## Selective vs Comprehensive Primary Health Care **Key Point:** Selective Primary Health Care (SPHC) and Comprehensive Primary Health Care (CPHC) represent two different philosophical and operational approaches to PHC. The distinction lies in scope, depth, and underlying principles. ## Comparative Framework | Dimension | Selective PHC (SPHC) | Comprehensive PHC (CPHC) | |-----------|---------------------|-------------------------| | **Scope** | Limited set of high-impact interventions | Holistic, addresses all health needs | | **Focus** | Vertical disease programs (immunization, ORS, FP) | Horizontal integration across health issues | | **Social Determinants** | Minimal emphasis | Central to the approach | | **Community Participation** | Limited, top-down | Active, bottom-up | | **Sustainability** | Short-term, donor-dependent | Long-term, system-building | | **Coverage** | Selective population groups | Universal health coverage | | **Implementation** | Vertical programs (Polio, EPI, RCH) | Integrated health systems | **High-Yield:** CPHC was endorsed by the Alma-Ata Declaration (1978) and is the WHO-recommended model. India's National Health Mission (2013) explicitly shifted toward CPHC principles. ## Core Distinction SPHC emerged in the 1980s as a pragmatic, cost-effective approach targeting the most common, treatable conditions in resource-limited settings. CPHC, by contrast, views health holistically and addresses underlying social, economic, and environmental factors. **Mnemonic: SPHC vs CPHC** - **SPHC:** **S**elective, **P**riority interventions, **H**igh-impact, **C**ost-effective - **CPHC:** **C**omprehensive, **P**articipatory, **H**olistic, **C**ommunity-centered **Clinical Pearl:** India's current policy framework (NHM 2013, Sustainable Development Goals) emphasizes CPHC, though many vertical programs (e.g., NRHM disease surveillance) still operate in parallel. [cite:Park 26e Ch 3]
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