On a cold January day in 1976, Dr Dimitri Venediktov, the Soviet deputy health minister, turned up unannounced at his colleague's home in Geneva.

It was the eve of the World Health Organization's (WHO's) Executive Board. Member States had decided the previous May, at the 28th World Health Assembly, that an international conference on primary health care, proposed by the Soviet Union, was "desirable". But funds were needed and a venue had yet to be named, and Moscow was lobbying hard to host it in the Soviet Union.

"I'll give you US$ 2 million for an international conference on primary health care," Venediktov told assistant director-general Dr David A Tejada de Rivero, according to the Peruvian physician, who recalls how the Soviet offer took him by surprise.

The following day, Venediktov repeated his offer to the Executive Board which accepted it on one condition: the conference would not be held in Moscow--as Venediktov proposed--but in a developing country.

In the midst of the Cold War, in a world divided between communist and capitalist spheres of influence, primary health care--a new concept at the time--became the unlikely vehicle for a political and ideological battle, especially in the socialist camp.

The concept of primary health care did not appear overnight. Some trace it back to an intergovernmental conference in Bandoeng, Indonesia, in 1937. That conference was held by the health organization of the League of Nations-a predecessor to WHO--that recommended that "the greatest benefit to the health of the rural populations, at the smallest cost, can be obtained through some process of decentralization".

This recommendation was in line with the vision of missionaries working in community health care in developing countries. Notably, the Christian Medical Commission (CMC), which was part of the World Council of Churches, encouraged the training of village workers at grassroots level, equipped with essential drugs and simple methods. In an article published in the American Journal of Public Health in November 2004, historian Marcos Cueto writes that the CMC created...