Declaration on primary health care adopted at global conference

Astana, Kazakhstan

Forty years after World Health Organisation (WHO) highlighted the importance of primary health care in tackling health inequality in every country, through the historical Alma Alta Declaration, global health leaders converged in Kazakhstan to renew the declaration.

The leaders are also reassessing and reflecting on the reasons for the slow progress and the implications for today’s health systems.

Convened by the international health agency and the United Nations Children’s Fund (Unicef), the Alma Ata conference drew an estimated 1,200 delegates and representatives from different countries, international organisations, and many non-governmental organisations.

But 40 years on, almost half the world’s population lacks access to essential health services, and 100 million people are pushed into extreme poverty by the costs of paying for care out of their own pockets, said WHO’s Director General Dr Tedros Tedros Adhanom Ghebreyesus.

“The truth is, we have allowed the vision of health for all to become too small, too diluted. We have allowed ourselves to become too focused on fighting specific diseases, at the expense of strengthening health systems,” he went on.

According to Dr Tedros, there is still a 31-year discrepancy between the countries with the shortest and longest life expectancies. Some people enjoy the benefits of cutting edge medical technologies, while others don’t have the basics.

The new declaration for the first time acknowledge the need to create decent work and appropriate compensation for health workers working at the primary health care level. It also puts emphasis on investing in the education, training, recruitment, development, motivation and retention of the workforce, with an appropriate skill mix.

On Thursday, United Nations 193 Member States unanimously vowed to strengthen their primary health care systems as an essential step toward achieving universal health coverage. This commitment is part of the agreed to the Declaration of Astana 2018, which seeks to reaffirm the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care.

“This declaration, and the commitment it represents, lay a path for a healthier, more prosperous world, where quality, affordable health services are easily accessible to all,” noted UNICEF Executive Director Henrietta Fore.

To do this, leaders, among them a Kenyan delegation led by Health Ministry’s Cabinet Secretary Sicily Kariuki and Universal Health Coverage co-chair and Amref CEO Dr Githinji Gitahi, agreed that to achieve an efficient health system, a multi-sectoral action that includes technology, scientific and traditional knowledge, along with well-trained and compensated health professionals, and people and community participation is needed.

This will strengthen primary health care and provide quality “health for all”, the World Health Organisation said in its Astana Declaration on Primary Health Care released in the Kazakhstan capital.

After years of relative neglect, the WHO has recently given strategic prominence to the development of primary health care. Also known as PHC, Primary health care is a concept tailored to care for people, rather than simply treating specific diseases or conditions.

The WHO defines primary healthcare (PHC) as the first point of contact for individuals within a healthcare system, noting that it should “provide comprehensive, accessible, community-based care that meets the health needs of individuals throughout their life”.

It further notes that PHC ranges from health promotion to palliative care that can meet 80-90 per cent of an individual’s health needs over the course of their life.

Every few weeks a news headline pops up that one of the referral hospitals in Kenya is reeling with patients. Little wonder that the recent report on the congestion at Kiambu Level 5 Hospital caused merely minor ripples in the form of public outrage.

Even with the Treasury recently allocating Sh2 billion to free primary healthcare, more patients still prefer referral hospitals to their local clinics and health centres. On paper, patients are encouraged to visit the health centre nearest to their homes as their primary point of contact.

To strengthen the primary health care, Unicef, through its country representative Werner Shultink in August pledged Sh15 billion ($150 million) to support Kenya’s Universal Health Care programme through immunization and nutrition programs in the next four years.

Early efforts at expanding primary health care in the late 1970s and early 1980s were overtaken in many parts of the developing world by economic crisis, sharp reductions in public spending, political instability, and emerging disease.