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<div>A juxtaposition of the original text of the Alma Ata Declaration and what is deemed necessary for a PHC framework 30 years later makes for an interesting discussion topic: </div>
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<p style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: center" align="center"><b><span style="FONT-SIZE: 16pt"><font face="Times New Roman">Declaration of Alma-Ata</font></span></b></p>
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<p style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: center" align="center"><span><font face="Times New Roman"><strong><font size="2">International Conference on Primary Health Care, Alma-Ata, USSR,</font> </strong></font><font face="Times New Roman"><font size="2">6-12 September 1978</font></font></span></p>
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<p style="MARGIN: 6pt 0in; TEXT-ALIGN: center" align="center"><span style="COLOR: blue; FONT-VARIANT: small-caps"><font size="4">Primary Health Care remains the Best Tool </font></span></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: center" align="center"><span style="COLOR: blue; FONT-VARIANT: small-caps"><font size="4">to Achieve "Health for All"</font></span></p>
<p style="MARGIN: 0in 0in 0pt; TEXT-ALIGN: center" align="center"><span><font color="#3333ff" size="2"><strong>Position of the People's Health Movement (PHM)</strong></font><a title="" onclick="return top.js.OpenExtLink(window,event,this)" href="http://mail.google.com/mail/?ui=1&view=page&name=gp&ver=sh3fib53pgpk#_edn1" target="_blank" name="11d28e80e4c6152c_11d1938f7ddb2f46_11d17eb8b5c78763_11d17d71fe85e287_11d17d387c6fa7d5__ednref1"><span><span><span><span style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial"><font color="#3333ff">[i]</font></span></span></span></span></a><font color="#3333ff"><strong>,</strong><font size="2"><strong> </strong>June</font><font size="2"> 2008.</font></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">"The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:</font></span></p>
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<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">[A PHC policy for 2008 and beyond needs renewed commitment which, while reaffirming the fundamental positions of thirty years back, also takes into account the new realities of this day and age. The comprehensive Primary Health Care (PHC) approach articulated at Alma Ata remains as relevant today as it was 30 years ago. It was never really implemented to reflect its true spirit, i.e., the basic intent of the Alma Ata Declaration which highlighted the need for a new international economic order </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(iii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> to ultimately solve inequities in health. <span> </span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">In its renewed commitment to PHC, in 2008, PHM vies to address the obstacles that have blocked PHC's implementation so far and is furthermore committed to incorporate into-it the new challenges that have emerged since 1978]. </span><span style="FONT-SIZE: 9pt; COLOR: red; FONT-FAMILY: Arial">(Numbers in Roman numerals cross-reference the issues in the Alma Ata Declaration with those in the current position of PHM towards PHC in 2008 and beyond). </span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The Alma Ata Declaration:</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">I</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right <span style="COLOR: red">(i)</span> and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. </font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">II</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. <span style="COLOR: red">(ii)</span></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">III</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">Economic and social development, based on a New International Economic Order <span style="COLOR: red">(iii)</span>, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">contributes to a better quality of life and to world peace. <span style="COLOR: red">(iv)</span></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">IV</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. <span style="COLOR: red">(v)</span></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">V</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures <span style="COLOR: red">(v-a)</span>. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice. <span style="COLOR: red">(vi)</span></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">VI</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology <span style="COLOR: red">(vii)</span> made universally accessible to individuals and families in the community through their full participation and at a cost that the community and 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 both 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 community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">VII</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">Primary health care:</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">1. reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research <span style="COLOR: red">(viii)</span> and public health experience;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">2. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">3. includes at least (*): (1)education concerning prevailing health problems and the methods of preventing and controlling them <span style="COLOR: red">(ix)</span>; (2)promotion of food supply and proper nutrition <span style="COLOR: red">(x)</span>; (3)an adequate supply of safe water and basic sanitation <span style="COLOR: red">(xi)</span>; (4)maternal and child health care, including family planning; (5)immunization against the major infectious diseases; (6)prevention and control of locally endemic diseases <span style="COLOR: red">(xii)</span>; (7)appropriate treatment of common diseases and injuries <span style="COLOR: red">(xii-a)</span>; and (8)provision of essential drugs <span style="COLOR: red">(xiii)</span>;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">4. involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors <span style="COLOR: red">(xiv)</span>;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">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 communities to participate <span style="COLOR: red">(v, xiv)</span>;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">6. should be sustained by integrated, functional and mutually supportive referral systems <span style="COLOR: red">(xv)</span>, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">7. relies, at local and referral levels <span style="COLOR: red">(xv)</span>, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community. <span style="COLOR: red">(xvi)</span></font></span></p>
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<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">[PHM is committed to promote</span></b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> <b>the still unshaken basic principles of the Alma Ata Declaration</b> --way beyond its original eight technical components<b>. (*)</b></span></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">PHM reiterates that PHC is to be embedded in the social and political processes in each specific context where it is applied.</span></b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> For that, <span>it<b> </b>must</span>:</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">be neither limited to just the primary level of care, nor be considered merely as a "basic" package of care for the poor, but include public health interventions, health promotion and a working referral system to secondary and tertiary levels of care </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xvi)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">;</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">be financed through public sources, so as to ensure universal and equitable access </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(v-a)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">; </span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">address the socio-economic injustice underlying a system of health care that does not provide equitable access and care according to need </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(vi)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">;</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">resolutely address the social, political, economic and environmental determinants of health and not just be limited to health care </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xiv)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">;</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">address the issues of global warming </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xiv)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">, the current international economic order and the militarization </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(iv)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> the latter has brought about. </span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">empower communities, especially, the most disadvantaged, so that they can act as protagonists in improving their health and their livelihoods </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(v)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">;</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">use technology<b> </b>in a manner that is sensitive to local needs and contexts </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(vii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">;</span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">combine traditional and modern medicine to maximize benefits to patients </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xii-a)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> since <span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">PHC has to be open to different health systems, not only to the allopathic system <font color="#ff0000">(xvi)</font>. </span></span></p>
<p style="MARGIN: 0in 0in 0pt 11.35pt; TEXT-INDENT: -11.35pt"><span style="FONT-SIZE: 12pt"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">embed policies and interventions in the <b>human rights framework</b>, i.e., recognizing and supporting the role of beneficiaries as <b>claim holders</b> with an internationally sanctioned right to hold to account <b>duty bearers</b> in bringing about needed changes in the provision of health care services </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(i)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">].</span><b><span style="FONT-SIZE: 12pt"></span></b></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">VIII</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally. <span style="COLOR: red">(xvii)</span></font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">IX</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 14pt"><font face="Times New Roman">X</font></span></b></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">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 <span style="COLOR: red">(iv)</span>. A genuine policy of independence, peace, d้tente and disarmament could and should release additional resources that could well be devoted to</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">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.</font></span></p>
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<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order <span style="COLOR: red">(iii)</span>. It urges governments, WHO and UNICEF, and</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries.</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 14pt"><font face="Times New Roman">The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration".</font></span></p>
<p style="MARGIN: 0in 0in 0pt"><b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">[PHC Beyond Alma Ata or The PHC of 2008 and Beyond:</span></b></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">PHM takes the new challenges that have emerged in the last 30 years, as challenges that must be incorporated in a renewed vision for PHC. In this context, <b>PHM strongly believes that:</b></span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Neoliberal globalisation presents us with new threats to health such as, among other, an increase in trade in unhealthy commodities, international trade agreements that are promoting the penetration of transnational corporations into the health sector, patent rights being used against the dire health needs of poor people, and unfair rules in the international trade of agricultural products that devastate the livelihood and health of poor peasants.<span> </span>All of them seriously undermine the ability of poor countries to adequately support PHC systems. Global inequities also result in poor countries being left with too few resources to sustain funding for health systems overall, thereby becoming reliant on external sources of funding. PHM posits that <b>the negative aspects of globalization are the major obstacle to Health For All.</b> Outside the present neoliberal framework, certain aspects of globalization can and should be used to address the social, economic and political determinants of health.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">After over 25 years, selective, vertical health care programs remain dominant, not only fragmenting wider health systems, but also drawing away scarce resources, treating patients as passive recipients of care and ignoring the ever-present social, economic and political determinants of health. PHM recognizes that, while there may be a need for focused programmes, the same need to be integrated into a comprehensive PHC approach.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">The planning and execution of PHC activities must be genuinely community-driven and community-centered </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(v)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Both in light of the looming health manpower crisis, and as a core PHC principle, there must be a renewal of the role of community health workers to not only extend coverage at the local level, but also to give them a concrete role as social mobilizers in <b>the right to health-based empowerment of communities</b> </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(i)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">, <b>particularly in relation to the social determinants of health</b>. PHM thus strongly emphasizes the training of health workers, not only in clinical and preventive health skills, but also in skills that make them effective agents of social change </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xvi)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Significant investments in PHC can and <u>do</u> bring about important positive changes in people's health --as the example of Brazil has demonstrated. PHM advocates for similar investments/initiatives being actively pursued by countries across the globe, because for a good PHC policy to succeed and to make a real difference in <b>access</b> and in <b>equity</b>, it must have sufficient resources specifically allocated to it. PHM thus lobbies states to invest more in public health, particularly in PHC. At the same time, PHM strongly feels that WHO should lead this effort: WHO simply cannot consider itself as just a technical agency.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Global public private partnerships (PPPs) are seen by the Establishment as a way to bring new financial resources to address global health challenges. However, in reality, they have further reinforced selective programs by focusing on non-sustainable, technocentric solutions to single issues that are neither addressing the <b>social determinants of health</b> nor addressing many of the burning needs of national health systems to deliver such services. PPPs need to be seriously questioned since they have proven to be a) unable to promote horizontally-integrated, sector-wide approaches with an explicit commitment to strengthen local health systems, b) unable to respond to locally felt needs, and c) unable to build new alliances with civil society, people's organisations and social movements --thus reasserting the central place of democratic, participatory decision-making in all health services. PHM purports that there is a need to carry out a proper audit of existing global PPPs, in order to expose the basic flaws and rules that such PPPs apply ongoingly --among other making them not to build upon existing public systems and not to embed themselves in a genuine PHC structure.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">The last thirty years have seen increasing privatisation and commercialisation of health systems across the world. The new market economy in health has undermined public sector health systems and has eroded the ethical standards among health workers, as well as the trust between communities and the health system. The result has been exacerbated inequity and growing disparities in access to health care </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(ii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">. PHM thus thinks that there is a profound need in most countries to strengthen the <u>public</u> health sector </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(v-a)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> and the 'public ethic' of service provision and that the private medical sector needs to be regulated as a matter of priority.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">PHC in 2008 and beyond</span></b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> must address the critical problems of the global health workers' labour market and must ensure an adequate human resource base for the health systems of all countries </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xvi)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> --including compensating poor countries for the losses suffered by their health systems as a consequence of outmigration of their health humanpower. </span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Intellectual property issues are increasingly used against the interests of poor countries. The development of technology for the treatment of diseases is oligopolistic and ignores the research needs for diseases of poverty </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(vii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">. Moreover, many useful technologies already available in 1978 are still unavailable to most people. Intellectual property rules cannot be allowed to continue to make new life-saving medications unavailable and unaffordable to the people who need them the most. PHC requires universal access to essential medicines, with most of them made available as generics </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xiii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">. PHM will confront patent regimes that are primarily market-oriented; it will support countries to make full use of the flexibilities in TRIPS that make necessary drugs available to all who need them.</span></p>
<p style="MARGIN: 6pt 0in 6pt 11.35pt; TEXT-INDENT: -11.35pt; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue"><span>-<span> </span></span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">The institutions involved in PHC will need to change their focus. But it is not a time to blame; it is a time to move forward </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xvii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">].</span></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><b><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">[PHC and WHO:</span></b></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Three decades have passed since Alma Ata and the situation is worse than what it was in 1978. Our ability to support human health is now at greater risk from an unjust and unsustainable process of development; inequities have increased between and within countries </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(ii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">; access to food </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(ix)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">, education </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(x)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">, water and sanitation </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xi)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">, shelter and employment are still greatly inadequate for many; <b>the challenges of globalization, poverty, gender inequity and social exclusion continue</b>; both communicable and non-communicable disease epidemics challenge health systems already stretched to the limit </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(xii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">; and war, violence and conflict abound </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(iv)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">.</span></p>
<p style="MARGIN: 6pt 0in"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Today, 30 years after Alma Ata, <b>PHM looks at WHO to provide not only the technical, but also the moral and political leadership in this entire process.</b> WHO simply has to reclaim its legitimate position as the global leader in promoting policies that lead to a world with healthy populations. <span> </span>Specifically, PHM expects WHO to prompt and support member countries to adopt policies that promote PHC as an integral part of their national policies </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(v-a).-</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"><span> </span><span> </span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">This support is not just to be given in the area of health systems development, but also in promoting policies that more resolutely address the issues related to the <b>social determinants of health</b>. <span> </span><span> </span></span></p>
<p style="MARGIN: 6pt 0in"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Last Last, but not least, WHO should also take the lead in promoting alternate models of research that promote the development of health products that address the critical needs of people in developing countries </span><span style="FONT-SIZE: 12pt; COLOR: red; FONT-FAMILY: Arial">(viii)</span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">]. </span></p>
<p style="MARGIN: 6pt 0in; TEXT-ALIGN: justify"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Symbol"><span>๐</span></span><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial"> <b>For PHM, while THE PRIMARY HEALTH CARE OF 2008 AND BEYOND reiterates the core principles of Alma Ata, it must, in addition, address these new challenges at local, national, regional and global levels. This is PHM's commitment, i.e., to put the health of marginalized groups at the center of its commitment to 'Health for All Now' --a commitment already espoused by the People's Health Movement in 2000 as the core principle of its People's Charter for Health (<span><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.phmovement.org/" target="_blank">www.phmovement.org</a>)</span>.</b></span></p>
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<p style="MARGIN: 0in 0in 0pt"><u><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">Epilogue</span></u><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">: PHC in 2008 and beyond is to empower communities to counter the current negative trends in globalization, in trade patent regimes that favor market strategies over people's health needs and in all the other social ills depicted above. </span></p>
<p style="MARGIN: 0in 0in 0pt"><span style="FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: Arial">This renewal of PHC thus is the core of a social movement we simply have to build towards Health For All Now, a movement based on equity, human rights and solidarity --which should have actually started in 1978. This is the vision PHM has when calling for the revitalization of PHC as articulated in Alma Ata and adapted to a changed world. PHM will continue to empower communities <u>and</u> have them coalesce into wider regional and global movements. </span></p>
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<p style="MARGIN: 0in 0in 6pt"><a title="" onclick="return top.js.OpenExtLink(window,event,this)" href="http://mail.google.com/mail/?ui=1&view=page&name=gp&ver=sh3fib53pgpk#_ednref1" target="_blank" name="11d28e80e4c6152c_11d1938f7ddb2f46_11d17eb8b5c78763_11d17d71fe85e287_11d17d387c6fa7d5__edn1"><span><span style="FONT-SIZE: 8pt; COLOR: red; FONT-FAMILY: Arial"><span><span><span style="FONT-SIZE: 8pt; COLOR: red; FONT-FAMILY: Arial">[i]</span></span></span></span></span></a>:<span style="FONT-SIZE: 8pt; COLOR: red; FONT-FAMILY: Arial"> PHM is working on a more elaborate position paper (<font color="#ff0000">widely discused by our constituency) </font>to be released later this year; it will include a critical analysis of how WHO is profiling its role to support PHC in 2008 and beyond. It will also address difficult questions such as whether WHO and member states are ever going to bring health to poor and marginalized groups in society ---and if not, who will and who should PHM be engaging with more closely. </span></p>
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