Global Call for Action
On the 30th Anniversary of the Alma Ata Declaration
Comprehensive Primary Health Care remains an Essential Tool to Achieve "Health for All"
In 1978, at the Alma-Ata Conference, ministers from 134 countries in association with WHO and UNICEF called for 'Health for All by the Year 2000' and identified Primary Health Care as the strategy to achieve it.
Unfortunately, that dream never came true. The health status of many people in low and middle-income countries has not improved. Currently, we are facing a global health crisis, characterized by growing inequalities within and between countries. New threats to health are continually emerging. This is compounded by negative forces of globalization which prevent the equitable distribution of resources necessary for people's health, particularly the poor. Within the health sector, failure to implement the principles of Primary Health Care as set out in the Alma-Ata Declaration, has significantly aggravated the global health crisis.
Governments and the international community are fully responsible for this failure.
People's Charter for Health 2000.
The Declaration of
Alma-Ata<http://www.phmovement.org/cms/files/Alma-Ata_Declaration.pdf> [1] urged world governments, health and development workers, and the international community to protect and promote the health of the world's population. It identified Primary Health Care (PHC) as the best strategy to achieve the goal of "Health for All".
On the thirtieth anniversary of the Declaration of Alma-Ata, the role of the United Nations' organizations, including the World Health Organization, has been increasingly marginalized.
The People's Health Movement (PHM) affirms that
- 'Health for All' is an achievable goal and resources were and are still available to achieve it;
- 'Comprehensive Primary Health Care' remains an essential tool to achieve 'Health for All';
- 'Health for All' means that powerful interests have to be challenged, that neoliberal globalization [2]<http://www.phmovement.org/cms/en/node/867#Footnote%202>has to be challenged, and that political and economic priorities have to be drastically changed (People's Charter for Health<http://www.phmovement.org/cms/en/resources/charters/peopleshealth>2000\).
And calls upon
- individuals, families, communities, people's organizations, civil society organizations and networks, and social movements to continue struggling for their fundamental right to health and health care;
- governments to urgently adopt health sector reform policies that
- promote the principles of equity, universal access, comprehensiveness, adequate public financing and community participation;
- use comprehensive primary health care as the core strategy to achieve Health for All; and
- address the structural determinants of ill-health.
- WHO to return to its constitutional mandate "to act as the directing and co-ordinating authority on international health work" [3]; and to unequivocally identify the emerging threats to people's health and boldly advise member states how they must be addressed; ensure that innovation in medicines and health technology are protected as public goods;
- the Bretton Woods institutions to cease undermining people's health and stop protecting and promoting private-for-profit interests in the provision of health care.
On the anniversary of the Alma Ata Declaration, the PHM will continue struggling for 'Health for All' through
- developing position paper(s) that critically analyse the implementation of CPHC over the three decades since the Alma Ata Declaration, focusing on the continually emerging threats to HFA. Such position papers will be part of the mobilization processes at country level;
- organizing events that advocate for the fundamental right to health, challenging the commercialization and privatization of health care, exposing the structural determinants of ill-health and, above all, making the voices of the unheard heard;
- studying and disseminating country-based alternatives that ensure universal access and equity and address the structural determinants of ill-health.
[1] Declaration of Alma-Ata was signed by 134 states as a final statement of the International Conference on Primary Health Care, Almaty (formerly Alma-Ata), Kazakhstan, 6-12 September 1978.
[2] We mostly refer to the current global economic order and dominant neo-liberal policies.
[3] WHO constitution, chapter 2, article 2a. Read the WHO constitution in
English <http://www.phmovement.org/cms/files/WHO-Constitution-EN.pdf>,
Spanish <http://www.phmovement.org/cms/files/WHO-Constitution-ES.pdf>,
French <http://www.phmovement.org/cms/files/WHO-Constitution-FR.pdf> and
Arabic <http://www.phmovement.org/cms/files/WHO-Constitution-AR.pdf>\.
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Comprehensive Primary Health Care remains an Essential Tool to Achieve "Health for All" Interim Position of the People's Health Movement (PHM) October 2008.
The Comprehensive Primary Health Care (CPHC) approach articulated in the Alma Ata Declaration in 1978, remains as relevant today as it was 30 years ago. It recognized the need for a new international economic orderif inequities in health were to be successfully addressed.
A PHC policy in 2008 needs renewed commitments that should affirm and consolidate Alma Ata and also take into account new realities.
PHM insists that PHC should be take account of but also influence the political, economic and social processes in each specific context CPHC should also be based on the fundamental concept that all citizens have rights to the conditions that create health. It must:
- include not only the primary level of care, but also a working referral system to secondary and tertiary levels of care;
- be adequately financed through public sources;
- ensure systems of health care provide equitable access and care according to need;
- through action across sectors public health interventions and health promotion address the social, political, economic and environmental determinants of health and not just be limited to health care;
- empower communities, especially the most disadvantaged and marginalized, so that they can act as protagonists in improving their health and their livelihoods;
- use technology in a manner that is sensitive to local needs and contexts;
- combine traditional and modern medicine to maximize benefits to patients; and
- embed policies and interventions in the human rights framework with a special focus on the rights of vulnerable groups
- PHM has identified new challenges that have emerged in the last 30 years and which should be incorporated in a renewed commitment to PHC.
PHM notes that:
- Neoliberal globalization brings new threats to health such as; the increase in trade in unhealthy commodities, international trade agreements that: promote the penetration of transnational corporations into the health sector, enforce patent rights that are used against the interests of poor people, and apply unfair rules in the international trade of agricultural products that devastate the livelihood and health of poor farmers.
- Selective, vertical health care programs remain dominant, and not only fragment wider health systems, but also draw away scarce resources from public health systems, treating patients as passive recipients of care and ignoring the ever-present socioeconomic and political determinants of health.
- In light of the looming health staffing crisis, the role of paid community health workers should be revisited; not only to extend coverage at the local level, but also to act as social mobilizers in the empowerment of communities.
- Increasing privatization and commercialization of health systems has undermined the role of the public sector and has often eroded standards of care among health workers whose activities may be influenced more by the profit motive than the health needs of the communities they serve.
- Poor countries have continued to lose their health workers under the current unregulated health workers' labor market. Regulation must ensure an adequate human resource base for the health systems of all countries
--including compensating poor countries for their losses as a consequence of migration (i.e., costs of training and opportunity costs of losing skilled staff).
- Intellectual property rules continue to make new life-saving medications unavailable and unaffordable to the people who need them the most. PHC requires universal access to essential (mostly generic) medicines.
PHM reiterates the core principles of Alma Ata. PRIMARY HEALTH CARE IN 2008 AND BEYOND, must, in addition, address these new challenges at local, national, regional and global levels. PHM reasserts its commitment to putting the health of marginalized groups as the focus of its call for 'Health for All Now' – a call made by the PHM in 2000 in its People's Charter for Health<http://www.phmovement.org/cms/en/resources/charters/peopleshealth>