Global Conference on Primary Health Care From Alma-Ata towards universal health coverage and the Sustainable Development Goals
Astana, Kazakhstan, 25 and 26 October 2018
Conferencia Mundial sobre Atención Primaria de Salud Desde Alma-Ata hacia la cobertura sanitaria universal y los Objetivos de Desarrollo Sostenible
Astaná (Kazajstán), 25 y 26 de octubre de 2018
Conférence internationale sur les soins de santé primaires d’Alma-Ata à la couverture sanitaire universelle et aux objectifs de développement durable , Astana, Kazakhstan, 25 et 26 octobre 2018
La Carta de los Pueblos para la Salud es una declaración de la visión compartida, los objetivos, los principios y los llamamientos a la acción que unen a todos los miembros de la coalición PHM. Es el documento de consenso sobre salud más ampliamente respaldado desde la Declaración de Alma Ata
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continue...s to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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Primary health care, as outlined in the 1978 Declaration of Alma-Ata and again 40 years later in the 2018 WHO/UNICEF document A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals, is a whole-of-government and whole-of-society a...pproach to health that combines the following three components: multisectoral policy and action; empowered people and communities; and primary care and essential public health functions as the core of integrated health services.(1) Primary health care-oriented health systems are health systems organized and operated so as to make the right to the highest attainable level of health the main goal, while maximizing equity and solidarity. They are composed of a core set of structural and functional elements that support achieving universal coverage and access to services that are acceptable to the population and that are equity enhancing. The term “primary care” refers to a key process in the health system that supports first-contact, accessible, continued, comprehensive and coordinated patient-focused care.
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Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute
both to a better quality of life and also to global peace a...nd security
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Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute
both to a better quality of life and also to global peace a...nd security
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The People’s Charter for Health is a statement of the shared vision, goals, principles and calls for action that unite all the members of the PHM coalition. It is most widely endorsed consensus document on health since the Alma Ata Declaration
Available in different languages
[Preface]. For more than forty years Primary Health Care (PHC) has been recognized as the cornerstone of an effective and responsive health system. The Alma-Ata Declaration of 1978 reaffirmed the right to the highest attainable level of health, with equity, solidarity and the right to health as its ...core values. It stressed the need for comprehensive health services, not only curative but services that addressed needs in terms of health promotion, prevention, rehabilitation and treatment of common conditions. A strong resolutive first level of care is the basis for health system development [...] The Pan American Health Organization/World Health Organization (PAHO/WHO) has supported the countries in the establishment of interprofessional PHC teams, in the transformation of health education and in building capacity in the strategic planning, and management of human resources for health. Nursing can play a critical role in advancing PHC. New profiles such as the advanced practice nurses, as discussed in this document, can be fundamental in this effort, and in particular, in health promotion, disease prevention and care, especially in rural and underserved areas.
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This South-East Asia Regional Strategy for Primary Health Care: 2022-2030 aims to accelerate progress in all countries of the Region towards universal health coverage (UHC), health security and the health-related Sustainable Development Goals (SDGs). It is intended to provide Member States with guid...ance on facilitating PHC-orientation through the identification of seven values and 12 strategic actions that collectively embody the philosophy and practice of PHC, enunciated in the 1978 Declaration of Alma-Ata and reaffirmed in the 2018 Declaration of Astana.
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Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 110
This report compiles evidence from published, grey literature and key informants on the UNMHCP
since its introduction in Uganda’s health system, and findings were further validated during a oneda...y
national stakeholder meeting.
Three main factors motivated introduction of the UNMHCP. First, Uganda, along with other lowincome countries, was unable to implement holistically the primary healthcare (PHC) concepts as set out in the Alma Ata Declaration. Second, the macro-economic restructuring carried out in the 1990s, which was an international conditionality for low-income countries to access development financing, influenced the trend towards more stringent prioritisation of health interventions as a means of rationing and targeting use of resources. Third, the government sought to achieve equity with a service package that would be universally available for all people.
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The essential medicines are those that meet the priority needs of the healthcare of the population. While reviewing the 5th edition of the essential Medicines, special attention focused on the health sector policy. Indeed, medicines play an important role in protecting, maintaining and restoring th...e peoples’ health and credibility of health facilities. Their availability is a fundamental aspect of primary health care as defined in different declarations including Alma-Ata of 1978.
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As countries aim to progress towards the Sustainable Development Goals (SDGs) and achieving universal health coverage, health inequities driven by racial discrimination and intersecting factors remain pervasive. Inequities experienced by indigenous peoples as well as people of African descent, Roma ...and other ethnic minorities are of concern globally; they are unjust, preventable and remediable.
Health systems themselves are important determinants of health and health equity. They can perpetuate health inequities by reflecting structural racism and discriminatory practices of wider society. For instance, systemic racism, implicit bias, misinformed clinical practice, or discrimination by health professionals contributes to health inequities. However, health systems can also be a leading force for tackling the inequities faced by populations experiencing racial discrimination.
Primary health care (PHC) is the essential strategy for reorientating health systems and societies to become healthier, equitable, effective and sustainable. In 2018, on the 40th anniversary of the Declaration of Alma-Ata, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) renewed the emphasis on PHC with their strategy,
WHO outlines 14 strategic and operational levers for policy-makers to strengthen PHC. Within each lever, there are multiple potential entry points for targeted actions to address racial discrimination, foster intercultural care, and reduce health inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities.
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Mientras los países se esfuerzan por avanzar hacia los Objetivos de Desarrollo Sostenible (ODS) y lograr la cobertura sanitaria universal, las desigualdades sanitarias provocadas por la discriminación racial y los factores interrelacionados siguen estando omnipresentes. Las desigualdades que sufre...n los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas son preocupantes a nivel mundial; son injustas, prevenibles y remediables
Los propios sistemas de salud son determinantes importantes de la salud y la equidad sanitaria. Pueden perpetuar las desigualdades sanitarias al reflejar el racismo estructural y las prácticas discriminatorias de la sociedad en general. En este sentido, el racismo sistémico (por ejemplo, relacionado con la ubicación de los servicios o los requisitos para acceder a ellos), los prejuicios implícitos, la práctica clínica mal informada o la discriminación por parte de los profesionales de la salud contribuyen a las desigualdades sanitarias. Ahora bien, los sistemas de salud también pueden convertirse en una de las principales fuerzas para combatir las desigualdades a las que se enfrentan las poblaciones que sufren discriminación racial.
La atención primaria de salud (APS) representa la estrategia esencial que permite reorientar los sistemas de salud y las sociedades para que sean más saludables, equitativos, eficaces y sostenibles. En 2018, al cumplirse el 40.º aniversario de la Declaración de Alma-Ata, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF) renovaron el énfasis en la atención primaria de salud con su estrategia sobre la atención primaria de salud en el siglo XXI.
La OMS ha señalado 14 mecanismos estratégicos y operacionales con los que los responsables políticos pueden reforzar la atención primaria de salud. Cada mecanismo dispone de múltiples puntos de partida posibles para emprender acciones específicas dirigidas a combatir la discriminación racial, fomentar la atención de salud intercultural y reducir las desigualdades sanitarias que sufren los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas
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Die Gesundheitskonferenz in Alma-Ata definierte 1978 Gesundheit als Menschenrecht. Man setzte auf Teilhabe und Basisgesundheitsdienste. Nun wird das Konzept wiederbelebt.
Глобальная конференция по первичной медико-санитарной помощи:от Алма-Атинской декларации к всеобщему охвату
услугами здравоохранения и Целям в области у стой чи...вого развития
Астана, Казахстан, 25 и 26 октября 2018 г.
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المؤتمر العالمي المعني بالرعاية الصحية الأولية
انطلاقاً من ألما- آتا صوب تحقيق التغطية الصحية الشاملة
وأهداف التنمية المستدامة