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Primary Health Care

Dr. Adalia P. Amoyo


DECLARATION OF ALMA ATA DECLARATION OF ALMA ATA The declaration of Alma Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata), currently in Kazakhstan, 6-12 September 1978. It expressed 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. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of "Health for All". The Conference called 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. It urged governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non-governmental 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. The Conference called on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of the Declaration. The Declaration has 10 points and is non-binding on member states. Definition of health The first section of the declaration reaffirms the WHO definition of health. The definition seeks to include social and economic sectors within the scope of attaining health and reaffirms health as a human right.

Equity The declaration highlighted the inequity between the developed and the developing countries and termed it politically, socially and economically unacceptable.

Heal th as a so ci o-econo mi c issu e and as a hu man righ t The third section called for economic and social development as a pre-requisite to the attainment of health for all. It also declared positive effects on economic and social development and on world peace through promotion and protection of health of the people. Participation of people as a group or individually in planning and implementing their health care was declared as a human right and duty.

Role of the State This section emphasized on the role of the State in providing adequate health and social measures. This section enunciated the call for Health for all which became a campaign of the WHO in the coming years. It defined Health for All as the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. The declaration urged governments, international organizations and the whole world community to take this up as a main social target in the spirit of social justice.

Primary health care and components This section defined primary health care and urged signatories to incorporate the concept of primary health care in their health systems. Primary health care has since been adopted by many member nations. More recently, Margaret Chan, the Director-General of the WHO has reaffirmed the primary health care approach as the most efficient and cost-effective way to organize a health system. She also pointed out that international evidence overwhelmingly demonstrates that health systems oriented towards primary health care produce better outcomes, at lower costs, and with higher user satisfaction. The seventh section lists the components of primary health care. The next two sections called on all governments to incorporate primary health care approach in their health systems and urged international cooperation in better use of the world's resources.

The Declaration of Alma Ata outlined essential components of PHC such as principles of 1. E q u i t a b l e D i s t r i b u t i o n - Health services must be shared equally by all people irrespective of their ability to pay and all must have access to health services. Primary health care aims to address the current imbalance in health care by shifting the centre of gravity from cities where majority of the health budget is spent to rural areas where a majority of people live in most countries. 2. C o m m u n i t y P a r t i c i p a t i o n - there must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance if health services, beside the maximum reliance on local resources such as manpower, money and materials. 3. I n t e r s e c t o r a l c o o r d i n a t i o n - PHC 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, public works, communication and other sectors. A p p r o p r i a t e T e c h n o l o g y - is technology that is scientifically sound, adoptable to local needs, acceptable to those who apply it and for those whom it is used and can be

maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford Four Essential Components of PHC 1. Universal coverage by ensuring sufficient supply of medicines and services; removing financial barriers to access and ensuring health protection. 2. People-centred care by transforming traditional health care delivery models (specialist, procedure or hospital-based) into people-centred primary care networks. 3. Inclusive leadership by shifting from conventional command-and-control approaches, increasing participation of all stakeholder and moving from supplyled to demand-led policies and programmes. 4. Health in all policies by ensuring that all relevant sectors (e.g. labour, environment, education) factor health in their agendas.

LEGAL B ASIS I N THE PHIL I PPINES LEGAL B ASIS I N THE PHIL I PPINES Letter of Instruction 949 signed on October 19, 1970 by then President Ferdinand E. Marcos- one year after the first International Conference on PHC which was held in Alma Ata, USSR on September 6-12, 1978, sponsored by the WHO and UNICEF. LETTER OF INSTRUCTIONS NO. 949 TO : The Minister, Ministry of Health

WHEREAS, the Honorable Enrique M. Garcia has been recently appointed Minister of Health; WHEREAS, the attainment of health for all Filipino is both a means and an end of the overall national development program of the New Society; WHEREAS, the Ministry of Health is charged with the supervision and coordination of all health and health- related activities within the Philippines; WHEREAS, these health and health-related activities must be integrated with other activities of the overall national development program of the New Society; NOW, THEREFORE, I, FERDINAND E. MARCOS, President of the Philippines, by virtue of the powers vested in me by law, do hereby instruct the Minister of Health and all officials and personnel of the Ministry of Health to: 1. Design, develop and implement programs which will:

1.1. Focus on Health Development at the community level particularly in rural areas by. a) Strengthening health care delivery at primary levels and immediate support systems at secondary levels; b) Developing a strong primary health care system in coordination/cooperation with all the Ministries and agencies engaged in social, political and economic development; c) Lowering the cost of drugs; and d) Rotation and increase of medical service personnel 1.2. Effectively utilize these systems in order to control or eradicate the immediate and specific health problems confronting Filipino communities by: a) Strengthening and re-orienting existing specific programs in family planning, nutrition, malaria eradication, schistosomiasis control, cancer control, and others to conform to the thrust of the peripheral services; b) Development of a plan to eradicate tuberculosis by means of a strong program which will be integrated with the health development at community levels. 1.3. Redirect and re-orient the organization of all its agencies at the central level so as to provide efficient and adequate administrative, planning and other support services for health development by: a) Strengthening their staff functions and capabilities; b) Streamlining their programs of activities. 2. Review all projected expenditures within the Ministry's budget including those for projects funded from external sources, with the end in view of ensuring that the Ministry's financial resources are distributed according to priorities dictated by this Letter of Instructions. DONE in the City of Manila, this 19th day of October, in the year of Our Lord, nineteen hundred and seventy-nine.