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Since the International Conference on Primary Health Care (PHC) held in Alma-Ata in September 1 9 7 8 , PHC has enjoyed great vogue . The idea, however, clearly did not just then drop from the clear sky . For a number of years in many places around the world a small-scale approach within the health sector had already been applied , often experimentally . Discussion of PHC grew in intensity , however, only after the WHO adopted it as official policy , initially in 1 9 7 5 and yet more emphatically in 1 9 7 8 . The enthusiasm that invariably accompanies a new trend was contagious . Flushed with excitement, the supporters of PHC now seem vulnerable to over-confidence : 'How could we have been b lind for so long' ! The cautionary remarks which follow are in no way an assault on the concept , the ideology , of PHC. My intention is to deflate runaway optimism . If we contemplate fitting leprosy control into PHC programmes, we need to ascertain whether the special character of the illness (chronicity , disabling com­ plications, fear and stigma) lends itself to such an undertaking. A period of attempts to integrate leprosy control within general health services lies just behind us indeed in many countries such attempts have only recently begun in earnest. Perhaps we need to consider more carefully the lessons these past years may have to teach us . Before addressing the specific question of whether PHC can accommodate leprosy control , however, we need to face the general issue of whether PHC promises a viable solution to the pressing health needs of developing countries. To a large extent my experience of PHC has been indirect ; that is , whilst I was engaged in research on leprosy control . During my most recent fieldwork

In reality: a medical anthropologist's reservations about the viability of leprosy control within Primary Health Care