It is now 30 years since the 1978 Alma-Ata Declaration on Primary Health Care (PHC). But the durability of old challenges such as maternal and child deaths and emergence of new ones such as HIV and increasing chronic diseases show the declaration is as important, if not more, than ever before. These are the conclusions of Dr Joy Lawn, Saving Newborn Lives/Save the Children, Cape Town, South Africa, and colleagues, in the first of an eight-paper Series in this week's Alma-Ata Special Issue of The Lancet.
The authors say that health has moved from under-investment, to single disease focus, and now to increased funding and multiple initiatives. Old debates on vertical versus horizontal primary health care are now giving way to approaches that combine the best of both. And delivering high and equitable coverage of integrated PHC requires consistent political and financial commitment, data to direct local priorities and more innovation for use of community workers, developing cheaper, basic drugs and simpler equipment. Despite the initial excitement that greeted the Alma-Ata Declaration and progress in some countries, top-down agendas driven by funding agencies and at times inter-agency competition has slowed the progress made.
The authors say: "If one key principle of Alma-Ata has been lost more than any other, it is that of community participation. If communities rise to set priorities and act accordingly, progress may be slower but will be more sustained than that achieved with top-down or commodity-driven approaches alone."
They conclude: "In 20 years from now, at the half century of Alma-Ata, we could see a different world, with basic health care reaching many of the poorest families. However to achieve this goal we need to revitalize the original principles of Alma-Ata, sticking consistently to the core values of universal access for care, equity, community participation, intersectoral collaboration, and appropriate use of resources. This special issue demonstrates that health for all and primary health care are more relevant and more possible today than 30 years ago."
Joy Lawn, Saving Newborn Lives/Save the Children-US, T) +27 (0) 21 532 3494/ +27 (0) 798839706 E) joylawn@yahoo.co.uk
full paper: http://press.thelancet.com/AA1.pdf
Journal
The Lancet