Components of "ALMA-ATA DECLARATION".(Briefly)

1.The importance of Equity as component of Health.
2.The Need for Community Participation.
3. The Need For Multisectoral Approach to Health Problems.
4. The Need to Ensure the adoption and use of Appropriate Technologies.
5. An Emphasis on Health Promotional Activities.
In addition two themes have emerged which were not explicit in the Declaration.
These were:
6. Decentralization
and
7. Involvement of a variety of Health Sector Agencies.
However at a second leve the Declaration listed particular essential services interventions these are:
1. Education concerning prevailing Health problems and Methods of prevention
and Control
2. Promotion of food supply and Proper Nutrition
3. Adequate supply of safe water and Basic Sanitation
4. Maternal and Child Health Care,Incuding family Planning
5. Immunization against the major infectious Diseases
6. Prevention and Control of the endemic Diseases
7. Appropriate treatment of Common Diseasea and Injuries
8. Provision of Essential Drugs

"Primary Health Care" as defined By The World Health Organization.

Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms an integral part both of the country's health system of which it is the nucleus and of the overall social and economic development of the community.

Address at the International Conference Dedicated to the 30th Anniversary of the Declaration of Alma-Ata

Dr Margaret Chan
Director-General of the World Health Organization

Honourable ministers, Ms Veneman, Dr Danzon, distinguished delegates, ladies and gentlemen,

We are meeting here to commemorate an event that launched primary health care as the route to health for all. This was a deliberate effort to tackle the huge, and largely avoidable, differences in the health status of populations. The Declaration of Alma-Ata put health equity on the international political agenda for the first time.

All those miracles of modern medicine paled when viewed against the vast numbers of people who had no access to even a minimum standard of basic health care. Their health was further compromised by low rates of literacy, poor nutrition, substandard housing, and a lack of safe water and sanitation.

The Declaration of Alma-Ata tackled all of these problems. It revolutionized the way health was interpreted and radically altered prevailing models for organizing and delivering care.

We are meeting here to launch a renewed call for primary health care. The World Health Report makes the case that primary health care is more relevant today than ever before. I fully agree, and want to stress this relevance in rich and poor countries alike.

All around the world, health is being shaped by the same powerful forces. More and more, all countries are facing similar health problems. In our closely interconnected and interdependent world, the distinctions between poor and wealthy nations are blurred. More developing countries have pockets of wealth that attract the lion’s share of spending on health. More wealthy countries have urban slums and shantytowns that drain health resources and strain the social welfare system.

Health care now faces three major ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends affect every country.

One of the consequences is the rise, everywhere, of chronic diseases, like heart disease, cancer, diabetes, and mental disorders. Long considered the companions of affluent societies, chronic diseases now impose their greatest burden on low- and middle-income countries.

The need for long-term care strains health systems and budgets. The catastrophic costs of care drive households, in the millions, below the poverty line. A great need for prevention faces a situation in which most risk factors lie outside the direct control of the health sector.

In other words, the response to these challenges requires fairness, efficiency, and multisectoral action. In other words: it requires a primary health care approach.

The Millennium Declaration and its Goals breathed new life into the values of equity and social justice, this time with a view towards ensuring that the benefits of globalization are more evenly distributed.

The AIDS epidemic showed the relevance of equity and universal access in an especially vivid way. With the advent of antiretroviral therapy, an ability to access medicines and services became equivalent to an ability to survive for many millions of people.

Equity, social justice, universal access, and solidarity for health are the values that underpin primary health care.

At a time when the costs of health care are increasing, and the expectations of consumers are rising, primary health care looks more and more like a smart way to pursue better health. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding hospital emergency wards.

WHO estimates that better use of existing measures, as promoted by primary health care, could prevent as much as 70% of the global disease burden.

No one can question the relevance or the wisdom of an approach that can contribute so much to better, more effective, more equitable, and less costly health care.

Ladies and gentlemen,

At a time when we are calling for a renewal of values, principles, and approaches put forward 30 years ago, I cannot overemphasize the importance of foresighted policies.

We are meeting at a time of crisis. We face a fuel crisis, a food crisis, and a severe global financial crisis. The effects of climate change, another global crisis, are already being felt. All of these crises have profound consequences for health.

The health sector had no say when the policies that led to these crises were formulated. But health bears the brunt.

Some things need to be said. The policies governing the international systems that link us all so closely together need to be more foresighted. They need to look beyond financial gains, benefits for trade, and economic growth for its own sake.

They need to be put to the true test. What impact do they have on poverty, misery, and ill health? Do they contribute to greater fairness in the distribution of benefits? Or are they leaving this world more and more out of balance, especially in matters of health?

Ladies and gentlemen,

This world will not become a fair place for health all by itself. Economic developments within a country will not automatically protect the poor or guarantee universal access to health care. Globalization will not self-regulate in ways that favour fairness. International trade and economic agreements will not automatically consider the impact on health. All of these changes require deliberate policy decisions.

We received visionary policy guidance for better global health thirty years ago in this city. That guidance is now renewed by the World Health Report.

The visionary thinkers who gathered in this city in 1978 could not have foreseen an oil crisis, a global recession, or the emergence of a world-transforming disease like AIDS.

In the recession that followed the Declaration of Alma-Ata, major mistakes were made in restructuring national budgets, with reductions in health and other fundamental social sectors. Health care has still not recovered from these mistakes, and the bill has been extremely high. This is especially true in sub-Saharan Africa, but also in large parts of Latin America and Asia.

If history tends to repeat itself, can we not at least learn from the past and avoid repeating mistakes?

Health is the very foundation of productivity and prosperity. Balanced health within a population contributes to social cohesion and stability. These are assets for every country, and they must be preserved, no matter what the crisis.

The World Health Report sets out a way forward that is highly and universally relevant today, and all the more important given the crises the world now faces.

The subtitle of the report is “now more than ever.” I believe this pertains to the financial crisis as well. Efficiency and fairness in health care are now more important than ever. Protection of the poor is now more important than ever.

With so much at stake for the health of so many millions, let us all hope that the report’s recommendations and advice are widely heeded.

Thank you.

"Primary health care - now more than ever"


Dr Margaret Chan
Director-General of the World Health Organization

Ladies and gentlemen,

I believe that the world, as it stands now, is out of balance in matters of health as never before. This year’s World Health Report supports my conviction.

Thirty years ago, in this city, the Declaration of Alma-Ata launched primary health care as the route to health for all. This was a deliberate effort to tackle huge, and largely avoidable, differences in the health status of populations. The declaration put health equity on the international political agenda for the first time.

Why was this so important? What does health equity mean? It means that people should not be denied access to life-saving and health-promoting interventions for unfair reasons, including those with economic or social causes. Simply stated: equity in health is of life-and-death importance.

Globally, health has progressed remarkably over the past three decades. On average, people are now living seven years longer. But if you look at individual countries or populations within countries, you get a very different picture.

Today, gaps in health outcomes, both within and between countries, are vastly greater than in 1978. Differences in life expectancy between the richest and poorest countries exceed 40 years. Annual government expenditure on health ranges from as little as US$ 20 per person to more than US$ 6000.

Never before has our world possessed such a sophisticated arsenal of tools and technologies for curing disease and prolonging life. Yet each year, nearly 10 million young children and pregnant women have their lives cut short by largely preventable causes.

Something is wrong.

A world that is greatly out of balance in matters of health is neither stable nor secure.

Ladies and gentlemen,

The World Health Report looks at the way health care is organized, financed, managed, and delivered in countries around the world. It finds striking inequalities in health outcomes, access to care, and what people pay for care. It also looks at the causes. Many problems arise from the way health systems are organized and how resources for health are managed. The report documents these problems in detail.

All too often, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves.

Some of the greatest waste and inefficiency occurs when health is treated as a commercial commodity, to be bought and sold, assuming that market forces will somehow self-adjust to iron out any problems. This seldom happens. What you see instead is unnecessary tests and procedures, more and longer hospital stays, higher costs, and the exclusion of people who cannot pay.

When the emphasis is placed on specialized or commercialized care, providers have no incentive to invest in prevention. This is a failure with huge consequences. WHO estimates that better use of existing measures could prevent as much as 70% of the global disease burden.

Ladies and gentlemen,

The World Health Report sets out a better way to manage and deliver health care. Primary health care is a people-centred approach to health that makes prevention as important as cure. As part of this preventive approach, it tackles the root causes of ill health, also in non-health sectors, thus offering an upstream attack on threats to health.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding the emergency wards of hospitals. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction.

Let me stress this last point: higher user satisfaction. I personally find this one of the most striking findings in the report. Social expectations for health are rising all around the world. People want care that is fair as well as efficient and affordable.

Studies show wide agreement. People surveyed in a range of countries believe that all members of society should have access to care and receive treatment when ill or injured, without going bankrupt as a result. When people are asked to name the top problems that they and their families face, financial worries usually head the list, closely followed by health.

Political leaders would be wise to heed these findings.

Ladies and gentlemen,

The visionary thinkers who gathered in this city thirty years ago could not have foreseen an oil crisis, a global economic recession, or the emergence of a world-transforming disease like AIDS.

Today, we know where we stand. We face a fuel crisis, a food crisis, and a financial crisis. The effects of climate change, another global crisis, are already being felt. All of these crises have profound implications for health.

We must face these events with resolve. This is not the time to back away or buckle under. The bill for failing to protect and promote health always comes, and this is especially true at a time when chronic diseases, like heart disease, cancer, diabetes, and mental disorders, are on the rise worldwide.

In the recession that followed the Declaration of Alma-Ata, major mistakes were made in restructuring national budgets, with reductions in health and other fundamental social services. Health care has still not recovered from these mistakes, and the bill has been extremely high. This is especially true in sub-Saharan Africa, but also in large parts of Latin America and Asia.

If history tends to repeat itself, can we not at least learn from the past and avoid repeating mistakes?

Health is the very foundation of productivity and prosperity. Cutting investments in health is not a viable option. We have made that mistake before and are still paying the price.

Every health system in the world has inefficiencies. Well-documented ways of reducing these inefficiencies, through better management, through incentives, through primary health care, exist.

But health systems will not automatically gravitate towards greater fairness and efficiency. This world will not become a fair place for health all by itself. Deliberate policy decisions are needed.

The World Health Report documents the problems, but it also shows what needs to be done. At a time of crisis on so many fronts, with so much at stake for health, let us all hope that the report has the impact it deserves.

Thank you.