The Alma Ata Declaration

The Alma Ata closureThe Alma Ata answer was form aloney adopted at the Inter issue Conference on pristine Health C be in Alma Ata (in stick Kazakhstan) in September 1978 (WHO, 1978). It identifies and stresses the pick up for an immediate action by any goernments, all wellness and teaching workers and the earth familiarity to promote and protect world wellness by dint of Primary Health C ar (PHC) (ibid). This has been identified by the Declaration as the key towards achieving a take aim of wellness that depart al depleted for a kindly and productive life by the year 2000.The principles of this declaration assume been built on three (3) key aspects which complicateEquity It ack straight offledges the item that both individual has the right to wellness and the fruition of this requires action crosswise the wellness sector as sanitary as other social and economic sectors.Participation It excessively identifies and recognises the need for full participation of co mmunities in the planning, organisation, instruction exe subvertion, operation and control of radical wellness fiscal aid with the use of local anesthetic or national unattached resource. coalition It strongly supports the idea of Partnership and collaboration between government, World Health Organisation (WHO) and UNICEF, other world(prenominal) organisations, multilateral and bilateral senescencies, non-governmental organisations, funding agencies, all wellness workers and the world corporation towards supporting the commitment to uncomplicated election wellness make out as well as increasing financial and technical support especially in developing countries.Other all- central(prenominal) principles identified by the Declaration include wellness promotion and the appropriate use of resources.The declaration calls on all governments to formulate st saygies, policies and actions to launch and sustain uncomplicated health pity and make up it into the national hea lth system. It was endorsed by the World Health Assembly in 1978 thereof enshrining it into the indemnity of the WHO (Horder, 1983).BackgroundBack in the 1960s and 1970s, galore(postnominal) developing countries of the world gained independence from their colonial intimationers. In efforts to provide considerably quality health rush return for the existence, these new governments found teaching hospitals, checkup and nursing schools most of which were located in urban areas (Hall Taylor, 2003) thus creating a problem of access to good quality health service especially for people that reside in rural communities.Successful programmes were initiated by Tanzania, Sudan, Venezuela and china in the 1960s and 1970s to provide radical coil trouble health services that was basic as well as world- simple (Benyoussef Christian, 1977 Bennett, 1979). It is on the basis of these programmes that the term Primary Health Care was derived (Hall Taylor, 2003). In low income countries, the primal health care strategy as described by the Alma Ata was very influential in exerciseting health insurance during the eighties however in advanced income countries such as the United Kingdom, it was considered orthogonal on the presumption that the level of primeval care service was already well developed (Green et al., 2007).Primary health care has been defined in the Declaration of Alma Ata asessential health care based on practical, scientifically sound and socially acceptable methods and technology made universally fond to individuals and families in the corporation with their full participation and at a cost that the club and country target afford to nurse at every stage of their development in the spirit of egotism reliance and self- closing. It forms an integral part several(prenominal)(prenominal) of the countrys health system, of which it is the central act upon and main focus, and of the overall social and economic development of the residential area. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people pass away and work, and constitutes the first element of a continuing health care answer. (WHO, 1978)The Alma Ata Declaration brought about a shift on emphasis towards pr correcttive health, preparation of multipurpose paramedical workers and community based workers (Muldoon et al., 2006).In order to secure the global target of health for all by the year 2000, goals were be set by the WHO (WHO, 1981) some of which includeAt least 5% of gross national product is spent on health.A liable percentage of the national health expenditure is devoted to local health care.Equitably distribution of resourcesAt least 90% of new-borne babes pee a birth weight of at least 2500g.The infant mortality rate for all identifiable subgroups is below 50 per atomic number 19 live-births.Life prediction at birth is over 60 years.A dult literacy rate for both men and women exceeds 70%.Trained forcefulness for attending pregnancy and tyke birth and caring for boorren for at least 1 year of age.It has been over 30 years now that the Declaration of Alma Ata was adopted by the WHO. A look at the online health trend roughly the world especially in developing countries such Nigeria, Ghana, Niger, Zimbabwe and so many others will reveal that the goal of achieving health for all by the year 2000 through basal health care has not been a reality. Although thither shake up been reasonable improvement in immunisation, sanitation and access to safe weewee, there is notwithstanding impediments in providing equitable access to essential care oecumenic (WHO, 2010)What went wrong?Lawn et al. (2008) explain that the Cold War significantly impeded the sought after impact expectation of the Alma Ata Declaration in the sense that global developmental policy at that fourth dimension was dominated by neo-liberal macro s cotch and social policies. The gist of this on patheticer countries of the world oddly in Africa was instruction execution of structural adjustment programmes in effort to reduce budget dearth through devaluations in local currency and cuts in in the worldly concern eye(predicate) spending. This resulted in the removal of subsidies, cost recovery in the health sector and cut backs in the number of medical health practitioners that could be hired. The introduction of substance abuser charges and encouragement of privatisation of services during this period had an untoward effect on poor people who could not afford to pay for such services. The combination of these factors hence resulted in part to the crippling of the quality of service that can be provided at the master(a) care level. People who could afford such service resorted to health service offered at secondary or tertiary care which in most typesetters cases is difficult to access.The introduction of a new design o f Selective Primary Health Care as proposed at heart a year of the adoption of the Alma Ata Declaration by Walsh Warren (1979) changed the dimension of primary health care. This interim apostrophize was proposed due to the difficulty experienced in initiating blanket(prenominal) primary health care services in countries with authoritarian leadership (Waterston, 2008). Walsh Warren (1979) argued that until comprehensive primary health care can be made available to all, services that are targeted to the most historic diseases may be the most trenchant intervention for improving health of a population. The measures bespeaked include immunisation, oral rehydration, breast feeding and the use of anti malarias. This discriminating approach was considered as being more feasible, measurable, rapid and slight risky, taking away decision making and control away from the community and placing it upon consultants with technical expertise hence making it more attractive particularly to funding agencies (Lawn et al., 2008). An example of a discriminating primary care approach is the Expanded Programme on Immunisation (EPI). Selective primary health care is concerned with providing solutions to particular diseases such as HIV/acquired immune deficiency syndrome and tuberculosis while comprehensive primary care as proposed the Alma Ata begins with providing a strong community infrastructure and involvement towards tackling health issues (Baum, 2007).The shift in agnatic, new-borne and child health as a result of programmes that removes control from the community hinders the actualisation of the goals of primary health care as emphasized by the Alma Ata Declaration. The reversal of policy in the 1990s by the WHO and other UN agencies to reprove traditional birth attendants and promoting facility based birth with skilled personnel (Koblinsky et al., 2006) is an example of such.The World Banks report Investing in Health which was print in 1993 saw the World Bank be come a keen influence and major key player in international public health as such robbing the WHO of the prestigious position (Baum, 2007). It considers investments for interventions that only fuck off the best impact on population health as such removing local control and advocating a vertical approach to health. This move counteracts the process of the social change described by the Alma Ata Declaration which is necessary for realisation of its goals.These go to show that consistency both in leadership (locally and globally), policy as well as good evidence (to drive policy making and actions), are important ingredients for global initiatives to succeed.What went right?Even with the several(prenominal) elements that prevailed against the achievement of the collective goals of the Alma Ata Declaration, several case studies show that when provided with a lucky surround, primary health care as prescribed by the Alma Ata is suitable to bring about a significant improvement in the health status of any population or country.Case poll 1 Primary Health Care in GambiaUsing data obtained from a longitudinal study conducted by the United Kingdom Medical search Council over a 15 year period for a population of about 17,000 people in 40 villages in Gambia, Hill et al. (2000) compared infant and child mortality between village with and without primary health care. The trim services that were provided in the villages with primary health care include a village health worker, a paid community nurse for every 5 villages and a trained traditional birth attendant. Maternal and child health services with vaccination programme were accessible to residents of both primary health care and non primary health care villages. There was mark improvement in infant and under 5 mortality in both sets of villages.After primary health care system was established in 1983, infant mortality dropped from 134/1000 in 1982 83 to 69/1000 in 1992 94 in the primary health care villages and from 155/1000 to 91/1000 in non primary health care villages over the same period of quantify. Between 1982 and 83 and 1992-94, the close rates for children aged 1-4 fell from 42/1000 to 28/1000 in the primary health care villages and from 45/1000 to 38/1000 in the non primary health care villages. However, in 1994 when watch of primary health care was weakened, infant mortality rate in primary health care villages rose to 89/1000 for primary health care village in 1994 96. The rate in non primary health care village fell to 78/1000 for this period.The implementation and supervision of primary health care is associated with a significant effect on infant mortality rates for these groups of villages that turn a profitted from the programme.Case study 2 Under 5 mortality and income of 30 countriesTo assess the progress for primary health care in countries since Alma Ata, Rohde et al. (2008) analysed life expectancy relative to national income and HIV prevalence in order to identi fy over achieving or under achieving countries. The study focused on 30 low income and center(a) income countries with the highest year reduction of mortality among children less than 5 years of age and it described coverage and justice of primary health care as well as other non health sector actions. The 30 countries in question wealthy person scaled up selective primary care (immunisation, family planning) and 14 of these countries have progressed to comprehensive primary care which has been marked with high coverage of skilled birth attendants. Equity with skilled birth attendance coverage across income groups was accessed as well as access to plum water and gender inequality in literacy.These 30 countries were grouped into countries with selective primary care mixture of selective and comprehensive primary health care and comprehensive primary health care alone. The major players among countries with comprehensive primary health care are Thailand, Brazil, Cuba, China and Vi etnam. Overall, Thailand tops the hark and it has comprehensive primary health care. Maternal, new-borne and child health in Thailand were prioritised even before Alma Ata and has been able to increase coverage for immunisation and family planning interventions. The political science investment in district health systems provided a bottom for comprehensive primary health care in maternal, new-borne and child health as well as other essential services. Community health volunteers also played a significant role towards Thailands medical advancement. They promoted the use of water sealed latrines to improve sanitation and were very instrumental towards the decline of protein kilocalorie malnutrition in pre-school children in the past 20 years (WHO, 2010). Participation of the community health volunteers is a major source of community involvement into health care of Thailand (ibid).The following factors were identified as important lessons from high achieving countries responsible l eadership and consistent national policy progress with time construct coverage of care and comprehensive health systems with time community and family mandate district level focus which is support by data to set priorities for funding, track results as well as identify and redress disparities and prioritising equity, removing financial barriers for poorest families and protection against unavoidable health cost.Case study 3 integrating of cognitive behaviour based therapy into routine primary health care work in rural PakistanRahman et al. (2008) in a cluster-randomised control study in Pakistan shows the benefits derived when cognitive behaviour therapy in postnatal depression is structured with community based primary health care. Training was provided to the primary health care workers in the intervention group to deliver psychological intervention. The health care workers also receive monthly supervision and monitoring. Significant benefit (lower depression and disability sc ores, overall functioning and perception of social support) was report in the intervention group to suggest that this kind of measures as support by the Alma Ata can drive the initiative towards Health for all.It is evident and kick the bucket that countries that practiced comprehensive primary health care as enshrined by the Alma Ata reaped great benefits in terms of population health improvement. Although it has been argued that comprehensive primary health care is too idealistic, expensive and unattainable (Hall Taylor, 2003), evidence suggest that it is more the likes ofly to deliver better health outcomes with greater public satisfaction (Macinko et al., 2003). This kind of care can deal with up to 90% of health demands in low income countries (World Bank, 1994).Relevance of Alma Ata in this play timeOur present world that has been characterised by marked epidemiological transition in health. Low income countries as well as high income ones are confront with increasing preva lence of non communicable as well as chronic disabling disease (Gillam, 2008) hence, the existence of infectious diseases (malaria, HIV/AIDS, Tuberculosis etc), and diseases like cardiovascular disease and diabetes. For low income countries such as sub-Sahara African Countries, this constitutes a major health problem because their health systems are mainly oriented towards providing services inclined with maternal and child health, acute or periodic illnesses. As such current health systems need to have the competency to provide effective management for the current disease trend. The Alma Ata provides a foundation for how such effective health service can be provided. Because, primary health care is the first line of contact an individual has to health care, it is thus very influential in determining community health especially when the community is fully empowered to participate. As societies modernise, as it is the case in our current world, the level of participation increases and people want to have a say in what affects their lives (Garland Oliver, 2004). Thus, the level participation in health care is better off and more powerful in this present time than it was when it was the Alma Ata was adopted. Evidence suggest that the set as enshrined by the Alma Ata are becoming the mainstream of modernising societies and it is a reflection of the way people look at health and what they expect from their health care system (WHO, 2008).Alma Ata failed in some countries because the Government of such countries refused to tramp strategies towards sustaining a strong and vibrant primary health care system that is appropriate to the health needs of the community such that access is change, participation and partnership is encouraged and health is improved in general. There is no goal standard guideline or manual on Alma Ata but individual governments have to develop their ingest strategies which should be well suited towards meeting their own needs. The Alma A ta founding principles is tranquillise relevant towards achieving these goals especially as it brings health care to peoples door timber as it encourages training of people to efficiently and effectively deliver health services. Evidence has shown that there is a greater range of cost effective interventions than was available 30 years ago (Jamison et al., 2006). It is for these reasons that primary health care is essential towards achieving the millennium development goals especially as it concerns child survival, maternal health, and HIV/AIDS, malaria, tuberculosis and other diseases.The Alma Ata emphasises the importance of collaboration as an important tool towards introducing, developing and maintaining primary health care. This partnership as supported by the Alma Ata is essential to increase technical and financial support to primary health care especially in low income countries. It is a current trend to find an increasing mixture of private and public health systems as we ll as increasing private-public partnerships. Governments, donor and private organisations are now working together to promote and protect health inappropriate after Alma Ata (OECD, 2005). There is also increased funding and this is shifting from selective global funds to strengthening health systems through sector wide approaches (Salama et al., 2008). This kind of collaborations is a step in the right direction and when it is strengthen according to the principles of the Alma Ata, it will not only improve the buoyancy of the health care system but also improve participation and equity in the sense that health care is more qualitative and accessible to the people.The years that followed after adoption of the Alma Ata by WHO member states was characterised by crank political leadership and military dictatorship especially among low income countries which lead to neglect of the health sector. This created unfriendly environments for the development and maintenance of stable primar y health care systems. In this current times however, most countries have embraced the democratic system of leadership that promotes equity, participation and partnership. Health equity is continually enjoying prominence in the dialogue of political leaders and ministries of health (Dahlgren Whitehead, 2006). Thus, the environment being created is friendlier to the Alma Ata hence making it more relevant in this time. 30 years ago, the values of equity, people centeredness, community participation and self determination embraced by the Alma Ata was considered as being radical but today these values have become widely share expectations for health (WHO, 2008).Our current time has been marked by gross technological advancement which was not available in the 1970s. There is also an increased wealth of knowledge and literary productions on health and on the growing health inequalities between and within countries all of which was not available 30 years ago. All these put together prov ides a relevant foundation to support the Alma Ata in the present time making it more relevant in delivering effective health care service.ConclusionThe prevailing political and economic situation around the world make the Alma Ata more relevant than it was in 1978. However, there is still need for more to be done. There is need for the revitalisation of primary health care according to the tenets of the Alma Ata and progress made should be consistently monitored. There is also the need for an increased commitment to the virtues of health for all as well as increased commitment of resources towards primary health care which should be driven by good evidence base. It is important that emphasis be changed from single interventions that produce short term or immediate results to interventions that will create an integrated, long term and a sustainable health care system. Even with the challenges being faced so furthest with full implementation of the Alma Ata, the ideals are relevant still relevant now more than ever.