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ALMA ATA DECLARATION

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Title: ALMA ATA DECLARATION


1
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

2
Primary Health Care
  • By
  • Dr Arshad Usmani
  • Lahore, Paksitan

3
Themes Leading toAlma Ata
  1. Changing theories of health development shift
    away from GNP as measure of development towards
    recognition of the need of social development
  2. Concerns about poverty population control
  3. Increasing reliance upon alternative approaches
    to medical care model
  4. Success of CHWs associated emphasis on
    community participation
  5. Revival of interest in public health tackling
    causes of ill health rather than symptoms

4
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

5
PRINCIPLES OF PHC
  1. Health Prevention Promotion
  2. Equity
  3. Appropriate Technology
  4. Community Participation
  5. Intersectoral Coordination
  6. Decentralization

6
COMPONENTS OF PHC
  1. Education concerning prevailing health problems
    the methods of preventing controlling them
  2. Promotion of food supply and proper nutrition
  3. An adequate supply of safe water and basic
    sanitation
  4. MCH including FP
  5. Immunization against major infectious diseases
  6. Prevention and control of locally endemic
    diseases
  7. Appropriate treatment of common diseases and
    injuries
  8. Provision of essential drugs

7
PHC EXTENDED ELEMENTS IN THE 21st CENTURY
  1. Expanded options of immunization
  2. Reproductive health needs
  3. Provision of essential technologies for health
  4. Health promotion as defined in Ottawa Charter and
    endorsed by resolution (WHA 42.44)
  5. Prevention and control of non-communicable
    diseases
  6. Food safety and provision of selected food
    supplements0

8
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 )

9
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

10
GLOBAL HEALTH TARGETS
  1. Health equity childhood stunting
  2. Survival MMR, CMR, life expectancy
  3. Reverse global trends of five major pandemics
  4. Eradicate and eliminate certain diseases
  5. Improve access to water, sanitation, food and
    shelter
  6. Measures to promote health
  7. Develop, implement and monitor national HFA
    policies
  8. Improve access to comprehensive essential,
    quality health care
  9. Implement global and national health information
    and surveillance systems
  10. Support research for health

11
Obstacles to the Implementation of PHC
Strategy
  1. Misinterpretation of the PHC Concept
  2. Misconception that PHC is a 2nd rate health care
    for the poor
  3. Selective PHC Strategies
  4. Resistance to Change
  5. Lack of political will
  6. Centralized Planning Management Infrastructure

12
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.

13
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

14
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

15
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

16
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

17
PHC FROM ALMA- ATA TO 21st CENTURY
  1. PHC as an approach has provided impetus and
    energy to progress towards HFA
  2. Some progress has been made in ensuring access to
    the original eight PHC elements
  3. PHC remains valid as the point of entry into a
    comprehensive health care system
  4. Intersect oral action for health has not been
    fully achieved
  5. Reorientation of health services and personnel to
    PHC principles remains elusive
  6. Community participation takes time and dedication
    by all

18
New Trends that Will Influence Health in the 21st
Century
  1. Widespread absolute and relative poverty
  2. Demographic changes aging and growth of cities
  3. Epidemiological changes continuing high
    incidence of infectious diseases increasing
    incidence of non- communicable diseases, injuries
    and violence
  4. Global environmental threats to human survival
  5. New technologies information and telemedicine
    services
  6. Advances in biotechnology
  7. Globalization of trade, travel and spread of
    values and ideas

19
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

20
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
  •  

21
PHC in the 21st CenturyPolicy Objectives to
Reinforce the PHC Approach
  1. Make health central to development and enhance
    prospects for intersect oral action
  2. Combat poverty as a reflection of PHCs concern
    for social justice
  3. Promote equity in access to health care
  4. Build partnerships to include families,
    communities and their organizations
  5. Reorient health systems towards promotion of
    health and prevention of disease

22
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

23
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
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