ALMA ATA DECLARATION

‘The main goal of Governments and World

Health Organization in the coming decades
should be the attainment by all people of
the world by the year 2000, a level of
health that would permit them to lead a
socially and economically productive life’

51ST WHA in 1998 reaffirmed the

declaration for the 21st century
Primary Health Care
Dr Shahzad Akhtar Aziz
Dr Shahzad Akhtar Aziz
MBBS ,MPH ,CHPE,PGD
Associate Professor-
Community Medicine
 Themes Leading to
Alma Ata
1. Changing theories of health &
development: shift away from GNP as
measure of development towards
recognition of the need of social
development
2. Concerns about poverty & population
control
3. Increasing reliance upon alternative
approaches to medical care model
4. Success of CHWs & associated emphasis
on community participation
5. Revival of interest in public health;
tackling causes of ill health rather than
symptoms
 PRIMARY HEALTH CARE
PHC is essential health care based on practical,
scientifically sound, and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation and at a
cost that the community and the country can
afford… It forms an integral part of the country's
health system, of which it is the central function
and the main focus, and of the overall social and
economic development of the community
 PRINCIPLES OF PHC
1. Health Prevention & Promotion

2. Equity

3. Appropriate Technology

4. Community Participation

5. Intersectoral Coordination

6. Decentralization*
 COMPONENTS OF PHC
1. Education concerning prevailing health problems &
the methods of preventing & controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic
sanitation
4. MCH including FP
5. Immunization against major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and
injuries
8. Provision of essential drugs
 PHC: EXTENDED ELEMENTS IN THE 21st CENTURY
1. Expanded options of immunization
2. Reproductive health needs
3. Provision of essential technologies for health
4. Health promotion as defined in Ottawa Charter
and endorsed by resolution (WHA 42.44)
5. Prevention and control of non-communicable
diseases
6. Food safety and provision of selected food
supplements0
 PHC: Global Targets
1. All people in every country will have ready access at least to essential
health care & to first-level referral facilities

2. All people will be actively involved in caring for themselves & their
families, as far as they can, in community action for health

3. Communities throughout the world will share government’s

responsibility for the health care of their members

4. All governments will assume the overall responsibility for the health of
their people

5. Safe drinking water & sanitation will be available to all people

(Cont …)
 PHC:Global Targets (Cont …)
6. All people will be adequately nourished

7. All children will be immunizes against the major

diseases of childhood

8. Communicable diseases in the developing countries will be of no greater

public health significance in the year 2000 than they were in the developed
develope
countries

in the year 1980

9. All possible ways will be applied to prevent &

control non-communicable diseases & promote mental health through

influencing the life styles &

controlling the physical & psychological environment

10. Essential drugs will be available to all

 GLOBAL HEALTH TARGETS
1. Health equity: childhood stunting
2. Survival: MMR, CMR, life expectancy
3. Reverse global trends of five major pandemics
4. Eradicate and eliminate certain diseases
5. Improve access to water, sanitation, food and shelter
6. Measures to promote health
7. Develop, implement and monitor national HFA
policies
8. Improve access to comprehensive essential, quality
health care
9. Implement global and national health information
and surveillance systems
10. Support research for health
Obstacles to the
Implementation of PHC Strategy
1. Misinterpretation of the PHC Concept
2. Misconception that PHC is a 2nd rate
health care for the poor
3. Selective PHC Strategies
4. Resistance to Change
5. Lack of political will
6. Centralized Planning & Management
Infrastructure
 SELECTIVE
PRIMARY HEALTH CARE
PHC implies that if one cannot afford
to offer universal coverage for even the
most basic of health care, one could
offer treatment & preventive strategies
for the few diseases identified as
having the greatest threat to mortality,
& which are amenable to prevention /
cure at low cost.
 Comprehensive PHC
ADVANTAGES
1. Looks at total health DISADVANTAGES
care 1. More costly to
2. Involvement of implement
community
2. Takes long time to see
3. Covers all elements of
impact
PHC
3. Long time to process
4. Ensures equitable
distribution of resources
4. Lack of specialized
5. Facilitates effective treatment
referral system 5. Expensive
6. Government goal 6. Inefficient referral
system ???-- misuse
 Selective PHC
ADVANTAGES DISADVANTAGES
1. Donor friendly 1. Disease rather than health
2. Elimination of selected oriented
disease 2. Doesn’t ensure equity
3. Easy to plan & 3. Top down decision making
implement 4. Neglect other problems
4. Is focused & have more 5. Leads to outbreak
impact
6. Resources (tight) might
5. Easy to manage & not be available for urgent
measure output needs (emergencies)
6. Require limited 7. Less community
resources involvement– donor
7. Improve quality of priority
services
 EVALUATION OF HFA:
1979 - 1996
Reasons for slow progress towards HFA

1. Insufficient Political commitment to implementatio

of HFA
2. Failure to achieve equity in access to all PHC elemen
3. The continuing low status of women
4. Slow socioeconomic development
5. Difficulty in achieving intersectoral action for health
6. Unbalanced distribution of, and weak
support for, human resources
 Reasons for slow progress toward
HFA (Cont….)
7. Widespread inadequacy of health promotion
activities
8. Weak health information systems and no
baseline data
9. Pollution, poor food safety, and lack of safe
water supply and sanitation
10. Rapid demographic and epidemiological changes
11. Inappropriate use of, and allocation of resources
for, high cost technology
12. Natural and man-made disasters
Strengthening Primary Health
care
 PHC: FROM ALMA- ATA
TO 21st CENTURY
1. PHC as an approach has provided impetus and
energy to progress towards HFA
2. Some progress has been made in ensuring access to
the original eight PHC elements
3. PHC remains valid as the point of entry into a
comprehensive health care system
4. Intersect oral action for health has not been fully
achieved
5. Reorientation of health services and personnel to
PHC principles remains elusive
6. Community participation takes time and dedication
by all
 New Trends that Will Influence
Health in the 21st Century
1. Widespread absolute and relative poverty
2. Demographic changes: aging and growth of
cities
3. Epidemiological changes: continuing high
incidence of infectious diseases; increasing
incidence of non- communicable diseases,
injuries and violence
4. Global environmental threats to human survival
5. New technologies: information and
telemedicine services
6. Advances in biotechnology
7. Globalization of trade, travel and spread of
values and ideas
 GOALS AND TARGETS OF HFA
1. An increase in life expectancy and in the quality of life
for all
2. Improved quality in health between and within
countries
3. Access for all to sustainable health systems and
services

An initial set of targets will guide the implementation

of the HFA policy and define priorities for action for
the first two decades of the 21st century
THE PRINCIPALS OF HEALTH
PROMOTION IN THE
OTTAWA CHARTER (1986)
1. Building a healthy public policy
2. Creating supportive environment
3. Developing personal skills
4. Strengthening community action
5. Reorienting health services
 PHC in the 21st Century:
Policy Objectives to Reinforce
the PHC Approach
1. Make health central to development and
enhance prospects for intersect oral
action
2. Combat poverty as a reflection of PHCs
concern for social justice
3. Promote equity in access to health care
4. Build partnerships to include families,
communities and their organizations
5. Reorient health systems towards
promotion of health and prevention of
disease
 Sustainable Health Systems:
Some Essential Components
 Attach greater emphasis to
comprehensive quality health care
throughout the life span
 Ensure equitable access to the original
eight PHC elements
 Expand PHC elements in response to
identification of new threats of health,
and opportunities to tackle these
threats
 Essential Health System Functions
that Complement and Support PHC
 Provide sustainable financing of PHC
 Invest in human and institutional capacity
for health
 Optimize private and public sector support
for PHC through appropriate regulations
 Strengthen research to support and
advance PHC
 Implement global, national and local
surveillance and monitoring systems
5-Star Doctor-Qualities