versão On-line ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.98 no.9 Cape Town Set. 2008
National Department of Health (in personal capacity)
September 12 1978 was a historic day for international health. It was the day on which, 30 years ago, the Alma-Ata Declaration on Primary Health Care was adopted. The politics of hosting the conference as well as the choice of the venue are recounted by David Tejada de Rivero, who was the Deputy Director-General of the World Health Organization and one of the key organisers of the conference.1 The conference was proposed by the Soviet Vice Minister for Health, Dimitri Venediktov, to the WHO Executive Board meeting in January 1996 with an offer to provide $2 million to support the hosting of the conference. After much planning and with the involvement of UNICEF the conference took place between 6 and 12 September 1978 with representatives from 134 countries, 67 international organisations and numerous non-governmental organisations.
The Declaration proposed the primary health care approach as the strategy to strengthen health systems, but was more than this, as argued by the current Director-General of the WHO, Margaret Chan. She argued that it was the 'heart of the Health for All Movement' and that the Health for All Movement and the Alma-Ata Declaration (i) called for equity and social justice; (ii) sought to emphasise the importance of prevention; (iii) recognised the social determinants of health; and (iv) recognised that health expenditure was an investment and not merely consumption - that it contributed to the growth of the economy and productivity.2
Anniversaries of the adoption of the Alma-Ata Declaration have been occasions for reflections and debates about the successes, failures and potential utility of the primary health care concept. At its 10th anniversary the WHO convened a meeting in Riga to assess the contributions of primary health care to Health for All 2000, about the midpoint between the adoption of the Declaration and the turn of the century. The 30th anniversary of Alma-Ata is similar - we are at the midpoint between 2000 when the Millennium Declaration was signed and 2015 when the Millennium Development Goals should be reached!
To assess primary health care development in South Africa the Department of Health convened a 2-day conference in April at which stakeholders, both government and nongovernment, discussed the current status and remaining challenges. The Birchwood Declaration3 proposed a way forward that reaffirmed the utility of the primary health care approach in the 21st century and noted eleven elements of a revisioned and revitalised primary health strategy for South Africa. These included the need to double the budget for primary health care activity in the next 10 years, to strengthen intersectoral collaboration and to reorient health professionals towards the primary health care approach. The WHO Regional Office for Africa (AFRO) hosted an international conference on primary health care and health systems in Africa in April 2008 in Burkina Faso to assess the relevance of primary health care for the 21st century and to recommit to health for all. The conference adopted the Ouagadougou Declaration which reaffirmed the principles adopted at Alma-Ata and recommitted to the strengthening of national health systems using the primary health care approach.4
Initiatives in countries such as Brazil and Thailand have improved health outcomes by investing in primary health care and others have demonstrated the importance of community participation to strengthen health systems and health outcomes. Evaluating the progress made in South Africa in implementing primary health care has also been stressed.
In South Africa and internationally there is much work that remains to be done to improve equity, strengthen intersectoral collaboration and involve communities in decisions about their health. This 30th anniversary of the adoption of the Alma-Ata Declaration should be used to reflect on our experiences and, as importantly, to commit ourselves to implementing the principles of Alma-Ata in the various roles that we play in the health sector.
1. Tejada de Rivero DA. Alma Ata revisited. Perspectives in Health Magazine 2003; 8 (2): 3. 7 www.paho.org/English/dd/pin/Number17_article1_4.htm (accessed 25 July 2008). [ Links ]
2. Chan M. 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 25 July 2008). [ Links ]
3. Department of Health. The Birchwood National Consultative Health Forum Declaration on Primary Health Care, April, 2008. http://www.doh.gov.za/docs/sp/2008/sp0411a.html (accessed 25 July 2008). [ Links ]
4. WHO/AFRO. 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 25 July 2008). [ Links ]