7/29/2019 Renaissance in Primary HealthCare - Lancet (AlmaAta).pdf

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Editorial

www.thelancet.com Vol 372 September 13, 2008 863

A renaissance in primary health care

30 years ago, in the midst of the Cold War, health experts

and policy makers from 134 WHO member states

convened in the former USSR to attend a conference on

international primary health care. On Sept 12, 1978, the

Alma-Ata Declaration was signed, with the ambitious

target of achieving Health for All by 2000.

In 1978, 2000 million people were estimated to have

no access to adequate health care. There were vast in-

equalities between rich and poor countries, and between

rich and poor populations within countries. The Alma-

Ata Declaration revolutionised the worlds interpretationof health. Its message was that inadequate and unequal

health care was unacceptable: economically, socially,

and politically. Unfortunately, the goal of health for all,

while a rallying call to action, was not met. Theories for

this failure abound: the vision for primary health care

was politically unacceptable to some nations and so was

marginalised; emerging health threats took precedence

(no one imagined the global disease burden that

HIV/AIDS would bring); and health priorities shifted (to

the Millennium Development Goals [MDGs]).

30 years on, what is the relevance of the Alma-AtaDeclaration in 2008? In short, primary health care is now

offering global health a lifeline. Progress towards the

MDGs has stalled. Weak health systems have restricted the

success of efforts to improve maternal, newborn, and child

health, and to reduce the disease burden from malaria and

tuberculosis. New epidemics of chronic disease threaten

to reverse what small gains have been achieved. To get

back on track, and to meet the MDGs by 2015, countries

need to strengthen their health systems through the

implementation of effective primary health care.

Now is the right moment to proclaim the urgent need

for a renaissance in primary health care. The continuing

relevance of this 30-year-old Declaration is remarkable.

Many of the challenges faced in 1978 remain, such

as infectious diseases (eg, the ongoing threat of

H5N1 avian influenza and HIV/AIDS), political instability

and conflict (most recently seen in Iraq and Zimbabwe),

and worsening poverty (the World Bank last month

estimated that 14 billion people now live in poverty).

In recognition of this timely reawakening of interest in

primary health care, this weeks Lancet revisits, updates,

and relaunches the key messages from Alma-Ata. A series

of eight papers begins with an analysis of modern

primary health care, and issues such as implementing

cost-effective interventions in low-resource settings

and tackling the growing burden of chronic diseases.

We publish an analysis of individual country progress

since 1978, with possible lessons for those who have

shown the least advance. Involvement of communities

in planning and implementation of health care (one of

the main tenets of the Alma-Ata Declaration) is explored

in the context of maternal, newborn, and child health,

as are the roles of national policies and effective service

integration, all foundations of a successful primary healthcare service. The final paper in the series looks to the

future and provides a series of action points to revitalise

primary health care, both nationally and globally.

WHOs vision for healthcomplete physical, mental,

and social wellbeingis the key to achieving Alma-Atas

prime goal of health for all. This weeks research articles

also focus on these three principles. Stephen Tollman and

colleagues discuss the challenges in managing chronic

diseases in primary health care and the importance of

providing adequate services to ensure physical wellbeing.

Atif Rahman and co-workers tackle mental health inBangladesh, with a psychological intervention that can

be delivered within communities to treat mothers with

perinatal depression. And the importance of social devel-

opment is shown by Luis Huicho and authors who present

data from four countries highlighting the importance

of health workers with shorter durations of training in

providing vital care to people in low-resource settings.

Importantly, WHO, under Margaret Chans effective

leadership and together with her regional directors, has

reaffi rmed its commitment to primary health care. This

revisioning of the principles of Alma-Ata is welcome and

illustrates a new unity of purpose across global health

institutions. Political progress is also encouraging.

Following the G8 meeting earlier this year, Japan has

announced its own commitment to lead international

initiatives to strengthen health systems. Such renewed

global interest in primary health care is promising. The

need remains great and there are no shortcuts to success.

But with refined international relationships, new and

emerging technologies, and 30 years of experience,

health for all need not be a dream buried in the past.

The right to the highest attainable standard of health

can be a reality within our grasp. The Lancet

For the original Alma-Ata

Declarationsee http://www.

who.int/hpr/NPH//docs/

declaration_almaata.pdf

See Comment page 865

See Articles pages 893, 902,

and 910

See Series pages 917, 928, 940,

950, 962, 972, 990, and 1001

WHO