Primary Health Care: Where Are We 40 Years After Alma-Ata?

[By Oriana Ramírez, Policy Analysis Coordinator, and Diana Tejada, student at the Master in Strategies and Technologies for Development UCM/UPM]

The Alma-Ata conference resulted in a declaration that marked a turning point in the evolution of the global health paradigm

Everyone who has studied public health knows about the International Conference on Primary Health Care in Alma-Ata (now Almaty), Kazakhstan—even those of us who were not yet born in 1978, when the event took place. The conference, which was organised by the World Health Organisation (WHO) and UNICEF, resulted in a declaration signed by 134 countries that marked a turning point in the evolution of the global health paradigm. No United Nations resolution adopted in the four decades since Alma-Ata has posed a challenge of such magnitude.

Conference on Primary Health Care in Alma-Ata-1978

Astana, the current Kazakh capital, hosted a follow-up event—the Global Conference on Primary Health Care—on 25 and 26 October 2018. Now is a good time to look back at what has happened since 1978 and take stock of what has been achieved since then.

The Spirit of Alma-Ata

The Declaration of Alma-Ata called for “Health For All” to be attained by the year 2000—a goal that required making primary health care (PHC) the cornerstone of health systems

The Declaration of Alma-Ata called for “Health For All” to be attained by the year 2000—a goal that required making primary health care (PHC) the cornerstone of health systems. It was a vision ahead of its time. The declaration eschewed overly “hospital-centric” and medicalised systems and favoured a more social approach to medicine, formulating a series of key elements that made sense in the Cold War context of 1978 and are still relevant today:

1. Cooperation and world peace
2. A new international economic order
3. Recognition of the social determinants of health
4. The need to involve other sectors in the promotion of health
5. Community participation in the planning, implementation and regulation of PHC
6. Health equity as the incontrovertible result of this approach

Various theoretical and descriptive frameworks were subsequently advanced on the basis of the declaration, including the Ottawa Charter for Health Promotion in 1986 and the WHO Commission on Social Determinants of Health in 2005. Ultimately, however, the implementation of PHC took a rather different path—especially in less advanced countries reliant on development aid—with programmes that focused on specific diseases, such as malaria or tuberculosis, or promoted a “selective” approach to PHC involving specific interventions based on affordable technologies shown to be cost-effective in the short term.

Despite these advances, progress has been uneven and health care has become even more inequitable

The results of these interventions, which took concrete form in the Millennium Development Goals (MDGs) of 2000-2015, were truly spectacular. Maternal and child mortality were reduced by almost 50% and the number of new HIV infections fell by 40%. The bad news, despite these advances, is that progress has been uneven and health care has become even more inequitable, leaving vulnerable groups without access to even basic health services.

The Legacy of Alma-Ata Lives On in the 2030 Agenda

It has been forty years since the Alma-Ata declaration formulated a vision for the future

It has been forty years since the Alma-Ata declaration formulated a vision for the future. The tension between the idealism of the declaration and the pragmatism of people working on the ground still exists today. Nevertheless, we remain optimistic. We believe that many lessons have been learned over the past four decades and that we might be reaching a new balance involving a diverse range of stakeholders, including various United Nations organisations (financial as well as technical), member states, research centres, philanthropic organisations, the private sector and an ever more engaged civil society. This spirit also permeates the current development agenda, which has, for the first time, succeeded in involving different sectors, encompassing, for example, sustainable development measures and efforts to combat climate change. The health sector has also undergone considerable changes. The third Sustainable Development Goal (SDG) establishes targets on the prevention and treatment of infectious and chronic diseases, major environmental risk factors, maternal and child health and sexual and reproductive health, as well as access to medicines, vaccines and health technologies. Meanwhile, the WHO continues to promote the concept of universal health coverage as the main catalyst for improving health equity.

The Astana Conference: 40 Years After Alma-Ata

At ISGlobal, we hope that the Astana conference will mark the beginning of a new dialogue

At ISGlobal, we hope that the Astana conference will mark the beginning of a new dialogue that will explicitly discuss what has been achieved in this field as well as the difficulties and obstacles encountered and the lessons learned from efforts to implement comprehensive PHC. As part of our collaboration with the Sustainable Development Solutions Network (SDSN), ISGlobal has contributed to this analysis through the publication of two articles, one that analyses the concept of “Health in All Policies” as a tool for implementing policies that expand PHC and another that discusses the specific example of how cities can be a good laboratory for introducing a multi-sector approach to human health.

We hope the Astana conference will foster a commitment to the values and principles of the Declaration of Alma-Ata, particularly with regard to health as a human right, social justice, solidarity and intersectional action, with the recognition that health is an essential driver of development, security and peace.