No subject

public health authorities in Baghdad, I listen to the blow by blow =
account of the impact of wars and sanctions on ordinary people. Half a =
million children have died due to war and sanctions related reasons in =
the first ten years. Depleted Uranium that was used extensively during =
the indiscriminate bombing by US and British forces is taking a heavy =
toll on children and others. Sanctions and the war didn't spare even =
those who weren't born then !

In 1997, UNICEF estimated that 32 percent of children under five, some =
960,000 children, were chronically malnourished-a rise of 72 percent =
since the imposition of sanctions in 1991. Of them 23 per cent were =
underweight - twice as high as the levels found in neighbouring Jordan =
or Turkey. The situation has further deteriorated since then.=20

Every month, over 6,000 children die due to sanctions (and war) related =
reasons. In the next 30 days another 6,000 children may die due to =
similar reasons. This is mass funeral in slow motion. A war will amplify =
/ accelerate the speed.=20

In your guest lecture I observe that you stop quoting Alma Ata when it =
reaches principle no : VI-7 and moves on to the report of the Director =
General.=20

Looking at the plight of ordinary people (especially children and women) =
in Iraq and their health that was devastated by the war and sanctions, I =
would like you to consider raising an equally important issue that Alma =
Ata deals with : i.e.; on peace and conflicts.

I quote below the relevant section from Alma Ata.

X=20
An acceptable level of health for all the people of the world by the =
year 2000 can be attained through a fuller and better use of the world's =
resources, a considerable part of which is now spent on armaments and =
military conflicts. A genuine policy of independence, peace, d=E9tente =
and disarmament could and should release additional resources that could =
well be devoted to peaceful aims and in particular to the acceleration =
of social and economic development of which primary health care, as an =
essential part, should be allotted its proper share.=20

Also please find below the relevant sections from the People's Charter =
for Health:
War, violence, conflict and natural disasters
War, violence, conflict and natural disasters devastate communities and =
destroy human dignity. They have a severe impact on the physical and =
mental health of their members, especially women and children. Increased =
arms procurement and an aggressive and corrupt international arms trade =
undermine social, political and economic stability and the allocation of =
resources to the social sector.

This Charter calls on people of the world to:=20

  a.. Support campaigns and movements for peace and disarmament.=20
  b.. Support campaigns against aggression, and the research, =
production, testing and use of weapons of mass destruction and other =
arms, including all types of landmines.=20
  c.. Support people's initiatives to achieve a just and lasting peace, =
especially in countries with experiences of civil war and genocide.=20
  d.. Condemn the use of child soldiers, and the abuse and rape, torture =
and killing of women and children.=20
  e.. Demand the end of occupation as one of the most destructive tools =
to human dignity.=20
  f.. Oppose the militarisation of humanitarian relief interventions.=20
  g.. Demand the radical transformation of the UN Security Council so =
that it functions democratically.=20
  h.. Demand that the United Nations and individual states end all kinds =
of sanctions used as an instrument of aggression which can damage the =
health of civilian populations.=20
  i.. Encourage independent, people-based initiatives to declare =
neighbourhoods, communities and cities areas of peace and zones free of =
weapons.=20
  j.. Support actions and campaigns for the prevention and reduction of =
aggressive and violent behaviour, especially in men, and the fostering =
of peaceful coexistence.=20
  k.. Support actions and campaigns for the prevention of natural =
disasters and the reduction of subsequent human suffering.=20
There may be many opinions when Iraq is discussed. But teh situation =
reminds me of an old saying from the region: "When two big elephants =
fight, it is the grass that suffers". This is what people are going =
through.

Regards and in solidarity

Unni

Dr. Unnikrishnan PV; E-mail: unnikru at yahoo.com
=20
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++=
++++++++++++++++++++

In the next 24 hours, 30,000 children will die from preventable diseases =
on planet earth.=20
These deaths can be stopped.=20
Join www.TheMillionSignatureCampaign.org, a march demanding Health for =
All NOW !!

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

----- Original Message -----=20
From: aviva <aviva at netnam.vn>
To: <pha-exchange at kabissa.org>
Sent: Thursday, February 13, 2003 11:42 AM
Subject: PHA-Exchange> PHC: a reminder of its principles


> From: "DBanerjee" <nhpp at bol.net.in>
> PRIMARY HEALTH CARE: AN OVERVIEW
> DEBABAR BANERJI
> Guest Lecture for National Seminar on Health For All in the New
> Millenium, NIHFW, February 24-26, 2003.
> (Professor Emeritus, Centre of Social Medicine and Community Health,
> Jawaharlal Nehru University)
>=20
> A WATERSHED IN PUBLIC HEALTH
>=20
>=20
> The concept of Primary Health Care (PHC), which was approved by the
> World
> Health Assembly in 1977 and endorsed at the International Conference =
on
> Primary Health Care at Alma Ata in 1978, marks a watershed in the
> discipline
> of public health. It had virtually turned the discipline up side down,
> as it
> were; technology, administrative practices were subordinated to the
> needs of
> the people.  Halfdan Mahler, the then Director-General of WHO, had
> rightly
> labelled it as a revolution. He had also acknowledged that the work
> done in
> India had substantially contributed to the development of the concept
> of
> PHC.
>=20
> The concept of Primary Health Care has to be distinguished from the
> concept
> of a  Primary Health Centre in India. Failure to do so has very often
> led to
> trivialisation of the concept of Primary Health Care. The ideas behind
> setting up Primary Health Centres can be considered as a component of
> the
> concept of Primary Health Care.
>=20
> Reference to the term, primary health care, is made in the
> Director-General'
> s report to the 53rd meeting of the WHO Executive Board as early as in
> January 1975, proclaiming that `primary health care services at the
> community level is seen as the only way in which the health services
> can
> develop rapidly and effectively'. He had enunciated seven guiding
> principles
> for this purpose:
>=20
> 1. to shape PHC `around the life pattern of the population';
> 2. for involvement of the local population;
> 3. for `maximum reliance on the available community resources', while
> remaining within cost limitations;
> 4. for an `integrated approach to preventive, curative and promotive
> services for both community and for the individual';
> 5. for all interventions to be undertaken `at the most peripheral
> practicable level of the health services by the worker most simply
> trained
> for this activity';
> 6. for other echelons of services to be designed  in support of the
> needs of
> the peripheral level; and,
> 7. for PHC services to be `fully integrated with the services of the
> other
> sectors involved in community development'.
>=20
> By the time of the Alma Ata Conference on PHC had taken its now well
> known
> form, it was seen as the `key to attaining' the target of health for
> all by
> the year 2000 (HFA-2000/PHC). Only the outstanding elements of the
> Declaration are being presented below:
>=20
>  I The Conference strongly reaffirms that health is a fundamental =
human
> right and that the attainment of the highest level of human health is
> the
> most important social goal and whose realization requires action in
> many
> other social and economic sectors in addition to the health sector.
>=20
>  II The existing gross inequality in health status of the people
> particularly, between developed and developing countries and as well =
as
> within countries is politically, socially and economically =
unacceptable
> and
> is, therefore, of common concern to all countries.
>=20
>  III. Economic and social development is of basic importance to the
> fullest
> attainment of health for all and to the reduction of the gap between
> developing and developed countries. The promotion and protection of =
the
> health of the people is essential for sustained social and economic
> development and contributes to better quality of life and to world
> peace.
>=20
>  IV. The people have the right and duty to participate individually =
and
> collectively in the planning and implementation of their health care.
>=20
>  V. Governments have a responsibility for the health of their people
> which
> can only be fulfilled by the provision of adequate health and social
> measures. A main social target of governments, international
> organizations
> and the whole world community in the coming decades should be
> attainment by
> all the people of the world by the year 2000 of a level of health that
> will
> permit them to live a socially and economically productive life.
> Primary
> health care is the key to attaining this target as a part of
> development in
> the spirit of social justice.
>=20
>  VI. Primary health care is essential health care based on practical,
> scientifically sound and socially acceptable methods and technology
> universally made accessible to individuals and families in the
> community
> through their full participation and at a cost the community and the
> country
> can afford to maintain at every stage of their development in the
> spirit of
> self-reliance and self-determination. It forms an integral part of the
> country's health system, of which it is the central function and main
> focus,
> and of the overall social and economic development of the country. The
> first
> level of  individuals, family and the community with the national
> health
> system bringing health care as close as possible to where people live
> and
> work and constitute the first of the continuing health care process.
>=20
> Primary health care
>  1. reflects and evolves from the economic conditions and
> socio-cultural and
> political characteristics of the country and its communities and is
> based on
> application of the relevant results of social, biomedical and health
> services research and public health experience,
>  2.addressses the main health problems in the community, providing
> promotive, preventive, curative and rehabilitative services
> accordingly,
>  3. includes at least: education concerning prevailing health problems
> and
> methods of preventing and controlling them; promotion of food supply
> and
> nutrition; adequate supply of safe water and sanitation; maternal and
> child
> health care, including family planning; immunization against major
> infectious diseases; prevention and control of local endemic diseases
> and
> injuries; and provision of essential drugs,
>  4. Involves, in addition to the health sector, all related aspects of
> national and community development, in particular agriculture, animal
> husbandry, food, industry, education, housing, public works,
> communication
> and other sectors, and demands the coordinated efforts of all those
> sectors,
>  5. requires and promotes maximum community and individual
> self-reliance and
> participation in the planning, organization, operation and control of
> primary health care, making fullest use of local, national and other
> available resources, and to this end develops through appropriate
> education
> the ability of the community to participate,
>  6. should be sustained by integrated, functional and mutually
> supportive
> referral systems, leading to progressive improvement of comprehensive
> health
> care to all, giving priority to those most in need,
> 7. relies, at local and referral levels, on health workers, including
> physicians, nurses, midwives, auxiliaries, as needed, suitably trained
> socially and technically, to work as a health team and to respond to
> the
> expressed health needs of the community.
>=20
> The foregoing quotations from official WHO documents (unavoidably
> repetitive) show  how revolutionary have indeed been the ideas which
> culminated from the Alma Ata Declaration on Primary Health Care. These
> ideas
> are being put together below in a summary form:
>=20
>  1.Health is considered as a fundamental right. The state has the
> responsibility to enforce this right.
>=20
> 2. Instead of starting with various types of health technologies and
> considering people as almost passive recipients for them, the
> Declaration
> sought to reverse the relationship by considering people as the prime
> movers
> for shaping their health services. It sought to strengthen the =
capacity
> of
> the people to cope with their health problems which they have =
developed
> through ages.
>=20
> 3, It also visualised a wider approach to health by strengthening such
> intersectoral areas as ensuring adequate supply of potable water,
> environmental sanitation, nutritive food and housing.
>=20
> 4. It called for social control of the health services that are meant
> to
> strengthen people's coping capacity.
>=20
> 5. It considered health as an intergral whole, including promotive,
> preventive, curative and rehabilitative components. Any concept of
> `selective care' was considered antithetical to the concept of PHC.
>=20
> 6. Health services ought to cover the entire population, including the
> underserved and the unserved.
>=20
> 7. Those aspects of traditional systems of medicine, which are proven
> to be efficacious or which are the only one accessible to the people,
> ought
> to be used in providing PHC.
>=20
> 8. Choice of Western medical technology should conform to the =
cultural,
> social, economic and epidemiological conditions prevailing in
> countries.
>=20
> 9. Particular care is to be taken to use only essential drugs.
>=20
> It may be emphasised that PHC is a PROCESS; it provides a road map for
> developing heath service in different countries of the world. Health
> service development in India is taken up here as a case study.
>=20
>  [The case study is available by contacting the author directly].
>=20
> ---
> PHA-Exchange is hosted on Kabissa - Space for change in Africa
> To post, write to: PHA-Exchange at kabissa.org
> Website: http://www.lists.kabissa.org/mailman/listinfo/pha-exchange
>=20

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<HTML><HEAD>
<META content=3D"text/html; charset=3Diso-8859-1" =
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<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial size=3D2>
<DIV><FONT face=3DArial size=3D2>Dear Dr. Banerjee</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>Greetings from Baghdad, Iraq =
!</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>I trust you are fine. I read your =
informative paper=20
with great interest. Thanks for posting it. </FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>From numerous visits to =
the hospitals and=20
discussions with people and public health authorities in Baghdad, I =
listen to=20
the blow by blow account of the impact of wars and sanctions on =
ordinary=20
people. Half a million children have died due to war and =
sanctions=20
related reasons in the first ten years. Depleted Uranium that was =
used=20
extensively during the indiscriminate bombing by US and British forces =
is taking=20
a heavy toll on children and others. Sanctions and the war didn't =
spare=20
even those who weren't born then !</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>In 1997, UNICEF estimated that 32 =
percent of=20
children under five, some 960,000 children, were chronically =
malnourished—a rise=20
of 72 percent since the imposition of sanctions in 1991. Of them 23 per =
cent=20
were underweight - twice as high as the levels found in neighbouring =
Jordan or=20
Turkey. The situation has further deteriorated since then. </FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>Every month, over 6,000 children =
die due to=20
sanctions (and war) related reasons. In the next 30 days another 6,000 =
children=20
may die due to similar reasons. <FONT size=3D3><STRONG>This is =
mass=20
funeral in slow motion. A war will amplify / accelerate the speed.=20
</STRONG></FONT></FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>In your guest lecture =
</STRONG>I=20
observe that you stop quoting Alma Ata when it reaches =
principle no :=20
VI-7 and moves on to the report of the Director General. </FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial><STRONG>Looking at the plight of ordinary people =

(especially children and women) in Iraq and their health that was =
devastated by=20
the war and sanctions, <U>I would like you to consider raising an =
equally=20
important issue that Alma Ata deals with : i.e.; on peace=20
and conflicts.</U></STRONG></FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>I quote below the relevant =
section from=20
Alma Ata.</STRONG></FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>X <BR>An acceptable level of health for =
all the=20
people of the world by the year 2000 can be attained through a fuller =
and better=20
use of the world's resources, a considerable part of which is now spent =
on=20
armaments and military conflicts. A genuine policy of independence, =
peace,=20
d=E9tente and disarmament could and should release additional resources =
that could=20
well be devoted to peaceful aims and in particular to the acceleration =
of social=20
and economic development of which primary health care, as an essential =
part,=20
should be allotted its proper share. </FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>Also please find below the =
relevant=20
sections from the People's Charter for Health:</STRONG></FONT></DIV>
<P align=3Dleft style=3D"FONT-WEIGHT: normal; TEXT-ALIGN: justify"><FONT =

face=3DArial><FONT size=3D2><FONT color=3D#490a83><SPAN =
style=3D"FONT-WEIGHT: bold">War,=20
violence, conflict and natural disasters</SPAN></FONT><BR><FONT=20
color=3D#400040></FONT></FONT><FONT size=3D2><FONT face=3DArial><SPAN=20
style=3D"FONT-STYLE: italic; FONT-WEIGHT: bold">War, violence, conflict =
and=20
natural disasters devastate communities and destroy human dignity. They =
have a=20
severe impact on the physical and mental health of their members, =
especially=20
women and children. Increased arms procurement and an aggressive and =
corrupt=20
international arms trade undermine social, political and economic =
stability and=20
the allocation of resources to the social sector.<BR><BR></SPAN><SPAN=20
style=3D"FONT-STYLE: italic">This Charter calls on people of the world =
to:=20
</SPAN></FONT></FONT></FONT></P>
<UL style=3D"TEXT-ALIGN: left"><FONT color=3D#400040>
  <LI><FONT face=3DArial size=3D2>Support campaigns and movements for =
peace and=20
  disarmament. </FONT>
  <LI><FONT face=3DArial size=3D2>Support campaigns against aggression, =
and the=20
  research, production, testing and use of weapons of mass destruction =
and other=20
  arms, including all types of landmines. </FONT>
  <LI><FONT face=3DArial size=3D2>Support people's initiatives to =
achieve a just and=20
  lasting peace, especially in countries with experiences of civil war =
and=20
  genocide. </FONT>
  <LI><FONT face=3DArial size=3D2>Condemn the use of child soldiers, and =
the abuse=20
  and rape, torture and killing of women and children. </FONT>
  <LI><FONT face=3DArial size=3D2>Demand the end of occupation as one of =
the most=20
  destructive tools to human dignity. </FONT>
  <LI><FONT face=3DArial size=3D2>Oppose the militarisation of =
humanitarian relief=20
  interventions. </FONT>
  <LI><FONT face=3DArial size=3D2>Demand the radical transformation of =
the UN=20
  Security Council so that it functions democratically. </FONT>
  <LI><FONT face=3DArial size=3D2>Demand that the United Nations and =
individual=20
  states end all kinds of sanctions used as an instrument of aggression =
which=20
  can damage the health of civilian populations. </FONT>
  <LI><FONT face=3DArial size=3D2>Encourage independent, people-based =
initiatives to=20
  declare neighbourhoods, communities and cities areas of peace and =
zones free=20
  of weapons. </FONT>
  <LI><FONT face=3DArial size=3D2>Support actions and campaigns for the =
prevention=20
  and reduction of aggressive and violent behaviour, especially in men, =
and the=20
  fostering of peaceful coexistence. </FONT>
  <LI><FONT face=3DArial size=3D2>Support actions and campaigns for the =
prevention=20
  of natural disasters and the reduction of subsequent human suffering.=20
  </FONT></LI></UL>
<DIV><FONT color=3D#000000 face=3DArial size=3D2>There may be =
many opinions when=20
Iraq is discussed. But teh situation reminds me of an old saying =
from the=20
region: <EM>"When two big elephants fight, it is the grass that =
suffers".=20
</EM>This is what people are going through.</FONT></DIV>
<DIV> </DIV><FONT color=3D#000000>
<DIV><FONT face=3DArial size=3D2>Regards and in =
solidarity</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial size=3D2>Unni</FONT></DIV>
<DIV> </DIV>
<DIV><FONT size=3D2><FONT face=3DArial>Dr. Unnikrishnan PV; E-mail: <A=20
href=3D"mailto:unnikru at yahoo.com">unnikru at yahoo.com</A></FONT></FONT></DI=
V>
<DIV></FONT></FONT> </DIV>
<DIV><FONT face=3DArial=20
size=3D2>++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++=
+++++++++++++++++++++++++++++</FONT></DIV>
<DIV> </DIV>
<DIV><FONT face=3DArial><STRONG>In the next 24 hours, 30,000 children =
will die=20
from preventable diseases on planet earth. </STRONG></FONT></DIV>
<DIV><FONT face=3DArial><STRONG>These deaths can be stopped.=20
</STRONG></FONT></DIV>
<DIV><FONT face=3DArial><STRONG>Join <A=20
href=3D"http://www.TheMillionSignatureCampaign.org">www.TheMillionSignatu=
reCampaign.org</A>,=20
a march demanding Health for All NOW !!</STRONG></FONT></DIV>
<DIV> </DIV>
<DIV></FONT>+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++=
+++++++++</DIV>
<DIV> </DIV>
<DIV>----- Original Message ----- </DIV></DIV>
<DIV>
<DIV>From: aviva <<A=20
href=3D"mailto:aviva at netnam.vn">aviva at netnam.vn</A>></DIV>
<DIV>To: <<A=20
href=3D"mailto:pha-exchange at kabissa.org">pha-exchange at kabissa.org</A>>=
</DIV>
<DIV>Sent: Thursday, February 13, 2003 11:42 AM</DIV>
<DIV>Subject: PHA-Exchange> PHC: a reminder of its =
principles</DIV></DIV>
<DIV><BR></DIV>> From: "DBanerjee" <<A=20
href=3D"mailto:nhpp at bol.net.in">nhpp at bol.net.in</A>><BR>> PRIMARY =
HEALTH=20
CARE: AN OVERVIEW<BR>> DEBABAR BANERJI<BR>> Guest Lecture for =
National=20
Seminar on Health For All in the New<BR>> Millenium, NIHFW, February =
24-26,=20
2003.<BR>> (Professor Emeritus, Centre of Social Medicine and =
Community=20
Health,<BR>> Jawaharlal Nehru University)<BR>> <BR>> A =
WATERSHED IN=20
PUBLIC HEALTH<BR>> <BR>> <BR>> The concept of Primary Health =
Care=20
(PHC), which was approved by the<BR>> World<BR>> Health Assembly =
in 1977=20
and endorsed at the International Conference on<BR>> Primary Health =
Care at=20
Alma Ata in 1978, marks a watershed in the<BR>> discipline<BR>> of =
public=20
health. It had virtually turned the discipline up side down,<BR>> as=20
it<BR>> were; technology, administrative practices were subordinated =
to=20
the<BR>> needs of<BR>> the people.  Halfdan Mahler, the then=20
Director-General of WHO, had<BR>> rightly<BR>> labelled it as a=20
revolution. He had also acknowledged that the work<BR>> done =
in<BR>> India=20
had substantially contributed to the development of the concept<BR>>=20
of<BR>> PHC.<BR>> <BR>> The concept of Primary Health Care has =
to be=20
distinguished from the<BR>> concept<BR>> of a  Primary Health =
Centre=20
in India. Failure to do so has very often<BR>> led to<BR>> =
trivialisation=20
of the concept of Primary Health Care. The ideas behind<BR>> setting =
up=20
Primary Health Centres can be considered as a component of<BR>> =
the<BR>>=20
concept of Primary Health Care.<BR>> <BR>> Reference to the term, =
primary=20
health care, is made in the<BR>> Director-General'<BR>> s report =
to the=20
53rd meeting of the WHO Executive Board as early as in<BR>> January =
1975,=20
proclaiming that `primary health care services at the<BR>> community =
level is=20
seen as the only way in which the health services<BR>> can<BR>> =
develop=20
rapidly and effectively'. He had enunciated seven guiding<BR>>=20
principles<BR>> for this purpose:<BR>> <BR>> 1. to shape PHC =
`around=20
the life pattern of the population';<BR>> 2. for involvement of the =
local=20
population;<BR>> 3. for `maximum reliance on the available community=20
resources', while<BR>> remaining within cost limitations;<BR>> 4. =
for an=20
`integrated approach to preventive, curative and promotive<BR>> =
services for=20
both community and for the individual';<BR>> 5. for all interventions =
to be=20
undertaken `at the most peripheral<BR>> practicable level of the =
health=20
services by the worker most simply<BR>> trained<BR>> for this=20
activity';<BR>> 6. for other echelons of services to be =
designed  in=20
support of the<BR>> needs of<BR>> the peripheral level; =
and,<BR>> 7.=20
for PHC services to be `fully integrated with the services of =
the<BR>>=20
other<BR>> sectors involved in community development'.<BR>> =
<BR>> By=20
the time of the Alma Ata Conference on PHC had taken its now =
well<BR>>=20
known<BR>> form, it was seen as the `key to attaining' the target of =
health=20
for<BR>> all by<BR>> the year 2000 (HFA-2000/PHC). Only the =
outstanding=20
elements of the<BR>> Declaration are being presented below:<BR>> =
<BR>>=20
 I The Conference strongly reaffirms that health is a fundamental=20
human<BR>> right and that the attainment of the highest level of =
human health=20
is<BR>> the<BR>> most important social goal and whose realization =
requires=20
action in<BR>> many<BR>> other social and economic sectors in =
addition to=20
the health sector.<BR>> <BR>>  II The existing gross =
inequality in=20
health status of the people<BR>> particularly, between developed and=20
developing countries and as well as<BR>> within countries is =
politically,=20
socially and economically unacceptable<BR>> and<BR>> is, =
therefore, of=20
common concern to all countries.<BR>> <BR>>  III. Economic =
and social=20
development is of basic importance to the<BR>> fullest<BR>> =
attainment of=20
health for all and to the reduction of the gap between<BR>> =
developing and=20
developed countries. The promotion and protection of the<BR>> health =
of the=20
people is essential for sustained social and economic<BR>> =
development and=20
contributes to better quality of life and to world<BR>> =
peace.<BR>>=20
<BR>>  IV. The people have the right and duty to participate=20
individually and<BR>> collectively in the planning and implementation =
of=20
their health care.<BR>> <BR>>  V. Governments have a =
responsibility=20
for the health of their people<BR>> which<BR>> can only be =
fulfilled by=20
the provision of adequate health and social<BR>> measures. A main =
social=20
target of governments, international<BR>> organizations<BR>> and =
the whole=20
world community in the coming decades should be<BR>> attainment =
by<BR>>=20
all the people of the world by the year 2000 of a level of health =
that<BR>>=20
will<BR>> permit them to live a socially and economically productive=20
life.<BR>> Primary<BR>> health care is the key to attaining this =
target as=20
a part of<BR>> development in<BR>> the spirit of social =
justice.<BR>>=20
<BR>>  VI. Primary health care is essential health care based on =

practical,<BR>> scientifically sound and socially acceptable methods =
and=20
technology<BR>> universally made accessible to individuals and =
families in=20
the<BR>> community<BR>> through their full participation and at a =
cost the=20
community and the<BR>> country<BR>> can afford to maintain at =
every stage=20
of their development in the<BR>> spirit of<BR>> self-reliance and=20
self-determination. It forms an integral part of the<BR>> country's =
health=20
system, of which it is the central function and main<BR>> =
focus,<BR>> and=20
of the overall social and economic development of the country. =
The<BR>>=20
first<BR>> level of  individuals, family and the community with =
the=20
national<BR>> health<BR>> system bringing health care as close as =
possible=20
to where people live<BR>> and<BR>> work and constitute the first =
of the=20
continuing health care process.<BR>> <BR>> Primary health =
care<BR>>=20
 1. reflects and evolves from the economic conditions and<BR>>=20
socio-cultural and<BR>> political characteristics of the country and =
its=20
communities and is<BR>> based on<BR>> application of the relevant =
results=20
of social, biomedical and health<BR>> services research and public =
health=20
experience,<BR>>  2.addressses the main health problems in the=20
community, providing<BR>> promotive, preventive, curative and =
rehabilitative=20
services<BR>> accordingly,<BR>>  3. includes at least: =
education=20
concerning prevailing health problems<BR>> and<BR>> methods of =
preventing=20
and controlling them; promotion of food supply<BR>> and<BR>> =
nutrition;=20
adequate supply of safe water and sanitation; maternal and<BR>> =
child<BR>>=20
health care, including family planning; immunization against =
major<BR>>=20
infectious diseases; prevention and control of local endemic =
diseases<BR>>=20
and<BR>> injuries; and provision of essential drugs,<BR>>  4. =

Involves, in addition to the health sector, all related aspects =
of<BR>>=20
national and community development, in particular agriculture, =
animal<BR>>=20
husbandry, food, industry, education, housing, public works,<BR>>=20
communication<BR>> and other sectors, and demands the coordinated =
efforts of=20
all those<BR>> sectors,<BR>>  5. requires and promotes =
maximum=20
community and individual<BR>> self-reliance and<BR>> participation =
in the=20
planning, organization, operation and control of<BR>> primary health =
care,=20
making fullest use of local, national and other<BR>> available =
resources, and=20
to this end develops through appropriate<BR>> education<BR>> the =
ability=20
of the community to participate,<BR>>  6. should be sustained by =

integrated, functional and mutually<BR>> supportive<BR>> referral =
systems,=20
leading to progressive improvement of comprehensive<BR>> =
health<BR>> care=20
to all, giving priority to those most in need,<BR>> 7. relies, at =
local and=20
referral levels, on health workers, including<BR>> physicians, =
nurses,=20
midwives, auxiliaries, as needed, suitably trained<BR>> socially and=20
technically, to work as a health team and to respond to<BR>> =
the<BR>>=20
expressed health needs of the community.<BR>> <BR>> The foregoing=20
quotations from official WHO documents (unavoidably<BR>> repetitive)=20
show  how revolutionary have indeed been the ideas which<BR>> =
culminated=20
from the Alma Ata Declaration on Primary Health Care. These<BR>>=20
ideas<BR>> are being put together below in a summary form:<BR>> =
<BR>>=20
 1.Health is considered as a fundamental right. The state has =
the<BR>>=20
responsibility to enforce this right.<BR>> <BR>> 2. Instead of =
starting=20
with various types of health technologies and<BR>> considering people =
as=20
almost passive recipients for them, the<BR>> Declaration<BR>> =
sought to=20
reverse the relationship by considering people as the prime<BR>>=20
movers<BR>> for shaping their health services. It sought to =
strengthen the=20
capacity<BR>> of<BR>> the people to cope with their health =
problems which=20
they have developed<BR>> through ages.<BR>> <BR>> 3, It also =
visualised=20
a wider approach to health by strengthening such<BR>> intersectoral =
areas as=20
ensuring adequate supply of potable water,<BR>> environmental =
sanitation,=20
nutritive food and housing.<BR>> <BR>> 4. It called for social =
control of=20
the health services that are meant<BR>> to<BR>> strengthen =
people's coping=20
capacity.<BR>> <BR>> 5. It considered health as an intergral =
whole,=20
including promotive,<BR>> preventive, curative and rehabilitative =
components.=20
Any concept of<BR>> `selective care' was considered antithetical to =
the=20
concept of PHC.<BR>> <BR>> 6. Health services ought to cover the =
entire=20
population, including the<BR>> underserved and the unserved.<BR>> =
<BR>>=20
7. Those aspects of traditional systems of medicine, which are =
proven<BR>> to=20
be efficacious or which are the only one accessible to the =
people,<BR>>=20
ought<BR>> to be used in providing PHC.<BR>> <BR>> 8. Choice of =
Western=20
medical technology should conform to the cultural,<BR>> social, =
economic and=20
epidemiological conditions prevailing in<BR>> countries.<BR>> =
<BR>> 9.=20
Particular care is to be taken to use only essential drugs.<BR>> =
<BR>> It=20
may be emphasised that PHC is a PROCESS; it provides a road map =
for<BR>>=20
developing heath service in different countries of the world. =
Health<BR>>=20
service development in India is taken up here as a case study.<BR>> =
<BR>>=20
 [The case study is available by contacting the author =
directly].<BR>>=20
<BR>> ---<BR>> PHA-Exchange is hosted on Kabissa - Space for =
change in=20
Africa<BR>> To post, write to: <A=20
href=3D"mailto:PHA-Exchange at kabissa.org">PHA-Exchange at kabissa.org</A><BR>=
>=20
Website: <A=20
href=3D"http://www.lists.kabissa.org/mailman/listinfo/pha-exchange">http:=
//www.lists.kabissa.org/mailman/listinfo/pha-exchange</A><BR>>=20
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