This paper summarizes information on the characteristic-flaws in primary health care services, and their geographic patterns of occurrence, with reference to their local, medical, and bureaucratic contexts. The data are derived from published medical ethnographic reports, evaluations of programmes, surveys of physicians in developing countries, and some anecdotal reports. Several key issues emerge from this combination of sources. There is a lack of high-quality services in developing countries; most centres lack medicines, caring and skilled personnel, and convenient locations and scheduling. Also, the professional medical personnel are rarely sufficiently trained to communicate effectively with patients of different economic and ethnic backgrounds or to manage a health team of different backgrounds. The most successful programmes are those that have effective local leadership, adequate training, some curative potential, and powerful political will. The combined public health, medical, political science, sociological, and anthropological studies suggest no “cookbook” solutions as to what exact set of factors will make any programme successful. They appear to illustrate the effectiveness of flexible regional or local policies as opposed to global ones.
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