Primary Health Care: More Action Less Words please!
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Revive the spirit of Alma Ata!
Press release from the People's Health Movement (PHM)
Geneva, May 21: The People's Health Movement welcomes the proposed
adoption of a resolution affirming the Alma Ata vision of Primary
Health Care (PHC) as the cornerstone of national health systems by
member states of the World Health Organization.
PHM however believes that the WHO, as well as many member states,
while paying lip service to the PHC approach have been in practice
promoting a completely different route, often detrimental, to public
health. The WHO's current approach is highly selective and disease
focused and driven by donor initiatives at the expense of people-
centred and holistic approaches.
PHM therefore calls upon the WHO to return to the original Alma Ata
vision that promised 'Health for All' by providing primary health
care while at the same time tackling the underlying socio-economic
and political causes of disease. Health, according to the PHM is a
basic human right and neither charity nor a mere input to economic
growth.
The PHM also warmly welcomes the statements made by the New Zealand,
South African, Nigerian and Thai delegations to World Health Assembly
(WHA) 2003 that variously called upon the WHO to address inequalities
in access to health care and not to reduce the PHC concept to a set
of 'nice words'. The statement of one of these delegations pointing
out that PHC is not just about diseases and technology and requires a
comprehensive approach is also to be applauded. The delegations have
welcomed the WHO resolution on PHC but called for it to be strength-
ened in a number of ways.
'There is little point in constructing a perfect building if the
foundation is weak. Primary Health Care is the foundation of health
systems globally' said the delegate from New Zealand.
'We need to set specific targets for Primary Health Care funding'
said a representative of the Nigerian delegation suggesting that 40 %
of the health budget be set aside for Primary Health Care.
According to the PHM, the proposed resolution on PHC to be adopted at
the World Health Assembly, 2003 while talking about the health needs
of the disadvantaged ignores the following factors that affect public
health, especially of the very poor:
* Increasing global inequities - the gap between developing and de-
veloped countries is growing
* Increasing inequities within countries
* Declining life expectancy in many African countries where HIV/AIDS
offers new challenges for PHC which are not acknowledged in the reso-
lution
* The absolute number of people living in poverty has increased world
wide and sharply in some regions.
According to the PHM the major cause of the growing inequities, both
within and among countries, is the increasingly unipolar world eco-
nomic order and its impact on the lives and livelihoods of people
around the world. Neither the Who's global report nor the resolutions
acknowledge this impact. Until the world is characterised by fair
economic and trade relationships the promise of Health for All cannot
be achieved.
Neo-liberal economic policies and World Bank/IMF inspired 'health re-
forms' being pushed through in developing countries have resulted in:
* Privatisation of public health services
* The introduction of user fees for patients
* Lack of public investment in state-run primary health care systems
* Lack of attention to leadership and management development for PHC
Sharp reductions in basic vaccination coverage since 1990 are stark
evidence of this.
All this has obviously also resulted in the overall deterioration in
quality and equitable delivery of public health services and had a
devastating effect on the ability of the poor to access health care.
PHM calls for wider consultation between WHO and civil society mem-
bers to revive the goal of Alma Ata!
"Governments have a fundamental responsibility to ensure universal
access to quality health care, education and other social services
according to people's needs, not according to their ability to pay."
- People's Charter For Health
The Charter, the guiding spirit of the PHM is the largest consensus
document on health in the world.
Dr Ravi Narayan
Prof. David Sanders
Co-ordinator - PHM Secretariat
International People's Health Council & PHM
Dr. Armando De Negri
ALAMES (Latin American Association for Social Medicine) & PHM
Dr. Unnikrishnan PV, India
mailto:unnikru@vsnl.com
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