[afro-nets] Reflection on PHC 30 years after Alma Ata and the challenges ahead

Reflection on Primary Health Care 30 years after Alma Ata and the challenges ahead:

The recently released World Health Report on PHC (WHO Oct 2008) is an attempt to bring PHC again to the forefront of our priorities in global health. Good for that!

But the world has changed in these 30 years.

In 1978, we *did not have*:
• Neoliberal globalization.
• Selective, vertical health programs (many of them aggressively pushed by public-private partnerships --PPPs that started, because they did not trust WHO…).
• A big health manpower crisis (only in part due to the AIDS pandemic).
• The magnitude of economic impediments to access to health by poor people with increasing inequities and disparities between the haves and the have nots.
• Increasing privatization and commercialization / commoditization of health services as a result of globalization *.
• Intellectual property issues (patent issues) used against the interest of poor countries and poor patients.

We also *did not have*:
• An energetic and active civil society.
• The People's Health Movement (PHM) and its global network.

Therefore, as a PHM member, on top of seeing PHC and Alma Ata as still alive, I think PHC-in-2008-and-beyond needs to address these (and other unmentioned) "did not have" issues as challenges at local, national and global level.

For this to happen, WHO is to recuperate its moral and political leadership in PHC, in health overall, and in proactively addressing the social determinants of health as per the recommendations of the ad-hoc WHO Commission that just released its report.

To go beyond well-meaning pronouncements, this will clearly need some internal reorganization in this UN agency. The question is whether its leadership plans such a reorientation…

PHM does not shy away from a political approach to PHC and is not really fighting its opponents; it is rather bringing the level of the discussion to a higher level. Therefore, it has published an alternative report to the World Health Report of 2008 --*the Global Health Watch 2* (being released today, see www.phmovement.org ).

PHM challenges the concept that good health is an imperative for increased economic productivity: Instead, it insists and departs from the premise that *health is an inalienable Human Right*. Health is not *either* a technical or a political issue: it is both…and pro-poor health interventions mean nothing if not concomitantly accompanied by poverty reduction actions that are pro-health.

Based on patients registers at health facilities, statistics want to make us believe that 50% of the poor choose to seek private health care. Such a fallacy hides the real fact that 50% of the poor do not seek *any* care (and thus escape facility-based statistics!). So, let us stop using the slogan "those who can pay should pay" without carefully weighing its meaning.

I am a perennial optimist. I hope recent developments mean a real new window of opportunity for PHC. But WHO/member states/civil society interactions will have to become more of a 'two-way street'. I am sure PHM will play its role in achieving this.

Claudio Schuftan, Ho Chi Minh City
mailto:cschuftan@phmovement.org