In 1978, 134 health ministers from around the world signed the Alma Ata declaration that set a deadline for the year 2000 for achieving a level of health that would enable all of the world's people to “lead a socially and econmically productive life.”1 The strategy to achieve the goal would be the implementation of primary health care, with its emphasis on community participation, and tackling the underlying causes of diseases, such as poverty, illiteracy, and poor sanitation. This week, at Gonoshasthya Kendra People's Health Centre (whose pioneering work formed a case study for the Alma Ata declaration), a People's Health Assembly will convene to discuss the failure to achieve “Health for All,” and plan what to do next.

Much of the problem lies in the persistence of poverty and a continuing lack of effective health services. Average per capita incomes in sub-Saharan Africa are lower than they were at the end of the 1960s, and half of the region's population must now survive on less than 40p (56 cents) a day.2 AIDS is ravaging a continent beset by rising levels of malaria and tuberculosis; many health services have …