30 years on from Alma-Ata and the pendulum is swinging back to primary health care

Sep 15 2008

Thirty years on from the signing of the historic Alma-Ata declaration, the famous rallying call to the global health community, the concept of Primary Health Care, which lay at its heart, is back on the global agenda.

The Alma-Ata declaration was a landmark event in the field of public health. It was signed at the International Conference on Primary Health Care in Alma-Ata, in what is now Kazakhstan, in 1978, an event attended by virtually all the member nations of the World Health Organisation and UNICEF. The Declaration identified Primary Health Care (PHC) as the key to the attainment of the goal of Health for All (HFA) by the year 2000, a goal which was championed by WHO and which became a powerful motivating idea for people concerned about continuing inequities and injustices in global health.

Primary health care, as supported by the Alma Ata Declaration, was a rallying call for better health through improved access to health care, and the involvement of people in the delivery of health care. But PHC fell out of favour over the next two decades, as global attention was diverted towards tackling diseases, improving efficiency and reforming health financing. Thirty years on, the pendulum has begun to swing, away from controlling diseases and back to supporting health systems, in line with the original aims of PHC.

To commemorate the 30th Anniversary of the signing of the declaration, and in recognition of the abiding interest in PHC from a range of stakeholders, the London School of Hygiene & Tropical Medicine, supported by the UK Department for International Development and the Lancet, is holding an International Symposium today and tomorrow at the Brunei Gallery in London. Experts from around the world will marshal the available evidence to address both the promise and the pitfalls of PHC from a range of perspectives, and discuss the continuing relevance of such concepts to improving world health.

Carissa Etienne, Assistant Director General of WHO will be speaking about the prospects for scaling up PHC, and there will be many excellent speakers from a range of countries including Ghana, India, Pakistan, Uganda, Thailand and Mexico. Julio Frenk, former Minister of Health of Mexico, adviser to the Bill and Melinda Gates Foundation and Dean designate of Harvard School of Public Health will give the concluding speech.

Gill Walt, Emeritus Professor of International Health Policy at the London School of Hygiene & Tropical Medicine, will be providing the conference overview. She comments: 'The context of 2008 is very different from that of 1978. Whereas the call for Primary Health Care thirty years ago was inspirational, and occurred within a context of strong leadership in the public health field, the move towards strengthening health systems today is now largely technical, and leadership more diffuse.

'By exploring and understanding the changing context of health policy over three decades, we can identify what needs to be done to strengthen the movement towards health systems today and in the future'.

Professor Walt was in Mozambique at the time of the declaration. She recalls: 'What I remember most about that meeting was the enthusiasm of the Mozambique delegation. They had clearly been inspired, energised and excited by the meeting in Alma Ata, and were more than ever committed to the primary health care approach'.

Dr. Ravi Narayan, an alumnus of the London School of Hygiene & Tropical Medicine and until recently a coordinator of the global people's health movement secretariat, will present the evidence from the global south, especially from India on how a new paradigm of community participation including community monitoring is bringing changes in the direction of primary health care policies at national level in India, Thailand and many other parts of the world. He says:

'One of the major contributing factors to the revival of primary health care has been the strong pressure evolving from the grass roots through civil society and social movements including the People's Health Movement. These have provided a strong current of solidarity and demand from below for greater focus on comprehensive primary health care systems with a equity, gender, social determinants and rights perspective.

'This "globalization of Health solidarity from Below" is a counter balance to the increasing health in equalities due to corporate led globalization of health from above'.

The Symposium will be highlight the successes and failures of PHC in the last 30 years, examine the threats and challenges to the PHC approach, and discuss how they might be combated. Experts will acknowledge the tensions between disease specific programmes and PHC approaches and seek solutions as to how they might be addressed.

A number of School staff have contributed to the Alma-Ata special issue of the Lancet. Simon Lewin writes about how task shifting to nurses and lay health workers may help achieve the Alma-Ata vision, while Shah Ehrabim discusses how tobacco and salt control, combination drugs and simple mental health interventions are required in order to tackle the growing chronic disease crisis in primary health care.

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