PHM-Exch> Fw: seminar at Kolkata commemorating 30th years of Alma Ata Declaration ; dedicated to works of Dr. Binayak Sen

Wed May 13 01:21:58 PDT 2009

To

Co-ordinator

,Peoples Health Movement          Dear Friend,                                                                                                                            We are organising a seminar," Whither Primary Health Care" commemorating 30 years of Alma Ata Declaration at Student's Hall ,Kolkata on 30.05.09.  We are dedicating this seminar to the works of  Dr. Binayak Sen whose uncompromisng     
committment for the cause of the down-trodden has become an ideal.
           . We heartily welcome all to join the seminar .
             The approach paper for the seminar is sent alongwith.
              Thanking you,
                                                                                                        Yours faithfully,
                                                                                                 Dr. Debashis Dutt  
                                                                                                                President,
                                                                                                             People's Health 

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Approach paper for seminar at Kolkata commemorating 30th years of Alma Ata Declaration 
WHITHER PRIMARY HEALTH CARE

(Approach paper of a seminar on “Primary Health Care” which will be organized by medicos of different medical colleges, “People’s Health” and other like minded health organizations on 30th May, 2009 at Student’s Hall, Kolkata. A series of seminars will be organized in different cities of West Bengal and India in the Year 2009 commemorating 30 years of Alma Ata Declaration)

Failure of medicine : Only 10 to 20% of the population of developing countries have been enjoying ready access to health services of any kind.. With the increased medical cost, increased benefits in terms of health has not been materialized. Despite spectacular advances in medicine, the threat posed by certain emerging and re-emerging fatal diseases has not lessened, rather has actually increased. The expectation of life has remained low and infant and child mortality rates have been high in many developing countries. Historical epidemiological studies showed that significant improvements in longevity had been achieved through improved food supplies and sanitation long before the advent of modern drugs and high technology. There is no equity in the distribution of health services, resulting in limited access to health care for large segments of population. Modern medicine shows elitist orientation even in health systems adapted to overcome social
 disparities.1

Health for All : Ongoing struggles of the people has made popular new ideas and concepts (e.g. increasing importance attached to social justice and equity, recognition of the crucial role of community participation, changing ideas about nature of health and development, the importance of political will) which called for new approaches to make medicine in the service of humanity more effective.2
The 30th World Health Assembly resolved in May 1977, that the “main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life.” This culminated in the international objective of Health for All by the year 2000 as the social goal of all governments. Viewed in the long-term context, it simply means the realization of the WHO’s objective of “attainment by all people of the highest possible level of health”2
In a Joint WHO–UNICEF international conference in 1978 at Alma Ata (USSR), the government of 134 countries and many voluntary agencies called for a revolutionary approach to health care and declared that “The existing gross inequality in the health status of people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable,”2

Primary Health Care is a new approach to health care system, which integrates at the community level all the factors required for improving the health status of the population. It consists of at least eight elements described as “Essential Health Care”. (1) Education about prevailing health problems and methods of preventing and controlling them; (2) Promotion of food supply and proper nutrition; (3) An adequate supply of safe water and basic sanitation; (4) Maternal and child health care, including family planning; (5) Immunization against infectious diseases; (6) Prevention and control of endemic diseases; (7) Appropriate treatment of common diseases and injuries and (8) Provision of essential drugs.2

The Alma Ata Declaration had called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of national health system. 2
Against this background, under ‘Global Strategy for Health for All’ by the 34th World Health-Assembly, in 1981, the members of WHO including India pledged themselves to an ambitious target to provide “Health for All by the year 2000”, that is attainment of a level of health that will provide all people “to lead a socially and economically productive life.”3
But the governments failed to materialize this call and settled on a compromising measure.

The Millennium Development Goals : In September 2000, representatives from 
189 countries met at the Millennium Summit in New York ( USA ) to adopt the United Nations Millennium Declaration. The leaders made specific commitments in seven areas : 
(1) Peace, security and disarmament; (2) Development and poverty eradication; (3) Protecting our common environment; (4) Human rights, democracy and good governance; (5) Protecting the vulnerable; (6) Meeting the special needs of Africa and (7) Strengthening the United Nations. The Road Map established goals and targets to be reached by the year 2015 in each seven areas. The MDG place health at the heart of development and represent commitments by governments throughout the world to do more to reduce poverty and hunger, to tackle 
ill-health, gender inequality, lack of education, to give access to clean water and to prevent environmental degradation4.

Three decades of Primary Health Care : Despite enormous progress in health globally, our collective failure to deliver in line with these values are painfully obvious and deserve our greatest attention. … significant regional, inter- and intra- country variations, social and health inequalities …5
One third of the world population still do not have access to essential maternal and child health services, safe water supply and food security. A girl born today in developed world is expected to live 80 years and if born in some developing countries, will live less than 
45 years. More than 50% deliveries in India are outside institutions, and 30% deliveries are not conducted by any skilled person. Only 44% infants in India receive full primary immunizations. For 5.6 billion* people in this world over half of all health care expenditures are through out-of-pocket payments, which are pushing more than 100 million people into poverty annually.5.6
The current trends are that of (a) The Government’s role becoming more and more marginalized, (b) increasing dependence on external funding, (c) Accelerated role of donor agencies that are taking centre-stage in influencing policies, (d) Corporatization of health system, (e) Rising role of private medical insurance companies and (f) Unregulated commercialization of health care delivery system. Reflections of these negative trends are obvious in most countries including India , resulting in disproportionately high focus on city and hospital based specialist services, fragmented approach to service delivery through selective disease control programmes from the extra-budgetary fund and instructions of foreign agencies and increasing privatization and commercialization of health system. Medical equipment and pharmaceutical industries are a dominant driving force behind the trend. They are promoting and facilitating the specialist or super-specialist
 centred services by aggressive marketing and business promotion strategies and by influencing the economic, industrial and health policies of the countries. Economic liberalization (globalization) has opened up avenues for massive private investments in health.5.6
The health systems, throughout the world, evidently, have deviated too much from the principles of primary health care. Economic and health disparities have actually aggravated in last three decades. Only a strong political commitment may reverse the situation and make primary health care the foundation of the health system around which the secondary and tertiary services should evolve. In India , National Rural Health Mission (2005-12) has intended to address some of the issues of equity and accessibility in the vulnerable section. But this too suffers from the problem of fragmented approach, supra structural excercises, policies not suited to field situation, reluctance from the parts of service providers, unsteady supply of fund and logistics, bureaucracy, high-handedness, time lag, corruption, nepotism etc. and mostly do not address the social determinants and felt needs.

Commemorating 30 years of Alma Ata : Participants from 65 countries throughout the globe came together in Almaty, Kazakhstan, on 15 & 16th October, 2008 and exchanged the lessons and experiences of the last three decades after Alma Ata and discussed their relevance and application to the health challenges of today’s world.7
They reiterated that countries have to fully adopt Primary Health Care (PHC) as the foundation of their health systems. They strongly endorsed the values and principles contained in the Declaration of Alma Ata on PHC.. They declared timeliness, equity, solidarity, the right to the highest attainable level of health and universal access to services are the key to health for all. The challenge is to apply them to the policies and processes required to strengthening national health systems.7
The conference took place at the time of grave crisis in the international financial system. A number of countries were taking action to revise their budgets for the coming years. Participants called upon governments and international financial institutions not to repeat past mistakes when restructuring had resulted in often-large reductions in allocations to the health and other fundamental social sectors. Ensuring strong health and social protection, especially for vulnerable populations, is a lesson of history. The conference unanimously called upon governments to protect health budgets and to seize opportunity of crisis to accelerate change towards strengthening their health systems based on the values and principles of PHC.7
Integrated models of PHC which include preventive, promotive and primary care are the best models to deliver holistic and people-centred services and should be adapted to the specific needs and resources of individual countries. In this regard, the increasing need to focus on chronic diseases is now a global challenge, not just a problem of rich countries. This comes on top of an unfinished agenda related to communicable diseases, and maternal, new born and child health.7

Crisis of global financial system and health : It is not clear what the current financial crisis will mean for low-income and emerging economies, but many predictions are highly pessimistic. In the face of a global recession, fiscal pressures in affluent countries may prompt cuts to official development assistance. Worse still, is the prospect of cuts in social spending–health, education and other social sectors–that many countries, especially 
low-income countries, may be forced to undertake. Both of these responses have occurred in the past. Both could be as equally devastating for health, development, security and prosperity as they were in the past.8
It is essential therefore to learn from past mistakes and counter this period of economic downturn by increasing investment in health and social sector. There are several strong reasons supporting this line of action; (1) To protect the poor (2) To promote economic recovery; (3) To promote social stability; (4) To generate efficiency and (5) To build security.
Dr. Margaret Chan, Director General, WHO, appeals “I’m calling on all governments and political leaders to maintain their efforts to strengthen and improve the performance of their health systems, to protect the health of the people of the world, and in particular of those most fragile, in face of the present financial and economic crisis.”8

Intention of seminar : In the approach paper, we have quoted the national and international institutions concerned with health regarding their thoughtful guidelines in making the health scenario acceptable to the down trodden people. But, in the past, they have miserably failed to keep up to these guidelines, especially in India . Thus, rises a need for a people’s conference dedicated to the 30th anniversary of the Alma Ata Declaration on Primary Health Care to keep vigilence on the performance of these institutions. People’s Health intends to accommodate various opinions so as to formulate the demands of the Indian people with emphasis on universal and equitable access to Primary Health Care which will lay the foundation of people’s health movement. It strives to act jointly with like minded organizations and intelligentsia to hold government to account by engaging in policy development, monitoring health spending and service delivery and exposing
 corruption.

1.         Park’s Text Book of Preventive & Social Medicine (17th Edition)
2.         WHO (1978), Health for All, Sr. No. 1
3.         WHO-UNICEF (1978), Health for all, Sr. No. 1
4.         Park’s Text Book of Preventive & Social Medicine (18th Edition)
5.         Bulletin of WHO. Vol 86, No. 11, Nov. 08
6.         The World Health Report : Primary Health Care Now Than Ever, WHO. 2008
7.         Resolutions of International Conference Dedicated to the 30th anniversary of the Alma Ata Declaration on Primary Health Care, Almaty, 15&16 October 08
8.         Impact of the global financial and economic crisis on health–Statement by WHO Director-General 
Dr. Margaret Chan, 2008
·          One million = 10,00,000 and one billion = 100,00,00,000

[People’s Health is a West Bengal based organization of doctors, medicos, nurses, other health workers and activists. Its mission is to propagate Health as a Right and to consolidate people’s movement to achieve this Right.]

Published by Dr. Debashis Dutt and Dr. Joydeb Pathak on behalf of the Executive Committee of “People’s Health” 
from 8, Raja Gurudas Street , Kolkata – 700006, Phone 9830115681 and 9830139750; E-mail : drdebashisdutt at yahoo.com.

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