Primary Healthcare. Can The Dream Be Revived?

Author Fran Baum, in this article writes about the need to revisit the vision and goal of the Alma Mata declaration. Here is my review of the article and analysis.

The article titled “Primary healthcare. Can the dream be revived?” appears in the opinion and commentary section of the journal Development in Practice, Volume 13, Number 5, 2003. The author supports the International People’s Health Council and People’s Health Movement and calls for the World Health Organization to revisit the Alma Ata declaration and push for comprehensive Primary Healthcare.

Summary of article

In this article, Baum outlines the critical elements of the Alma Ata declaration and its Health for All vision and argues that the World Health Organization (WHO) lost this vision captured in this document. This vision he states is comprehensive primary healthcare (CPHC) but sadly selective primary healthcare (SPHC) has been implemented. He points out that global economic activities and privatization of essential services that support primary healthcare have been key factors contributing to decline in access and equity in primary healthcare. Another factor he identifies is introduction of user-pay policies in health services. The World Bank, he argues, has been a major driver of these economic reforms and has resulted in decline in access and equity in primary healthcare. Finally, Baum supports the International People’s Health Council and People’s Health Movement call to WHO to revisit the Alma Ata declaration and sees these two organizations as key advocates for CPHC in the world.

Critical analysis

Baum argues that the Alma Ata declaration and the vision of Health for all (HfA) strategy captured in the Alma Ata declaration has been ignored by the World Health Organisation (WHO). The HfA strategy is to use a comprehensive primary healthcare (CPHC) approach to target health needs at the community level with community participation. Instead WHO has allowed selective primary healthcare (SPHC) approaches to be implemented around the world. SPHC approaches target specific diseases and aim to remove specific diseases. This approach is the opposite of CPHC as captured in the Alma Ata declaration document. One of the main reasons identified by Baum to be contributing to the adoption and implementation of SPHC approaches is economic globalization. Using global health strategies SPHC approaches have been used in many countries at the national level but have not involved the community and allowed community participation.

Another effect of economic globalization has been the privatization of other essential services that support CPHC, namely, transport, electricity, water and education. Privatisation of these services has made it more difficult to implement CPHC approaches in the poorer communities of the world because private entities want to make a profit and focus on providing essential services to paying customers, who in most cases are the rich segments of the population. Furthermore, implementation of user-pay policies in health services do not support the HfA vision because this strategy looks at cost effectiveness only and ignores equity and access to health services by the poor. Baum claims that the WHO is to be partly blamed because most of these changes have been the result of macroeconomic policies that do not support CPHC approaches, have been developed by the World Bank and forced upon poor countries to be implemented. As a result the uptake of SPHC has been increasing steadily worldwide since the Alma Ata declaration and the vision of HfA using a CPHC approach has been lost.

The increasing use of SPHC approaches also has resulted in more research to be done looking at SPHC interventions. Unfortunately research into CPHC approaches is complex and has been ignored. It seems that WHO no longer represents the voice and needs of the people, especially of the poor segments of the population therefore other non-government organizations have risen up to be advocates for a CPHC approach and continue to push for the HfA vision in the Alma Ata declaration.


About rodney itaki

Medical doctor and public health specialist from Papua New Guinea.
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