Alma Ata and the primary health care in India

Alma Ata and the primary health care in India:

The primary healthcare approach was described as "essential 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 the country can afford to maintain at every stage of their development in the spirit of self‐reliance and self‐determination". 

The Alma‐Ata Declaration also emphasizes that everyone should have access to primary healthcare, and everyone should be involved in it. The primary healthcare approach encompasses the following key components: Equity, community involvement/participation,  intersectorality, appropriateness of technology and affordable costs.

Primary healthcare is a vital strategy that remains the backbone of health service delivery. 

India was one of the first countries to recognize the merits of primary healthcare approach. Long before the Declaration of Alma‐Ata, India adopted a primary healthcare model based on the principle that inability to pay should not prevent people from accessing health services.

Derived from the recommendations of the Health Survey and Development Committee Report 1946, under the chairmanship of Sir Joseph Bhore, the Indian Government resolved to concentrate services on rural people. This committee report laid emphasis on social orientation of medical practice and high level of public participation.

With beginning of health planning in India and first five year plan formulation (1951‐ 1955) Community Development Programme was launched in 1952.

It was envisaged as a multipurpose program covering health and sanitation through establishment of primary health centers (PHCs) and subcenters.

By the close of second five year plan (1956‐1961) Health Survey and Planning Committee (Mudaliar Committee) was appointed by Government of India to review the progress made in health sector after submission of Bhore Committee report. The major recommendations of this committee report was to limit the population served by the PHCs with the improvement in the quality of the services provided and provision of one basic health worker per 10,000 population.

The Jungalwalla Committee in 1967 gave importance to integration of health services. The committee recommended the integration from the highest to lowest level in services, organization, and personnel.

       The Kartar Singh Committee on multipurpose workers in 1973 laid down the norms about health workers.

Shrivastav Committee (1975) suggested creation of bands of para‐professionals and semi‐professional worker from within the community like school teachers and post masters. It also recommended the development of referral complex by establishing linkage between PHCs and high level referral and service centers.

Rural Health Scheme was launched in 1977, wherein training of community health, reorientation training of multipurpose workers, and linking medical colleges to rural health was initiated. Also to initiate community participation, the community health volunteer "Village Health Guide" scheme was launched.

The Alma‐Ata Declaration of 1978 launched the concept of health for all by year 2000. The declaration advocated the provision of first contact services and basic medical care within the framework of an integrated health services.

Several critical efforts outlined Government of India's commitment to provide health for all of its citizens after Alma‐Ata declaration. The report of study group on "Health for All: An Alternative Strategy" commissioned by Indian Council for Social Science Research (ICSSR) and Indian Council for Medical Research (ICMR) (1980) argued that most of health problems of a majority of India's population were amenable to being solved at the primary healthcare level through community participation and ownership.

Alma‐Ata declaration led to formulation of India's first National Health Policy in 1983. The major goal of policy was to provide universal, comprehensive primary health services. Nearly 20 years after the first policy, the second National Health Policy was presented in 2002.

The National Health Policy, 2002 set out a new framework to achieve public health goals in socioeconomic circumstances currently prevailing in the country. It sets out an increased sectoral share of allocation out of total health spending to primary healthcare.

Recognizing  the  importance  of  health  in  the  process  of  economic  and  social development and improving the quality of life of our citizens, the Government of India has launched the National Rural Health Mission in 2005 to carry out necessary architectural correction in the basic healthcare delivery system. The goal of the mission is to improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women, and children.