Alma-Ata after 30 years: still relevant for Africa?
Through exploring the importance of sustainable and long-term health financing, Rotimi Sankore argues that effective primary health care will only be achieved when key obstacles in the shape of a lack of clear policies and Africa’s critical health workforce shortage are addressed. He stresses the debate around ‘health systems versus disease specific interventions’ to be a phantom one akin to asking whether food is more important than water to human life, arguing that the real challenge for the future will lie in creating and implementing effective policies that tackle persistent institutional and resource-based issues.
In the context of Africa’s present health crisis, only people suffering from policy blindness can fail to see that Africa’s survival as a continent depends on going beyond merely declaring emergencies, and actually financing and implementing universal primary health care (PHC).
In September 1978, the International Conference on Primary Health Care was held in Alma-Ata, Kazakhstan, then part of the Union of Socialist Soviet Republics (USSR). Led by the World Health Organisation (WHO), the conference produced the Alma-Ata Declaration, which underlined the need for governments to protect the health of all citizens and emphasised that health for all is both a socio-economic (or development issue), and also a human right. The conference also highlighted the inequalities between developed and developing countries, and between the elite and ordinary people within countries.
One of the most significant outcomes of the conference through the Alma-Ata Declaration identified primary health care as ‘the most efficient and cost effective way to provide health care’. This has been recently reemphasised by the current Director General of the WHO Dr Margaret Chan.
Going by its definition of ‘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 the principle that ‘[h]ealth services must be shared equally by all people irrespective of their ability to pay and all (and rich or poor, urban or rural) must have access to health services’, it was assumed at the time that with effective implementation PHC would lead to health for all by the magical year 2000.
Based also on the understanding of health agencies, professionals and academic institutions that ‘primary health care needs to be delivered close to the people’ through ‘maximum use of both lay and professional health care practitioners’, experts have distilled down the basic principles of primary health care to several core factors, including the following:
• Public education for the identification, prevention, and control of prevailing health challenges • Education on and provision of proper food supplies and nutrition, including adequate supply of safe water and basic sanitation • Provision of maternal and child care, including sexual and reproductive health education, and family planning • Immunisation and vaccinations against major infectious diseases. • Prevention and control of locally endemic diseases • Appropriate treatment of common diseases using the most up-to-date, cost effective and appropriate technology • Promotion of mental, emotional and spiritual health • Provision of essential drugs and commodities.
It cannot be emphasised enough that these primary health care principles can only be possible through long-term sustainable and combined financing of both health systems, and disease specific interventions. The phantom debate over ‘health systems versus disease specific interventions’ is a false one and a diversion equivalent to asking if food is more important than water to human life. It should be reasonably obvious that health systems without medicines and commodities are as useless as medicines and commodities without health systems. This applies to all health issues, whether malaria, TB or HIV/Aids.
Sustainable and long-term health financing must therefore mean identifying the specific challenges and obstacles to primary health care, and on the basis of costed plans work out clear and timely frameworks for resolving these obstacles. In addition to disease specific and wider health system challenges, this includes focusing on the resolution of key obstacles such as the lack of policies and financing sustainable plans for reproductive and sexual health, and resolving Africa’s critical health workforce shortage.
*Sankore is Coordinator of the Africa Public Health Alliance & 15% Now Campaign, which engages African governments, global and African and institutions on implementation of the AU Africa Health Strategy, Health MDGs and fulfilling the AU Abuja pledge to allocate 15% of domestic national resources to health. He is also on the editorial advisory board of Pambazuka.
The campaign can be contacted at contactus[at]africapublichealth[dot]org, and contactus[at]africa15percentcampaign[dot]org . Reactions and comments on the write up should also be copied to editor[at]pambazuka[dot]org
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