ALMA ATA DECLARATION

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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

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Primary Health Care

• By
• Dr Arshad Usmani
• Lahore, Paksitan

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Themes Leading toAlma Ata

• Changing theories of health development shift
  away from GNP as measure of development towards
  recognition of the need of social development
• Concerns about poverty population control
• Increasing reliance upon alternative approaches
  to medical care model
• Success of CHWs associated emphasis on
  community participation
• Revival of interest in public health tackling
  causes of ill health rather than symptoms

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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

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PRINCIPLES OF PHC

• Health Prevention Promotion
• Equity
• Appropriate Technology
• Community Participation
• Intersectoral Coordination
• Decentralization

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COMPONENTS OF PHC

• Education concerning prevailing health problems
  the methods of preventing controlling them
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic
  sanitation
• MCH including FP
• Immunization against major infectious diseases
• Prevention and control of locally endemic
  diseases
• Appropriate treatment of common diseases and
  injuries
• Provision of essential drugs

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PHC EXTENDED ELEMENTS IN THE 21st CENTURY

• Expanded options of immunization
• Reproductive health needs
• Provision of essential technologies for health
• Health promotion as defined in Ottawa Charter and
  endorsed by resolution (WHA 42.44)
• Prevention and control of non-communicable
  diseases
• Food safety and provision of selected food
  supplements0

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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
  governments 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 )

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PHCGlobal 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 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

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GLOBAL HEALTH TARGETS

• Health equity childhood stunting
• Survival MMR, CMR, life expectancy
• Reverse global trends of five major pandemics
• Eradicate and eliminate certain diseases
• Improve access to water, sanitation, food and
  shelter
• Measures to promote health
• Develop, implement and monitor national HFA
  policies
• Improve access to comprehensive essential,
  quality health care
• Implement global and national health information
  and surveillance systems
• Support research for health

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Obstacles to the Implementation of PHC
Strategy

• Misinterpretation of the PHC Concept
• Misconception that PHC is a 2nd rate health care
  for the poor
• Selective PHC Strategies
• Resistance to Change
• Lack of political will
• Centralized Planning Management Infrastructure

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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 would 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.

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Comprehensive PHC

• ADVANTAGES
• Looks at total health care
• Involvement of community
• Covers all elements of PHC
• Ensures equitable distribution of resources
• Facilitates effective referral system
• Government goal

• DISADVANTAGES
• More costly to implement
• Takes long time to see impact
• Long time to process
• Lack of specialized treatment
• Expensive
• Inefficient referral system ???-- misuse

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Selective PHC

• ADVANTAGES
• Donor friendly
• Elimination of selected disease
• Easy to plan implement
• Is focused have more impact
• Easy to manage measure output
• Require limited resources
• Improve quality of services

• DISADVANTAGES
• Disease rather than health oriented
• Doesnt ensure equity
• Top down decision making
• Neglect other problems
• Leads to outbreak
• Resources (tight) might not be available for
  urgent needs (emergencies)
• Less community involvement donor priority

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EVALUATION OF HFA1979 - 1996

• Reasons for slow progress towards HFA
• 1. Insufficient Political commitment to
  implementation of HFA
• 2. Failure to achieve equity in access to all
  PHC elements
• 3. The continuing low status of women
• 4. Slow socioeconomic development
• 5. Difficulty in achieving intersectoral
  action for health
• 6. Unbalanced distribution of, and week
• support for, human resources

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Reasons for slow progress towards 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

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PHC FROM ALMA- ATA TO 21st CENTURY

• PHC as an approach has provided impetus and
  energy to progress towards HFA
• Some progress has been made in ensuring access to
  the original eight PHC elements
• PHC remains valid as the point of entry into a
  comprehensive health care system
• Intersect oral action for health has not been
  fully achieved
• Reorientation of health services and personnel to
  PHC principles remains elusive
• Community participation takes time and dedication
  by all

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New Trends that Will Influence Health in the 21st
Century

• Widespread absolute and relative poverty
• Demographic changes aging and growth of cities
• Epidemiological changes continuing high
  incidence of infectious diseases increasing
  incidence of non- communicable diseases, injuries
  and violence
• Global environmental threats to human survival
• New technologies information and telemedicine
  services
• Advances in biotechnology
• Globalization of trade, travel and spread of
  values and ideas

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GOALS AND TARGETS OF HFA

• An increase in life expectancy and in the quality
  of life for all
• Improved quality in health between and within
  countries
• 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

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THE PRINCIPALS OF HEALTH PROMOTION IN THE OTTAWA
CHARTER (1986)

• Building a healthy public policy
• Creating supportive environment
• Developing personal skills
• Strengthening community action
• Reorienting health services
•  

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PHC in the 21st CenturyPolicy Objectives to
Reinforce the PHC Approach

• Make health central to development and enhance
  prospects for intersect oral action
• Combat poverty as a reflection of PHCs concern
  for social justice
• Promote equity in access to health care
• Build partnerships to include families,
  communities and their organizations
• Reorient health systems towards promotion of
  health and prevention of disease

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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

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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