1. ALMA ATA DECLARATION
‘The main goal of Governments and World Health Organization in the coming decades should be the attainment by all people of the world by the year 2000, a level of health that would permit them to lead a socially and economically productive life’
51ST WHA in 1998 reaffirmed the declaration for the 21st century

2. By Dr Arshad Usmani Lahore, Paksitan
Primary Health Care By
Dr Arshad Usmani
Lahore, Paksitan

3. Themes Leading to Alma Ata
Changing theories of health & development: shift away from GNP as measure of development towards recognition of the need of social development
Concerns about poverty & population control
Increasing reliance upon alternative approaches to medical care model
Success of CHWs & associated emphasis on community participation
Revival of interest in public health; tackling causes of ill health rather than symptoms

4. PRIMARY HEALTH CARE
PHC is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford… It forms an integral part of the country's health system, of which it is the central function and the main focus, and of the overall social and economic development of the community

5. PRINCIPLES OF PHC Health Prevention & Promotion Equity
Appropriate Technology
Community Participation
Intersectoral Coordination
Decentralization*

6. COMPONENTS OF PHC
Education concerning prevailing health problems & the methods of preventing & controlling them
Promotion of food supply and proper nutrition
An adequate supply of safe water and basic sanitation
MCH including FP
Immunization against major infectious diseases
Prevention and control of locally endemic diseases
Appropriate treatment of common diseases and injuries
Provision of essential drugs

7. PHC: EXTENDED ELEMENTS IN THE 21st CENTURY
Expanded options of immunization
Reproductive health needs
Provision of essential technologies for health
Health promotion as defined in Ottawa Charter and endorsed by resolution (WHA 42.44)
Prevention and control of non-communicable diseases
Food safety and provision of selected food supplements0

8. PHC: Global Targets
1. All people in every country will have ready access at least to essential health care & to first-level referral facilities
2. All people will be actively involved in caring for themselves & their families, as far as they can, in community action for health
3. Communities throughout the world will share government’s responsibility for the health care of their members
4. All governments will assume the overall responsibility for the health of their people
5. Safe drinking water & sanitation will be available to all people (Cont …)

9. PHC:Global Targets (Cont …)
6. All people will be adequately nourished
7. All children will be immunizes against the major
diseases of childhood
8. Communicable diseases in the developing countries will be of no greater public health significance in the year 2000 than they were in the developed countries
in the year 1980
9. All possible ways will be applied to prevent &
control non-communicable diseases & promote mental health through influencing the life styles &
controlling the physical & psychological environment
10. Essential drugs will be available to all

10. GLOBAL HEALTH TARGETS Health equity: childhood stunting
Survival: MMR, CMR, life expectancy
Reverse global trends of five major pandemics
Eradicate and eliminate certain diseases
Improve access to water, sanitation, food and shelter
Measures to promote health
Develop, implement and monitor national HFA policies
Improve access to comprehensive essential, quality health care
Implement global and national health information and surveillance systems
Support research for health

11. Obstacles to the Implementation of PHC Strategy
Misinterpretation of the PHC Concept
Misconception that PHC is a 2nd rate health care for the poor
Selective PHC Strategies
Resistance to Change
Lack of political will
Centralized Planning & Management Infrastructure

12. SELECTIVE PRIMARY HEALTH CARE
PHC implies that if one cannot afford to offer universal coverage for even the most basic of health care, one could would offer treatment & preventive strategies for the few diseases identified as having the greatest threat to mortality, & which are amenable to prevention / cure at low cost.

13. Comprehensive PHC ADVANTAGES DISADVANTAGES Looks at total health care
Involvement of community
Covers all elements of PHC
Ensures equitable distribution of resources
Facilitates effective referral system
Government goal
DISADVANTAGES
More costly to implement
Takes long time to see impact
Long time to process
Lack of specialized treatment
Expensive
Inefficient referral system ???-- misuse

14. Selective PHC ADVANTAGES DISADVANTAGES Donor friendly
Elimination of selected disease
Easy to plan & implement
Is focused & have more impact
Easy to manage & measure output
Require limited resources
Improve quality of services
DISADVANTAGES
Disease rather than health oriented
Doesn’t ensure equity
Top down decision making
Neglect other problems
Leads to outbreak
Resources (tight) might not be available for urgent needs (emergencies)
Less community involvement– donor priority

15. EVALUATION OF HFA: 1979 - 1996 Reasons for slow progress towards HFA
1. Insufficient Political commitment to implementation of HFA
2. Failure to achieve equity in access to all PHC elements
3. The continuing low status of women
4. Slow socioeconomic development
5. Difficulty in achieving intersectoral action for health
6. Unbalanced distribution of, and week
support for, human resources

16. Reasons for slow progress towards HFA (Cont….)
7. Widespread inadequacy of health promotion activities
8. Weak health information systems and no baseline data
9. Pollution, poor food safety, and lack of safe water supply and sanitation
10. Rapid demographic and epidemiological changes
11. Inappropriate use of, and allocation of resources for, high cost technology
12. Natural and man-made disasters

17. PHC: FROM ALMA- ATA TO 21st CENTURY
PHC as an approach has provided impetus and energy to progress towards HFA
Some progress has been made in ensuring access to the original eight PHC elements
PHC remains valid as the point of entry into a comprehensive health care system
Intersect oral action for health has not been fully achieved
Reorientation of health services and personnel to PHC principles remains elusive
Community participation takes time and dedication by all

18. New Trends that Will Influence Health in the 21st Century
Widespread absolute and relative poverty
Demographic changes: aging and growth of cities
Epidemiological changes: continuing high incidence of infectious diseases; increasing incidence of non- communicable diseases, injuries and violence
Global environmental threats to human survival
New technologies: information and telemedicine services
Advances in biotechnology
Globalization of trade, travel and spread of values and ideas

19. GOALS AND TARGETS OF HFA
An increase in life expectancy and in the quality of life for all
Improved quality in health between and within countries
Access for all to sustainable health systems and services
An initial set of targets will guide the implementation of the HFA policy and define priorities for action for the first two decades of the 21st century

20. THE PRINCIPALS OF HEALTH PROMOTION IN THE OTTAWA CHARTER (1986)
Building a healthy public policy
Creating supportive environment
Developing personal skills
Strengthening community action
Reorienting health services

21. PHC in the 21st Century: Policy Objectives to Reinforce the PHC Approach
Make health central to development and enhance prospects for intersect oral action
Combat poverty as a reflection of PHCs concern for social justice
Promote equity in access to health care
Build partnerships to include families, communities and their organizations
Reorient health systems towards promotion of health and prevention of disease

22. Sustainable Health Systems: Some Essential Components
Attach greater emphasis to comprehensive quality health care throughout the life span
Ensure equitable access to the original eight PHC elements
Expand PHC elements in response to identification of new threats of health, and opportunities to tackle these threats

23. Essential Health System Functions that Complement and Support PHC
Provide sustainable financing of PHC
Invest in human and institutional capacity for health
Optimize private and public sector support for PHC through appropriate regulations
Strengthen research to support and advance PHC
Implement global, national and local surveillance and monitoring systems