Magazine article UN Chronicle

Now More Than Ever Primary Health Care

Magazine article UN Chronicle

Now More Than Ever Primary Health Care

Article excerpt

In 1978, the Declaration of Alma-Ata at the International Conference on Primary Health Care launched primary health care as a route to better health for all. The ambition was bold. The Declaration of Alma-Ata responded to a world characterized by vast and largely avoidable differences in the health status of populations, and mapped out a strategy for reducing these gaps through fundamental changes in the way health systems were organized and care delivered. As the Declaration of Alma-Ata argued, enlightened policy that made fair access to health care an explicit objective could raise the level of health within populations, enabling people to lead socially and economically productive lives, and thus driving overall development.

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The primary health care approach broadened the medical model of health to include social and economic dimensions, since the health of disadvantaged populations was often compromised by low rates of literacy, poor nutrition, substandard housing, contaminated water, and lack of sanitation. In line with this broad public health approach, primary health care sought population-wide solutions that emphasized prevention, as well as cure. The approach placed particular emphasis on local ownership and community participation. In doing so, it honoured the resilience and ingenuity of the human spirit and made space for solutions created, owned and sustained by communities.

The approach was almost immediately misunderstood. It was a radical attack on the medical establishment. It was Utopian. It was confused with an exclusive focus on first-level care. For some, it looked cheap: poor care for poor people, a second-rate solution for the developing world.

Nor could the visionary thinkers of 1978 have foreseen world events: an oil crisis that hit hard in 1979, a subsequent economic recession, and the introduction by development banks of structural adjustment programmes that shifted national spending away from the social services, including health.

As resources for health shrank, selective approaches using packages of interventions gained favour over the intended aim of fundamentally reshaping health care. The emergence of HIV/AIDS, the associated resurgence of tuberculosis, and a deterioration of the malaria situation moved the focus of international public health away from broad-based programmes and towards the urgent management of high-mortality emergencies. In 1994, a World Health Organization (WHO) review of world changes in health development since Alma-Ata bleakly concluded that the goal of health for all by the year 2000 would not be met.

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What can be gleaned from the experiences of a movement that failed to reach its goal? Apparently, quite a lot. Today, primary health care is no longer so deeply misunderstood. In fact, several recent trends and events have clarified its relevance in ways that could not have been imagined thirty years ago. More and more, primary health care looks like a smart way to get health development back on track.

BREATHING NEW LIFE

The Millennium Development Goals breathed new life into the values of equity and social justice, this time with a view towards ensuring that the benefits of globalization do not bypass the poor. Taken together, the eight Millennium Development Goals represent the most ambitious attack on human misery in history. They acknowledge the contribution of health to the overarching goal of poverty reduction. Like the primary health care approach, they address root causes of ill health that arise in other sectors.

In the drive to reach the health-related goals, multiple global health initiatives were formed to tackle priority diseases and increase childhood immunization coverage. In the past ten years, commitments of official development assistance for health rose more than three-fold, from $6. …

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