Alma-Ata at 40 Years: Reflections from the Lancet Commission on Investing in Health

In 2013, the Lancet Commission on Investing in Health published its report, “Global health 2035: a world converging within a generation” (GH2035). The report concluded that a grand convergence in health—a reduction in infectious, child, and maternal mortality to rates seen in the best-performing middle-income countries—is technically and financially feasible for all but the poorest countries by 2035. Mortality from non-communicable diseases could be reduced through inexpensive population-based and clinical interventions, especially fiscal policies such as heavy tobacco taxation. Pro-poor pathways to universal health coverage, such as publicly financed insurance, would provide financial protection and essential health-care interventions to everyone—ensuring high-quality, low-cost services at the point of care. And the returns on investing in health, based on methods that include both the benefits of improved economic productivity and the intrinsic value of health, would far exceed the costs. Putting nursing and midwifery at the heart of the Alma-Ata visionThe Alma-Ata vision of a health system rooted in primary health care, which is person-centred and multisectoral, is as relevant now as it ever was. Nursing and midwifery can play a more central part in making this vision a reality. The health workforce has always been central to the 1978 Declaration of Alma-Ata that recognised the important role of health workers in achieving this vision.1 More recently, the World Health Assembly adopted resolutions on the Global Strategy on Human Resources for Health in 20162 and the Working for Health 5-year action plan in 20173 that committed countries to develop a primary health care workforce responsive to population needs as part of universal health coverage. Full-Text PDF Reform of primary health care in PakistanWith a neonatal mortality rate exceeding 45 per 1000 livebirths, a UNICEF report ranked Pakistan as the riskiest place to be born on earth.1 Although the recent Demographic and Health Survey indicates that the situation has improved, the neonatal mortality rate in Pakistan is among the highest in the world.2 Other health indicators, particularly those pertaining to maternal and child health and nutrition, are worse than other countries in the region with comparable or lower socioeconomic indicators. Full-Text PDF Primary health care and universal health coverage: competing discourses?In October, 2018, WHO celebrates 40 years since the International Conference on Primary Health Care (PHC) and offers a renewed vision of PHC—building on, but not replacing, the Declaration of Alma-Ata.1 In those four decades, PHC has faced challenges. Undermined early by the divisive selective-comprehensive debate, PHC was marginalised by structural adjustment and sectoral reforms in the 1990s.2 PHC was, however, acknowledged in the World Health Report 2000 Health Systems: Improving Performance as a precursor of the new universalism: “high quality delivery of essential health care, defined mostly by the criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor”. Full-Text PDF How primary health care can make universal health coverage a reality, ensure healthy lives, and promote wellbeing for all40 years on from the Declaration of Alma-Ata in 1978,1 primary health care (PHC) is at a defining moment. Progress in the uptake of PHC across the world has contributed to raising global standards of health care and improving health, including a revolution in child survival and dramatic improvements in life expectancy. However, we are still far from addressing the determinants of health and the growing health needs of the 21st century and from realising a vision for health supported by health systems oriented around PHC. Full-Text PDF Primary health care for the 21st century, universal health coverage, and the Sustainable Development GoalsGood health and wellbeing are fundamental to the prosperity of societies. By many measures, modern humanity enjoys better health than earlier generations.1 But the benefits of modern health care are not accessible to all. Even as the incidence of infectious diseases such as HIV, tuberculosis, and malaria are reduced, many countries struggle to cope with the growing burden of non-communicable diseases, and the complex and growing health needs of ageing populations.2,3 Full-Text PDF Investing in leadership for universal health coverageOn Sept 23, our sights focus once again on universal health coverage (UHC), and, in the words of the partnership organisation UHC2030 , on “the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC and sustain health investments in a harmonised manner”. The UN High-Level Meeting, ahead of the 74th UN General Assembly in New York, will see governments debate and commit to a high-level political declaration , and as WHO Director-General Tedros Adhanom Ghebreyesus has said on many an occasion, UHC is a political choice. Full-Text PDF Open AccessThe Astana Declaration: the future of primary health care?Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge. Half the world's population has no access to the most essential health services. Yet 80–90% of people's health needs across their lifetime can be provided within a primary health-care framework—from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care. As populations age, and multimorbidity becomes the norm, the role of primary health-care workers becomes ever more important. Full-Text PDF