diverse ‘functional districts’.