Back to the Basics

Oct 15th, 2008 3:38 PM UTC
By Nora Coghlan

Government ministers and global health advocates from across the world are making their way to Almaty, Kazakhstan this week to focus on primary health care. The summit marks the 30th anniversary of the Alma-Ata Conference, which took place in the Kazakhstani city before the collapse of the USSR.

In the years since 1978, Alma-Ata has become somewhat of a hallmark and source of nostalgia in global health circles. The conference was the first of its kind to put the concept of health equity on the international agenda. Aiming to launch a campaign for health for all, attendees laid out their vision of primary health care. Identifying health as a fundamental human right, they argued that health care should not only be universal and affordable, but should be delivered in collaboration with local citizens in a way that is appropriate to the context.

These tenets were laid out in the Alma-Ata Declaration, which gave countries and international organizations a target date of 2000 for implementation.

Thirty years later the ideals of Alma Ata are far from being realized. Here at ONE, we know the stats on the global health deficit all too well: over 9 million children die before their fifth birthday every year from preventable, treatable causes; half a million mothers die every year during childbirth. While many at the time branded Alma-Ata and utopian, in retrospect its failure was more a result of unforeseen social and economic challenges that shaped the global health landscape of the 1980s and 1990s. WHO Director-General, Dr. Margaret Chan, speaks to this in a recent article featured in the Lancet:

Nor could the visionary thinkers in 1978 have foreseen world events: an oil crisis, a global recession, and the introduction, by development banks, of structural adjustment programs that shifted national budgets away from the social services, including health…The emergence of HIV/AIDS, the associated resurgence of tuberculosis, and an increase in malaria cases moved the focus of international public health away from broad-based programs and towards the urgent management of high-mortality emergencies.

Thirty years on, the WHO returns to the city of Almaty with a vision to refocus the global health dialogue on primary health care, a call to go back to the basics of global health. The WHO and Chan argue that the global health climate is more ripe than ever for such a shift. The ideas of equity and universal access were part of the founding culture of the Millennium Development Goals and the campaign for universal access to HIV/AIDS treatment. Moreover, the lessons learned in the past thirty years demonstrate the value of investing in primary health care. Chan explains:

Stalled progress towards the health-related Millennium Development Goals forced a hard look at the results of decades of failure to invest in fundamental health infrastructures, services, and staff. As we have seen, powerful interventions and the money to purchase them will not buy better health outcomes in the absence of efficient systems for delivery.

Stay tuned here for more on primary health care and the WHO’s efforts this week.

-Nora Coghlan

TAGS: Maternal and Child Health, Millennium Development Goals, Policy News, World Health Organization