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Commemorative Conference Examines Primary Health Care Three Decades After Alma-Ata

Primary Health Care (PHC) was centre stage at a prestigious conference addressed by five LIDC members last week, three decades after the concept was championed at

Alma-Ata. Their wide-ranging presentations at the two-day symposium held by the London School of Hygiene and Tropical Medicine (LSHTM) compared the context of 1978 with today, and explored the continuing challenges of promoting a PHC-focused health system. The Future of Primary Health Care: Alma-Ata 30 Years On took place at the Brunei Gallery at the School of Oriental and African Studies (SOAS) in London and the discussions demonstrated that the pendulum regarding global health concerns has begun to swing away from controlling diseases and back to supporting health systems, in line with the original aims of PHC.

Contributions from LIDC members

LIDC members Professor Sir Andy Haines, Director of LSHTM, Emeritus Professor Gill Walt, Professor Lucy Gilson, Professor Allen Foster and Professor Anne Mills (all from LSHTM) spoke at the conference supported by The Lancet, the UK’s Department for International Development (DFID) and the Royal Society of Tropical Medicine and Hygiene (RSTMH).

Walt spoke about the Alma-Ata declaration, a landmark event which identified PHC as the key to the attainment of the goal of Health For All (HFA) by the year 2000, when she delivered her conference overview. She said: “The context of 2008 is very different from that of 1978. Whereas the call for PHC thirty years ago was inspirational, and occurred within a context of strong leadership in the public health field, the move towards strengthening health systems today is now largely technical, and leadership more diffuse. By exploring and understanding the changing context of health policy over three decades, we can identify what needs to be done to strengthen the movement towards health systems today and in the future.”

Haines chaired sessions reflecting on the past and summing up the first day’s deliberations. Gilson gave a presentation entitled Social Determinants of Health and Health Equity Since Alma-Ata, which reviewed the experience of the last thirty years and identified key features of PHC-oriented systems important to promoting health equity. This provided part of the backdrop to subsequent discussions. Foster took part in a panel discussion on reconciling disease specific objectives with PHC approaches. On the second day Mills delivered a presentation called Strengthening Health Systems: the Policy and Research Challenge, which highlighted the need for improving the evidence base. The following discussion considered why health systems research was neglected, and how capacity to produce and use health systems research might be increased.

Global expertise

Carissa Etienne, Assistant Director General of the World Health Organization (WHO) and Julio Frenk, an adviser to the Bill and Melinda Gates Foundation and the former Minister of Health in Mexico also spoke at the event.  Experts from around the world (including Ghana, India, Pakistan, Uganda and Thailand) marshalled  evidence at the conference from 11-12 September to address both the promise and the pitfalls of PHC from a range of perspectives, and discussed the continuing relevance of such concepts to improving world health.

Highs and Lows: Primary Health Care since Alma-Ata

The Alma-Ata declaration was signed at the International Conference on PHC in what is now Kazakhstan in 1978. Virtually all the member nations of the WHO and UNICEF attended the event.  Primary health care, as supported by the Alma-Ata Declaration, was a rallying call for better health through improved access to health care, and the involvement of people in the delivery of health care. But PHC fell out of favour over the next two decades, as global attention was diverted towards tackling diseases, improving efficiency and reforming health financing. Thirty years on, the pendulum has begun to swing, away from controlling diseases and back to supporting health systems, in line with the original aims of PHC.

This article is based on a press release, entitled 30 Years on From Alma-Ata and the Pendulum is Swinging Back to Primary Health Care, from the London School of Hygiene and Tropical Medicine (LSHTM). Click here for the conference programme. To interview Professor Gill Walt please contact Gemma Howe in the LSHTM Press Office on 020 7927 2802/2073.