Title: ALMA ATA DECLARATION
1ALMA 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
2Primary Health Care
- By
- Dr Arshad Usmani
- Lahore, Paksitan
3Themes 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
4PRIMARY 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
5PRINCIPLES OF PHC
- Health Prevention Promotion
- Equity
- Appropriate Technology
- Community Participation
- Intersectoral Coordination
- Decentralization
6COMPONENTS 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
7PHC 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
8PHC 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 ) -
9PHCGlobal 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
10GLOBAL 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
11Obstacles 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
12SELECTIVE 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.
13Comprehensive 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
14Selective 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
15EVALUATION 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
16Reasons 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
17PHC 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
18New 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
19GOALS 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
20THE 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
-
21PHC 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
22Sustainable 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
23Essential 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