By Caroline Sell, Staff Member

This October 2018, world leaders and stakeholders gathered to reaffirm the principles of the Declaration of Alma-Ata through the Astana Declaration on Primary Health Care.[1] Led by a partnership between the World Health Organization (WHO), under the direction of Director-General Dr. Tedros Adhanom Ghebreyesus, and the United Nations Children’s Fund (UNICEF), under the direction of Executive Director Henrietta H. Fore, the world not only saw a reconfirmation of these values but a public call for serious dedication to investing and building up primary health care systems across the world.[2]

The Declaration of Alma-Ata was significant because at the time, it was the largest conference dedicated to such a specific topic within global health, with a total participation of 134 countries and countless NGOs.[3] Primary Health Care (PHC) was defined as “essential health care based on practical, scientifically sound and socially acceptable methods . . . made universally accessible to individuals and families in the community . . . and at a cost that the community and country can afford to maintain at every stage of their development . . .” [4] The Declaration of Alma-Ata was also seen as monumental for its emphasis on the importance of PHC as integral to the “overall social and economic development of the community.” [5]

However, despite setting forth these clear values shared by the international community, critics have continuously noted the gap in concrete guidelines for implementation of these policies.[6] These concerns were well-founded, as 40 years after the Declaration of Alma-Ata, half of the world’s population still lives without access to essential health services.[7] As Dr. Tedros put it, “Today, instead of health for all, we have health for some.”[8] While there has been significant progress in areas such as child mortality [9] and globally increased life expectancy, there are still too many deaths from preventable diseases.[10]

Enter the Astana Declaration on Primary Health Care. The global health community has since recognized these implementation challenges and the changed nature of population distribution, the sophistication of health technologies, and overall globalization in today’s modern world.[11] Thus, the Astana Declaration comes at a critical time when States are considering different methods of achieving the Sustainable Development Goals (SDGs).[12] The Astana Declaration points out that Universal Health Coverage (UHC) is explicitly stated in the SDGs[13], and PHC is a necessary foundation for these efforts.[14]

Yet the issue remains: in order to avoid the same fate of the Declaration of Alma-Ata, the Astana Declaration needs to address the implementation gap. It does this by not only calling on governments and international organizations to take the appropriate initiatives in developing health policies,[15] but also explicitly includes all stakeholders from health professionals to patients to the private sector within that call to arms.[16] The Astana Declaration promotes a community-focused approach to PHC that includes capacity building and empowering communities to take an active role in health promotion for the protection of human rights[17] While this idea was referenced and likely intended in the Declaration of Alma-Ata, it was soon lost due to the shift towards “selective primary health care.”[18] It is the hope that the spirit of the Astana Declaration can overcome the temptation of the facially economic advantages of reverting back to the system of selective primary health care, as it has become clear over the past 40 years that community-based approaches not only work, but are key to ensuring sustainability of health systems and ultimately achieving Health for All.[19]

[1] The Alma-Ata 40 Roundtable, Implementing The Astana Declaration—What Alma-Ata Taught Us, Health Affairs Blog (Oct. 25, 2018), https://www.healthaffairs.org/do/10.1377/hblog20181024.24072/full/.

[2] World Health Organization (WHO) & United Nations Children’s Fund (UNICEF), A Vision For Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals, at iii, WHO/HIS/SDS/2018.X (2018).

[3] Bhutta et al., Alma Ata and Primary Healthcare: Back to the Future, The BMJ, Oct. 22, 2018, at 1.

[4] World Health Organization, Primary Health Care, Report of the International Conference on Primary Health Care Alma-Ata, art. 6 (Sept. 1978) http://www.who.int/publications/almaata_declaration_en.pdf.

[5] Id. See also Bhutta supra note 3.

[6] Susan B. Rifkin, Health for All and Primary Health Care, 1978–2018: A Historical Perspective on Policies and Programs over 40 Years, Oxford Research Encyclopedia of Global Public Health, Oct. 2018, at 6. See also Bhutta supra note 3.

[7] Press Release, World Health Organization, New Global Commitment to Primary Health Care For All at Astana Conference (Oct. 25, 2018).

[8] Id.

[9] Child mortality is measured as death before a child has reached 5 years old. Alma-Ata Roundtable supra note 1.

[10] Id.

[11] WHO and UNICEF supra note 2 at iii, 4.

[12] Id. at 4.

[13] World Health Organization, SDG 3: Ensure Healthy Lives and Promote Wellbeing For All At All Ages, https://www.who.int/sdg/targets/en/.

[14] World Health Organization & United Nations Children’s Fund, Astana Declaration on Primary Health Care: From Alma-Ata Towards Universal Health Coverage and the Sustainable Development Goals, art 2. (Oct. 2018) https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf. See also World Health Organization supra note 7.

[15] Alma-Ata Roundtable supra note 1.

[16] World Health Organization & United Nations Children’s Fund, Astana Declaration on Primary Health Care: From Alma-Ata Towards Universal Health Coverage and the Sustainable Development Goals, art 7. (Oct. 2018) https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf.

[17] Id. at art. 5, art. 7.

[18] “Selective primary health care” focused on addressing diseases with the highest rates of morbidity and mortality as a way of controlling the cost and effectiveness of a health intervention, instead of a more comprehensive approach. Rifkin supra note 6 at 7.

[19] World Health Organization supra note 2 at 9.