Alma Ata Declaration and the goal of “Health for all”

Alma Ata Declaration and the goal of “Health for all”:

Health systems are part of the fabric of social and civic life. They both signal and enforce societal norms and values through the personal experiences of providers and users. The declaration of Alma Ata helped to entrench the idea of health care as a human right.

The Declaration of Alma‐Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty (formerly Alma‐Ata), Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6‐12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of "Health For All" but only in third world countries at first. This applied to all other countries five years later.

·              Evolution of the Alma Ata declaration:

Overthrow of colonial rule and rising aspirations of the liberated people, starting of democratic forms of government in some of the newly independent countries, initiation of the cold war and information of the Non Aligned Movement (NAM), have been some of the major factors which contributed to creation of conditions which tended to impel the new rules in these countries and the newly formed international organizations to pay attention to some of the urgently needed problem facing them. International organizations such as WHO and UNICEF bilateral agencies came forward to contribute to improvement of health status of the people in the needy countries. Availability of the so called silver bullets tempted these organization to launch special ‘vertical’ or ‘categorical’ programmes against some of the major scourges such as malaria (DDT and synthetic antimalarials), tuberculosis (BCG vaccination), leprosy (dapsone), filaraisis (hetrazan) and trachoma (aureomycin). It took them quite some time to realize that these vertical programmes were not only very expensive but they also failed to provide the expected results. These programme also hindered the growth of integrated health services. This impelled them to advocate integration of health services, then promotion of basic health services, then going to individual countries to promote country health planning and later, country health programming. In the mid – 1970s WHO got together with the World Bank to link activities with poverty reduction programmes. A World Health Assembly resolution in 1977 (6), aiming for a programme of Health for All through PHC by 2000 AD (HFA 2000/PHC), set the stage for the calling of the International Conference for PHC at Alma Ata in 1978.

1. What is the Alma‐Ata Declaration:

In September 1978, the International Conference on Primary Health Care was held in Alma‐Ata, USSR (now Almaty, Kazakhstan). The Declaration of Alma‐Ata, co‐sponsored by the World Health Organization (WHO), is a brief document that expresses "the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world." It was the first international declaration stating the importance of primary health care and outlining the world governments' role and responsibilities to the health of the world's citizens.

The Declaration of Alma‐Ata begins by stating that health, "which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world‐wide social goal . . . " It goes on to call for all governments, regardless of politics and conflicts, to work together toward global health. These are still some of the fundamental tenets that guide the work of the WHO today.

Those who ratified the Declaration of Alma‐Ata hoped that it would be the first step toward achieving health for all by the year 2000. Although that goal was not achieved, the Declaration of Alma‐Ata still stands as an outline for the future of international healthcare.

2. International conference on primary health care:

The Alma‐Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of Health for All. The following are excerpts from the Declaration:

Declaration:

I

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world‐wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II

The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

III

Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace. IV The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

V

Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

VI

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self‐determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

VII

Primary health care:

·reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;

· addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;

·includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

·involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;

· requires and promotes maximum community and individual self‐reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;

·should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;

·  relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

VIII

All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.

IX

All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

X

An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share. The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.