PHA-Exch> PHC in review

[Claudio Schuftan]

 Bulletin of the World Health Organization
*| *January 2008, 86 (1)*

3

Three decades of primary health care: reviewing the past and defining the
future
*

Suwit Wibulpolprasert,
a Viroj Tangcharoensathienb & Churnrurtai Kanchanachitrac

The year 2008 marks the 60th anniversary of the World Health Organization
and the 30th anniversary of the Alma-Ata Declaration advocating primary
health care as the main strategy for achieving health for all by the year
2000. At the turn of the century, it was clear that the health for all
target was not fully achieved. Despite a 34% reduction in global infant
death rates between 1975 to 1995, huge improvements in immunization coverage
for children less than one year old (from 20% to 80%) between 1980 and 1990,
and improvement in population access to safe water and sanitation, health
for all fell short of resolving health inequities.
1 New medicines and vaccines were developed, but prices were out of reach of
poor countries and delivery systems were often inadequate. The HIV epidemic
in the 1990s reversed 30 years of gains in life expectancy, particularly in
sub-Saharan Africa. Global health inequities persist ¨C infant mortality and
skilled birth attendances vary with income quintiles. Catastrophic
health-related expenditure and subsequent impoverishment show the failure of
health financing policies to build safety nets for poor populations. There
are many other examples of unacceptable and avoidable disparities, among and
between countries, which will need to be overcome. 2 Failing to achieve
health for all is equated by some with the failure of primary health care
itself. 3 The concept itself, its remaining potential, and its vital roles 4
are all undermined by this simplistic equation. The principle of community
participation and the use of appropriate technology have proved to be
effective strategies in combating some diseases. For example, the
eradication of guinea worm in African countries was accomplished without new
drugs or vaccines, but through grassroots public health interventions on the
modest budget of about US$ 225 million for a 20-year campaign. 5

Constraints in health systems, especially in resource poor settings, often
prevent lasting improvements in the health of the population. These
constraints range from physical and financial barriers to services, to a
persistent lack of appropriately skilled and motivated health workers
resulting in poor quality of care, to weak planning and management, and
deficits in inter-sectoral actions and partnerships.
6

To revitalize the functioning of primary health care in the context of
globalization, there is a need to review past experiences and redefine
future roles to meet the complexity of today's health challenges. To
contribute to this effort, the annual Prince Mahidol Award Conference
(available at: http://www.pmaconference.org) will discuss the theme of
"Three Decades of Primary Health Care: Reviewing the Past and Defining the
Future". The conference will be held from 30 January to 1 February 2008 in
Bangkok, Thailand.

The conference serves as a neutral and participatory global forum to discuss
significant global health issues and is co-hosted by WHO, the World Bank and
the Royal Thai Government. Interested partners can use this annual forum to
debate specific global health agenda items, provided that they are open to
different views and critiques. The organizing committee felt that it was
essential to hold an annual conference in order to anticipate and respond to
both rapidly emerging topics and the constant change in the global health
agenda.

This conference is the third in a series of primary health care conferences
(Buenos Aires in August 2007, Beijing in November 2007, Bangkok in January
2008, and others planned in Africa and Kazakhstan) to commemorate the 30th
anniversary of the Alma-Ata Declaration.

The conference invites the international community; public health leaders,
civil society, governments, private sector and academia, to contribute to
the global debate on primary health care and discuss lessons learnt. We will
measure its success by the degree of active participation and deliberations,
frank assessment and evidence-based recommendations that it generates. This
conference is expected to produce tangible recommendations on how primary
health care should address current and emerging challenges in public health.
¡ö
*

PHM WILL BE PRESENT IN THIS CONFERENCE THROUGH ITS GLOBAL COORDINATOR, DR
HANI SERAG.
*
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