ALMA ATA DECLARATION
‘The main goal of Governments and
World Health Organization in the coming
decades should be the attainment by all
people of the world by the year 2000, a
level of health that would permit them to
lead a socially and economically
productive life’
51ST WHA in 1998 reaffirmed the
declaration for the 21st century
Primary Health Care
By
Dr Arshad Usmani
Lahore, Paksitan
Themes Leading to
Alma Ata
1. Changing theories of health &
development: shift away from GNP as
measure of development towards
recognition of the need of social
development
2. Concerns about poverty & population
control
3. Increasing reliance upon alternative
approaches to medical care model
4. Success of CHWs & associated
emphasis on community participation
5. Revival of interest in public health;
tackling causes of ill health rather than
symptoms
PRIMARY HEALTH CARE
PHC 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 the country
can afford… It forms an integral part of the
country's health system, of which it is the
central function and the main focus, and of the
overall social and economic development of
the community
PRINCIPLES OF PHC
1. Health Prevention & Promotion
2. Equity
3. Appropriate Technology
4. Community Participation
5. Intersectoral Coordination
6. Decentralization*
COMPONENTS OF PHC
1. Education concerning prevailing health
problems & the methods of preventing &
controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic
sanitation
4. MCH including FP
5. Immunization against major infectious
diseases
6. Prevention and control of locally endemic
diseases
7. Appropriate treatment of common diseases
and injuries
8. Provision of essential drugs
PHC: EXTENDED ELEMENTS IN THE 21st CENTURY
1. Expanded options of immunization
2. Reproductive health needs
3. Provision of essential technologies for
health
4. Health promotion as defined in Ottawa
Charter and endorsed by resolution
(WHA 42.44)
5. Prevention and control of noncommunicable diseases
6. Food safety and provision of selected
food supplements0
PHC: Global Targets
1. All people in every country will have ready access at
least to essential health care & to first-level referral
facilities
2. All people will be actively involved in caring for
themselves & their families, as far as they can, in
community action for health
3. Communities throughout the world will share
government’s responsibility for the health care of their
members
4. All governments will assume the overall responsibility
for the health of their people
5. Safe drinking water & sanitation will be available to all
people
(Cont …)
PHC:Global Targets
(Cont …)
6. All people will be adequately nourished
7. All children will be immunizes against the major
diseases of childhood
8. Communicable diseases in the developing countries will
be of no greater public health significance in the year
2000 than they were in the developed countries
in the year 1980
9. All possible ways will be applied to prevent &
control non-communicable diseases & promote mental
health through influencing the life styles &
controlling the physical & psychological environment
10. Essential drugs will be available to all
GLOBAL HEALTH TARGETS
1. Health equity: childhood stunting
2. Survival: MMR, CMR, life expectancy
3. Reverse global trends of five major
pandemics
4. Eradicate and eliminate certain diseases
5. Improve access to water, sanitation, food and
shelter
6. Measures to promote health
7. Develop, implement and monitor national
HFA policies
8. Improve access to comprehensive essential,
quality health care
9. Implement global and national health
information and surveillance systems
10. Support research for health
Obstacles to the
Implementation of PHC Strategy
1. Misinterpretation of the PHC Concept
2. Misconception that PHC is a 2nd rate
health care for the poor
3. Selective PHC Strategies
4. Resistance to Change
5. Lack of political will
6. Centralized Planning & Management
Infrastructure
SELECTIVE
PRIMARY HEALTH CARE
PHC implies that if one cannot afford
to offer universal coverage for even
the most basic of health care, one
could would offer treatment &
preventive strategies for the few
diseases identified as having the
greatest threat to mortality, & which
are amenable to prevention / cure at
low cost.
Comprehensive PHC
ADVANTAGES
DISADVANTAGES
1.Looks at total health
1. More costly to
care
implement
2.Involvement of
2. Takes long time to see
community
impact
3.Covers all elements
3. Long time to process
of PHC
4.Ensures equitable 4. Lack of specialized
treatment
distribution of
resources
5. Expensive
5.Facilitates effective 6. Inefficient referral
referral system
system ???-- misuse
6.Government goal
Selective PHC
ADVANTAGES
1.Donor friendly
2.Elimination of
selected disease
3.Easy to plan &
implement
4.Is focused & have
more impact
5.Easy to manage &
measure output
6.Require limited
resources
7.Improve quality of
services
1.
2.
3.
4.
5.
6.
DISADVANTAGES
Disease rather than
health oriented
Doesn’t ensure equity
Top down decision
making
Neglect other problems
Leads to outbreak
Resources (tight) might
not be available for
urgent needs
(emergencies)
7. Less community
involvement– donor
priority
EVALUATION OF HFA:
1979 - 1996
Reasons for slow progress towards HFA
1. Insufficient Political commitment to
implementation of HFA
2. Failure to achieve equity in access to all PHC
elements
3. The continuing low status of women
4. Slow socioeconomic development
5. Difficulty in achieving intersectoral action for
health
6. Unbalanced distribution of, and week
support for, human resources
Reasons for slow progress
towards HFA
(Cont….)
7. Widespread inadequacy of health promotion
activities
8. Weak health information systems and no
baseline data
9. Pollution, poor food safety, and lack of safe
water supply and sanitation
10. Rapid demographic and epidemiological
changes
11. Inappropriate use of, and allocation of
resources for, high cost technology
12. Natural and man-made disasters
PHC: FROM ALMA- ATA
TO 21st CENTURY
1. PHC as an approach has provided
impetus and energy to progress towards
HFA
2. Some progress has been made in
ensuring access to the original eight PHC
elements
3. PHC remains valid as the point of entry
into a comprehensive health care system
4. Intersect oral action for health has not
been fully achieved
5. Reorientation of health services and
personnel to PHC principles remains
elusive
6. Community participation takes time and
dedication by all
New Trends that Will Influence
Health in the 21st Century
1. Widespread absolute and relative poverty
2. Demographic changes: aging and growth
of cities
3. Epidemiological changes: continuing high
incidence of infectious diseases;
increasing incidence of noncommunicable diseases, injuries and
violence
4. Global environmental threats to human
survival
5. New technologies: information and
telemedicine services
6. Advances in biotechnology
7. Globalization of trade, travel and spread
of values and ideas
GOALS AND TARGETS OF HFA
1. An increase in life expectancy and in the
quality of life for all
2. Improved quality in health between and
within countries
3. Access for all to sustainable health
systems and services
An initial set of targets will guide the
implementation of the HFA policy and
define priorities for action for the first
two decades of the 21st century
THE PRINCIPALS OF HEALTH
PROMOTION IN THE
OTTAWA CHARTER (1986)
1. Building a healthy public policy
2. Creating supportive environment
3. Developing personal skills
4. Strengthening community action
5. Reorienting health services
PHC in the 21st Century:
Policy Objectives to Reinforce
the PHC Approach
1. Make health central to development
and enhance prospects for intersect
oral action
2. Combat poverty as a reflection of
PHCs concern for social justice
3. Promote equity in access to health
care
4. Build partnerships to include families,
communities and their organizations
5. Reorient health systems towards
promotion of health and prevention
of disease
Sustainable Health Systems:
Some Essential Components
 Attach greater emphasis to
comprehensive quality health care
throughout the life span
 Ensure equitable access to the
original eight PHC elements
 Expand PHC elements in response
to identification of new threats of
health, and opportunities to tackle
these threats
Essential Health System
Functions that Complement and
Support PHC
 Provide sustainable financing of PHC
 Invest in human and institutional
capacity for health
 Optimize private and public sector
support for PHC through appropriate
regulations
 Strengthen research to support and
advance PHC
 Implement global, national and local
surveillance and monitoring systems