Vanakkam<br>Kia ora koutou<br><br>Please find below the text of the paper being circulated at the World Health Assembly which reflects the start of engagement by the People's Health Movement with the work being done on primary health care (PHC) by the World Health Organization leading up to the World Health Report on PHC in 2008.
<span style="font-weight: bold;">Please circulate to your networks</span>, and for those in Geneva <span style="font-weight: bold;">please highlight the session on PHC hosted by PHM next Thursday</span> described below.<br>
<br>This is a strategic paper to engage WHO staff and delegates of the WHA to frame the debate around PHC. It is purposely short and not in any way exhaustive, and the language and scope reflects the target audience. We look forward to further consultation with PHM members around PHC as we prepare a more formal contribution to the process. We will post a report on activities on this issue at the WHA after its completion, at which time we will have a better idea how best to proceed with our advocacy on this issue.
<br><br>Any comments on queries on this, or if you would like a pdf version of the paper, please contact the PHM Secretariat or me directly.<br><br>Best<br><br>Kumanan Rasanathan<br><br>---------------------------------------------------------
<div>
<p style="margin: 0cm 0cm 0pt; text-align: right;" align="right"><i><span style="font-size: 9pt;" lang="EN-GB"><strong><font face="Arial"> </font></strong></span></i></p>
<p style="margin: 0cm 0cm 0pt;"><span style="font-size: 9pt;" lang="EN-GB"><strong><font face="Arial"> </font></strong></span></p><p style="margin: 0cm 0cm 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><strong><font face="Arial">
REVITALISING PRIMARY HEALTH CARE: CHALLENGES FOR W.H.O. IN THE NEW
MILLENNIUM</font></strong></span></p>
<p style="margin: 0cm 247.9pt 0pt 0cm; text-align: justify;"><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></i></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB">The
People's Health Movement (PHM) welcomes the World Health Organization's (WHO)
renewed focus on primary health care (PHC), as signalled by Director-General Dr
</span><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB">Margaret</span><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB">
Chan's address at the Executive Board meeting in January 2007. Although the
world has changed since 1978, <b>the comprehensive PHC approach articulated at
</b></span><b><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB">Alma</span></b><b><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB">
Ata remains highly relevant today. </span></b></p>
<p style="margin: 0cm 247.9pt 0pt 0cm; text-align: justify;"><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB"> </span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">As
WHO engages with a revitalisation of PHC it must not only affirm the underlying
principles of the Alma Ata Declaration, but also address the obstacles that
blocked its implementation and incorporate new challenges that have emerged
since.<span> </span></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"> </span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">As
a start to an evolving dialogue with the World Health Organization and other
civil society and country delegates, the People's Health Movement is glad to
start the process to dialogue with WHO around core principles and key challenges
that WHO should<span> </span>incorporate into its
renewed commitment to PHC.</span></p>
<p style="margin: 0cm 247.9pt 0pt 0cm; text-align: justify;"><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB"> </span></p>
<p style="margin: 0cm 0cm 0pt;"><b><span style="font-size: 10pt; font-style: normal; font-family: Tahoma;" lang="EN-GB">At
the 60<sup>th</sup> World Health Assembly in
</span></b><b><span style="font-size: 10pt; font-style: normal; font-family: Tahoma;" lang="EN-GB">Geneva</span></b><b><span style="font-size: 10pt; font-style: normal; font-family: Tahoma;" lang="EN-GB">,
</span></b><b><span style="font-size: 10pt; font-style: normal; font-family: Tahoma;" lang="EN-GB">Switzerland</span></b><b><span style="font-size: 10pt; font-style: normal; font-family: Tahoma;" lang="EN-GB">,
The People's Health Movement (PHM) calls on member states, WHO staff and other
global health actors to consider these challenges to PHC and support WHO's
global leadership and co-ordination to develop and implement solutions that
advance towards 'Health for All'.<span>
</span></span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"><em>Answers
to these problems exist (with examples in the experience of many member states
and civil society). PHM will highlight these solutions in more detail to
contribute to WHO's upcoming work towards the World Health Report next
year.</em></span></b></p>
<p style="margin: 0cm 247.9pt 0pt 0cm; text-align: justify;"><span style="font-size: 9pt; font-family: Arial;" lang="EN-GB"> </span></p>
<h3 style="margin: 0cm 0cm 0pt;" align="center"><span style="font-size: 14pt; font-family: Tahoma;" lang="EN-GB">YOU
ARE INVITED TO A DIALOGUE</span><span style="font-family: Tahoma;" lang="EN-GB"></span></h3>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">with
the People's Health Movement on the Primary Health Care at a Special Round Table
Session at the 60<sup>th</sup> World Health Assembly in<span> </span>Geneva, Switzerland</span></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"> </span></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Date
: </span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Thursday,
17<sup>th</sup> May 2007</span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"></span></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Time
: </span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">5.30</span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">
to </span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">7.00
PM</span></b><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"></span></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"><span></span><span></span>Venue: Palais des Nations, Salle VIII (8)
</span></b></p>
<h3 style="margin: 0cm 0cm 0pt;" align="center"><font size="2"><span style="font-family: Tahoma;" lang="EN-GB">Theme:
</span><span style="font-weight: normal; font-family: Tahoma;" lang="EN-GB">From
Policy to Action : Civil Society Revisits Primary Health
Care</span></font></h3>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Organisers:</span></b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">
People's Health Movement (PHM)</span></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">and
World Council of Churches (WCC)</span></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB"> </span></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Short
case studies, experiences and reflections will be shared by delegates from
</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Asia</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">,
</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Latin
America</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">,
</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Africa</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">,
</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">Middle
East</span><span style="font-size: 10pt; font-family: Tahoma;" lang="EN-GB">,
and other parts of the world. The interactive participatory dialogue will
include short inputs and responses by delegates from countries.<span> </span>Members of the WHO Task Force on Primary
Health Care and other units will join us to listen to these experiences in a
spirit of dialogue and joint learning (see separate flyer for further
details).</span><span style="font-size: 10pt;" lang="EN-GB"></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt;" lang="EN-GB"> </span></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;" align="center"><b><i><span style="font-family: Arial;" lang="EN-GB">If you believe in 'Health
for All', Primary Health Care and Health as a Human Right, join us at the
dialogue in solidarity. All are welcome.</span></i></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></b> </p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">For
further information contact: </span></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Manoj
Kurian</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">, WCC,
</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Geneva</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">: +41 22
791 63 23<span> </span></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"><span></span>Genevieve Jourdan, PHM Geneva : +41 78 753 22
81 </span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">PHM
Global Secretariat</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">
Team<span></span>:<span>
</span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Hani
Serag</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">: +41
79 488 68 79<span> </span>Azza Salam: +41
79 488 29 36</span></p>
<p style="margin: 0cm 0cm 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><strong><font face="Arial"> </font></strong></span></p><p style="margin: 0cm 0cm 0pt;"><br><span style="font-size: 10pt;" lang="EN-GB">
<strong></strong></span></p><p style="margin: 0cm 0cm 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><strong><font face="Arial"><br></font></strong></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: center;"><span style="font-size: 10pt;" lang="EN-GB"><strong><font face="Arial">REVITALISING PRIMARY HEALTH CARE: CHALLENGES FOR W.H.O. IN THE NEW
MILLENIUM</font></strong></span></p><p style="margin: 0cm 0cm 0pt; text-align: center;"><span style="font-size: 10pt;" lang="EN-GB"><strong></strong></span><span><strong><span><font face="a"> </font>
</span><font face="a"><span style="font-family: arial,sans-serif;">A People's Health Movement (PHM) Dialogue
paper</span></font></strong></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></b></p>
<h3 style="margin: 0cm 0cm 0pt; text-align: center;"><span lang="EN-GB"><font size="2"><font face="Arial">CORE PRINCIPLES</font></font></span></h3>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">The term
'Primary Health Care' is defined and used in different ways. WHO's
revitalisation of PHC must be based on a definition as broad and ambitious as
that described in the Alma Ata Declaration and embedded in the social processes
detailed there. It must incorporate all of the following:</span></p>
<ul><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A
systems-wide approach</span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> that
incorporates more than just primary level health care. It must reflect an
approach that includes and co-ordinates </span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">public
health</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">
interventions, health promotion activities and hospital services, with referrals
to district and tertiary centres.</span></li><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A health
system that is progressively financed, inclusive and equitable.</span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> A PHC
approach is not limited to merely providing a 'basic' or 'minimal' package of
care for the poor. Instead it strives to reduce the impact of socio-economic
injustice by designing a single system of health care for all that provides
access and care according to need and fairness.</span></li><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A
comprehensive approach</span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> which
addresses the social, political and economic determinants of health and
implements multi-sectoral action to improve health – not just healthcare.
</span></li><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A
community empowerment approach</span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> which
enables individuals, families and communities to act towards improving their
health and the conditions they live in, especially for those who are most
disadvantaged.</span></li><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A health
system based on the 'Right to Health' </span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">recognising
the entitlements of citizens.</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></li><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">The
appropriate use of technology</span></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">
sensitive to local contexts and people's traditional culture - helping people
learn to combine the best and reject the worst of both traditional and modern
medicine. </span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></li></ul>
<h3 style="margin: 0cm 0cm 0pt;"><span style="font-size: 12pt;" lang="EN-GB"><font face="Arial">NEW
CHALLENGES FOR PRIMARY HEALTH CARE</font></span></h3>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Since
the formulation of the 1978 Alma Ata Declaration, new challenges have emerged
which must be addressed in any effort to revitalise the PHC concept. These
include:</span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><br><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></p><p style="margin: 0cm 0cm 0pt; text-align: justify;">
<span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial"><span style="font-weight: bold;">The proliferation and dominance of selective health care programmes
</span></font></span></p><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial"><span style="font-weight: bold;"></span>
</font></span>
<ul><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Selective
health care programmes are often characterised by a top-down and vertical
approach to health care. Such programmes often fragment and disorganise the
wider health system (especially by drawing away resources), treat patients as
passive recipients of medical care and ignore the broader social, economic and
political determinants of health. While there may </span><span style="font-size: 10pt; font-family: Arial;" lang="EN-AU">always
be a need for focused programmes and specialist health workers, the current
balance between narrow (often disease-specific) programmes and integrated health
care is skewed.<span> </span></span><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></i></b></li></ul>
<ul><li><span style="font-size: 10pt; font-family: Wingdings;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-AU"><span style="font-style: italic;"><span style="font-weight: bold;"></span></span>In
order to revitalise PHC, there needs to be a revitalisation of the District
Health System model which allows for more integrated, community-driven and
bottom-up health planning and provision - and more efficient implementation of
specialist programs when appropriate. There must be a renewal of the role of
community health workers to extend coverage at the local level and act as
advocates for their communities.</span></i></b><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></i></b></li></ul>
<p style="margin: 0cm 0cm 0pt 18pt; text-align: justify;"><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></i></b></p>
<h2 style="margin-top: 0cm; margin-right: 0cm; margin-bottom: 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial">Global public private partnerships </font></span></h2>
<ul><li><span style="font-size: 11pt; font-family: Symbol;"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Global
public private partnerships bring new financial resources to address health
challenges but, up to now, these initiatives have further reinforced selective
programmes by focusing on technocratic solutions to single issues, without
addressing the determinants of health or the needs of health systems. Such
programmes often employ narrow cost-effectiveness analysis (which ignore
benefits to other sectors from health improvement) and undermine PHC
sy</span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">stems. In
<span>addition, they raise concerns about
sustainability and accountability.</span></span><span style="font-size: 10pt; font-family: Arial;"></span></li></ul>
<ul><li><span style="font-weight: normal; font-size: 10pt; font-style: normal; font-family: Wingdings;"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><strong><em><font face="Arial"><span style="font-size: 10pt;" lang="EN-GB">These partnerships need to
be reoriented towards more horizontally integrated sector-wide approaches that
build health s</span><span style="font-size: 10pt;" lang="EN-GB">ystems; respond to
local needs; and build new</span><span style="font-size: 10pt;" lang="EN-GB"> relationships with civil
society, people's organisations and social movements - reasserting the central
place of democratic, participatory decision-making in all health
services.</span><span style="font-size: 10pt;"></span></font></em></strong></li></ul>
<h2 style="margin: 0cm 0cm 0pt 18pt;"><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial"> </font></span></h2><h2 style="margin-top: 0cm; margin-right: 0cm; margin-bottom: 0pt;"><span style="font-size: 10pt;" lang="EN-GB">
<font face="Arial">The new
market economy in health </font></span></h2>
<ul><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">The last
thirty years has seen increasing privatisation and commercialisation of health
systems across the world. This has undermined public sector health systems;
eroded ethical standards of behaviour among health workers and trust between
communities and the health system; and exacerbated inequity and disparities in
access to health care. </span></li></ul>
<ul><li><span style="font-size: 10pt; font-family: Wingdings;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">There is
a profound need in many countries to strengthen the public sector and the
'public ethic' of service provision; direct the existing private sector towards
serving the needs of the public as a whole; and reduce the presence of
profit-seeking and commercial initiatives that currently harm many interactions
between people and health care providers</span></i></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">.
</span></li></ul>
<p style="margin: 0cm 0cm 0pt 18pt; text-indent: -18pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></p>
<h2 style="margin-top: 0cm; margin-right: 0cm; margin-bottom: 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial">Unfair
globalisation </font></span></h2>
<ul><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Globalisation
presents opportunities for increased sharing of knowledge and information and
greater co-ordination of efforts at the global level to address the determinants
of health. However, globalisation also presents new threats to health such as
increased trade in unhealthy commodities and in health workers ("brain drain") -
undermining the ability of many poor countries to support PHC systems.
Furthermore, global inequalities mean that many poor countries lack any hope of
sustainable domestic funding for their health systems and are therefore
increasingly reliant on external sources of funding. </span></li></ul>
<ul><li><span style="font-size: 10pt; font-family: Wingdings;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><b><i><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">A
revitalised PHC strategy must address the globalised nature of the health worker
labour market and provide a framework to generate new global pools of finance
that ensure an adequate resource base for the health systems of all countries -
including compensating poor countries for their labour
losses.</span></i></b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"></span></li></ul>
<p style="margin: 0cm 0cm 0pt 18pt; text-indent: -18pt; text-align: justify;"><b><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></b></p>
<h2 style="margin-top: 0cm; margin-right: 0cm; margin-bottom: 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial">Intellectual property</font></span></h2>
<ul><li><span style="font-size: 11pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">In
recent years, the scope and length of patents has increased greatly. These
developments represent a profound transformation of patterns of ownership within
society, with major implications for the development of technology for the
treatment of disease. While technology offers tremendous potential to improve
health, it is sobering to recall that many of the most useful technologies
available in 1978, at the time of Alma Ata, are still unavailable to most
people. The implementation of intellectual property rules often makes new
life-saving medications unaffordable to the people who need them
most.</span></li></ul>
<ul><li><span style="font-weight: normal; font-size: 10pt; font-style: normal; font-family: Wingdings;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt;" lang="EN-GB"><strong><em><font face="Arial">Addressing the challenges to PHC requires universal access to
essential medicines. This will require confronting emerging trade and patent
regimes to be people-friendly rather than market-oriented and supporting
countries to make full and appropriate use of the flexibilities in TRIPS to make
necessary drugs available to all who need
them.</font></em></strong></span></li></ul>
<p style="margin: 0cm 0cm 0pt 18pt;"><span style="font-size: 10pt;" lang="EN-GB"><strong><em><font face="Arial"> </font></em></strong></span></p>
<h1 style="margin: 0cm 0cm 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><font face="Arial">Other new challenges</font></span></h1>
<ul><li><span style="font-size: 10pt; font-family: Symbol;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB">Finally,
in the three decades since Alma Ata, the global health situation has changed
drastically. The planet's ability to support human health is at great risk from
unsustainable development; inequities have increased between and within
countries; access to food, education, water, shelter, sanitation and employment
are still inadequate for many; the challenges of poverty, gender inequity and
social exclusion continue; both communicable and non-communicable disease
epidemics challenge health systems; and war, violence and conflict abound.
</span></li></ul>
<ul><li><span style="font-weight: normal; font-size: 10pt; font-style: normal; font-family: Wingdings;" lang="EN-GB"><span><span style="font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;">
</span></span></span><span style="font-size: 10pt;" lang="EN-GB"><strong><em><font face="Arial">Any renewal of primary health care, while reiterating the core
principles, must address these new challenges at local, national, regional and
global levels, and bring the health of marginalised groups to the centre of the
commitment to 'Health for All'. </font></em></strong></span></li></ul>
<p style="margin: 0cm 0cm 0pt 18pt;"><span style="font-size: 10pt;" lang="EN-GB"><strong><em><font face="Arial"> </font></em></strong></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><span style="font-size: 10pt; font-family: Arial;" lang="EN-GB"> </span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><span style="font-family: Arial;" lang="EN-GB">10<sup>th</sup>
May 2007</span></b><b><i><span style="font-family: Arial;" lang="EN-GB">.<span>
</span>Source: People's Health Movement</span></i></b></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><i><span style="font-family: Arial;" lang="EN-GB"><span> </span></span></i></b><span style="font-family: Arial;" lang="EN-GB">
<a href="mailto:secretariat@phmovement.org" target="_blank" onclick="return top.js.OpenExtLink(window,event,this)">secretariat@phmovement.org</a></span></p>
<p style="margin: 0cm 0cm 0pt; text-align: justify;"><b><i><span style="font-family: Arial;" lang="EN-GB"><span>
</span></span></i></b></p>
<p style="margin: 0cm 0cm 0pt;"><span lang="EN-GB"> </span></p></div><br>