SeriesPrimary health care: making Alma-Ata a reality
Section snippets
Revisiting Alma-Ata
30 years after the Alma-Ata Declaration for primary health care, “health for all”1 remains a long way off for many countries, even those that are on track for mortality reduction goals, yet it remains the ultimate vision. The Millennium Development Goals (MDGs), which were adopted in 2000 as the next generation of the “health for all goals”, specify eight aims and measurable targets, including reduction in maternal and child mortality and in the burden of HIV, malaria, and tuberculosis, and
Where are we now, and what are the gaps?
Despite the ideals and enthusiasm after Alma-Ata, primary health care continues to be inadequately supported and resourced.12 The coverage and quality of services in some countries has deteriorated because of conflict, poor governance, structural adjustment, population growth, and disinvestment in health.13, 14
There are notable exceptions, as shown by the 30 low-income countries that have made steady progress to reduce deaths in children younger than 5 years and, in some cases, also newborn and
Revitalisation of primary health care at scale
All levels—individual, family, community, facility, district, provincial, national, and global—have a role and responsibility if health for all is to be achieved. To deliver results with a primary health-care approach will need partnerships, links, and an enabling environment including bottom-up support from empowered communities, top-down support from responsible governments and across municipal and state levels, and external support with technical and financial resources, when needed and
Research priorities for primary health care
The so-called 10/90 gap indicates the imbalance of having a small proportion (10%) of research funding addressing the health needs of most of the population (90%) worldwide.38 Identification of research priorities for primary health care is important for optimising the effective use of scarce resources. Reviews have established the scarcity of rigorous evidence for implementation and delivery of services generally and for human resources particularly, especially in low-income and middle-income
Renewing commitment and investment in primary health care
We call for the global health community, governments, national authorities, international agencies, and civil society to revitalise primary health care according to the original tenets of Alma-Ata and to monitor progress. We propose the establishment of a process to set new measurable targets that build on, yet go beyond, the MDGs to reflect the broader primary health-care agenda and to ensure continued momentum towards health for all after 2015. A possibility for one such goal could be a
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