Primary health care und die folgen einer verleugnungsstrategie: Ineffizientes und unökonomisches management von gesundheitsproblemen durch weitgehendes ausblenden des weltverständnisses, des selbstbildes und der psyche der klienten aus dem behandlungskontext

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.