The history of primary
health care took its initiative from the activities of the “barefoot” doctors
in China in the 1960s. in the early
1960s, China developed a health care system which emphasized preventive, rather
than curative, care. China’s program consisted of rural medical services by
“barefoot doctors.” These “doctors” were individuals with
some general education, most of them in their 20s, who were selected to receive
a three-month to six-month intensive course in medical training. In 1974, in
order to obtain recognition for the health care model, China began pressing the
United Nations for a conference on primary health care. Stating that these
doctors lived in the same village in which they worked and their proximity to
patients made it easier for them to provide quicker help.
health care took its initiative from the activities of the “barefoot” doctors
in China in the 1960s. in the early
1960s, China developed a health care system which emphasized preventive, rather
than curative, care. China’s program consisted of rural medical services by
“barefoot doctors.” These “doctors” were individuals with
some general education, most of them in their 20s, who were selected to receive
a three-month to six-month intensive course in medical training. In 1974, in
order to obtain recognition for the health care model, China began pressing the
United Nations for a conference on primary health care. Stating that these
doctors lived in the same village in which they worked and their proximity to
patients made it easier for them to provide quicker help.
What is referred to today
as primary health care is as a result of the September 1978 declaration made at
a meeting attended by representatives of 134 nations gathered to propose a plan
that would keep as many people as possible healthy worldwide.
as primary health care is as a result of the September 1978 declaration made at
a meeting attended by representatives of 134 nations gathered to propose a plan
that would keep as many people as possible healthy worldwide.
In the city of Alma-Ata,
which was the capital of the Soviet Republic of Kazakhstan, on the 6-12 September
1978, an international conference was held and in the course of this
conference, the Declaration of Alma-Ata and the primary health care model
emerged. This declaration states that health is a human right and that
attaining this health should be the primary goal of every government. The main
purpose of this declaration was the involvement of community health workers and
traditional healers in the provision of health services to people.
which was the capital of the Soviet Republic of Kazakhstan, on the 6-12 September
1978, an international conference was held and in the course of this
conference, the Declaration of Alma-Ata and the primary health care model
emerged. This declaration states that health is a human right and that
attaining this health should be the primary goal of every government. The main
purpose of this declaration was the involvement of community health workers and
traditional healers in the provision of health services to people.
a.) Venue of the meeting: Almaty (formerly Alma-Ata), Kazakhstan
b.) Number of countries that were represented: 134
countries
countries
c.) Reasons why after decades of declaration, many
countries are still struggling to implement.
countries are still struggling to implement.
i.
The Declaration itself is criticized for being too
“idealistic” and “having an unrealistic time table”.
ii.
Implementation of PHC is said to be affected after
the introduction of structural adjustment programs by the World Bank
Implementation of PHC is said to be affected after
the introduction of structural adjustment programs by the World Bank
iii.
It is argued that PHC favoured short-term goals and
targeted health investment, but it did not address the social causes of
disease.
It is argued that PHC favoured short-term goals and
targeted health investment, but it did not address the social causes of
disease.
Specific
items in the declaration
items in the declaration
1.)
Use of appropriate technology – medical technology should be provided that is
accessible, affordable, feasible and culturally acceptable to the community.
Examples of appropriate technology include refrigerators for vaccine cold storage. Less
appropriate could include, in many settings, body scanners or heart-lung
machines, which benefit only a small minority concentrated in urban areas. They
are generally not accessible to the poor, but draw a large share of resources.
Use of appropriate technology – medical technology should be provided that is
accessible, affordable, feasible and culturally acceptable to the community.
Examples of appropriate technology include refrigerators for vaccine cold storage. Less
appropriate could include, in many settings, body scanners or heart-lung
machines, which benefit only a small minority concentrated in urban areas. They
are generally not accessible to the poor, but draw a large share of resources.
2.)
Multi-sectional
approach – recognition that health cannot be improved by intervention
within just the formal health sector; other sectors are equally important in
promoting the health and self-reliance of communities.
Multi-sectional
approach – recognition that health cannot be improved by intervention
within just the formal health sector; other sectors are equally important in
promoting the health and self-reliance of communities.
3.)
reducing exclusion and social disparities in health (universal coverage reforms);
reducing exclusion and social disparities in health (universal coverage reforms);
4.)
organizing health services around
people’s needs and expectations (service delivery reforms);
organizing health services around
people’s needs and expectations (service delivery reforms);
5.)
integrating health into all
sectors (public policy reforms);
integrating health into all
sectors (public policy reforms);
6.)
pursuing collaborative
models of policy dialogue (leadership reforms); and
pursuing collaborative
models of policy dialogue (leadership reforms); and
7.)
increasing stakeholder participation.
increasing stakeholder participation.
8.)
Equitable distribution of health care – according to this
principle, primary care and other services to meet
the main health problems in a community must be provided equally to all
individuals irrespective of their gender, age, caste, color, urban/rural
location and social class.
Equitable distribution of health care – according to this
principle, primary care and other services to meet
the main health problems in a community must be provided equally to all
individuals irrespective of their gender, age, caste, color, urban/rural
location and social class.
9.)
Community
participation – in order to make the fullest use of local, national and
other available resources. Community participation was considered sustainable
due to its grass roots nature and emphasis on self-sufficiency, as opposed to
targeted (or vertical) approaches dependent on international development
assistance.
Community
participation – in order to make the fullest use of local, national and
other available resources. Community participation was considered sustainable
due to its grass roots nature and emphasis on self-sufficiency, as opposed to
targeted (or vertical) approaches dependent on international development
assistance.
10.) Health workforce
development – comprehensive health care relies on adequate number and
distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at
the local and referral levels.
development – comprehensive health care relies on adequate number and
distribution of trained physicians, nurses, allied health professions, community health workers and others working as a health team and supported at
the local and referral levels.
References
Chan, M. (2007) The contribution of primary health
care to the Millennium Development Goals, Opening Address at the International
Conference on Health for Development, Buenos Aires, Argentina, 16 August 2007. http://www.who.int/dg/speeches/2007/20070816_argentina/en/ (accessed April 6, 2015)
care to the Millennium Development Goals, Opening Address at the International
Conference on Health for Development, Buenos Aires, Argentina, 16 August 2007. http://www.who.int/dg/speeches/2007/20070816_argentina/en/ (accessed April 6, 2015)
Cueto, M. (2004). The ORIGINS of Primary Health Care and SELECTIVE
primary health care. Am J Public Health 94 (11): 1864-1874.
primary health care. Am J Public Health 94 (11): 1864-1874.
Department of Health (2008). The Birchwood National
Consultative Health Forum Declaration on Primary Health Care, April, 2008. http://www.doh.gov.za/docs/sp/2008/sp0411a.html (accessed April 6, 2015)
Consultative Health Forum Declaration on Primary Health Care, April, 2008. http://www.doh.gov.za/docs/sp/2008/sp0411a.html (accessed April 6, 2015)
Tejada de Rivero, D.A. (2003). Alma Ata revisited. Perspectives
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WHO/AFRO (2008). Ouagadougou Declaration on Primary
Health Care and Health Systems in Africa: achieving better health for all in
the new millennium. http//www.who.afro.int/phc_hs_2008 (accessed April 6, 2015).
Health Care and Health Systems in Africa: achieving better health for all in
the new millennium. http//www.who.afro.int/phc_hs_2008 (accessed April 6, 2015).