Analysis

Is the declaration of Alma Ata still relevant to primary health care?

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39469.432118.AD (Published 06 March 2008) Cite this as: BMJ 2008;336:536
  1. Stephen Gillam, consultant in public health
  1. 1Institute of Public Health, Cambridge CB2 2SR
  1. sjg67{at}medschl.cam.ac.uk
  • Accepted 14 January 2008

Thirty years after WHO highlighted the importance of primary health carein tackling health inequality in every country, Stephen Gillam reflects on the reasons for slow progress and the implications for today’s health systems

After years of relative neglect, the World Health Organization has recently given strategic prominence to the development of primary health care. This year sees the 30th anniversary of the declaration of Alma Ata (box 1). Convened by WHO and the United Nations Children’s Fund (Unicef), the Alma Ata conference drew representatives from 134 countries, 67 international organisations, and many non-governmental organisations. (China was notably absent.) Primary health care “based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people’s full participation and at a cost that the community and country can afford” was to be the key to delivering health for all by the year 2000.1 Primary health care in this context includes both primary medical care and activities tackling determinants of ill health.

Box 1 Characteristics of primary health care from Alma Ata declaration1

  • Evolves from the economic conditions and sociocultural and political characteristics of a country and its communities

  • Is based on the application of social, biomedical, and health services research and public health experience

  • Tackles the main health problems in the community—providing promotion, preventive, curative, and rehabilitative services as appropriate

  • Includes education on prevailing health problems; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunisation against the main infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs

  • Involves all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, and industry

  • Requires maximum community and individual self-reliance and participation in the planning, organisation, operation, and control …

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