The WHO has seen significant changes in its policies and vision during the last three decades. A ‘comprehensive’ approach to the factors which determine people’s health has been squeezed out by narrow, technology-focused, disease-specific activities.
What is the ‘Alma-Ata Declaration’?
One of the milestones in international health was a set of principles outlined in the ‘Declaration of Alma-Ata’. These non-binding principles were proclaimed at the UN Conference on Primary Health Care that met in Alma Ata (now Almaty, in Kazakhstan) in 1978.
Why is the ‘Alma-Ata Declaration’still so important?
The declaration sets out a comprehensive approach to people’s health. Health was addressed as not primarily a medical challenge but one requiring political and economic justice in a demilitarised and peaceful world.
Health was defined as fundamentally an issue of human rights. Healthcare was not just the responsibility of the health sector but of all sectors and all people.
What are the principles it sets out?
The principles include:
- The importance of a comprehensive, multi-sectoral approach to health, including recognition of the need to improve families’ food security, promote women’s literacy and increase access to clean water, for example.
- Within the health sector, promotion of better integrated services, with facilities providing a range of services, programmes and levels of care.
- The principle of equity, such as correcting the neglect of rural populations and of socially and economically marginalised groups.
- The use of appropriate technology and care that is socially and culturally acceptable.
- Appropriate and effective community involvement.
- Affirming health as a human right and stressing the responsibility of governments to deliver what is required.
- Calls for peace, reduced military expenditure, and a New International Economic Order based on social justice. Today this would without doubt include addressing issues of climate change and environmental sustainability.
The declaration included a vision of ‘Health for All’ by the year 2000.
In recent years the Alma Ata vision has been undergoing something of a revival, helped by recognition of its 30th anniversary in 2008. It remains a powerful motivating force for people concerned about the persistent inequities and injustices in global health.
What is ‘selective primary health care’?
In tension with the comprehensive approach, some felt that it was best to start using a few cost-effective interventions to deliver what is known as ‘selective primary health care’, especially where health systems were weak.
This led to a rise in a more targeted approach using specific interventions, such as vaccinations against particular diseases, with more directly measurable results. A famous example is the UNICEF (United Nations Children’s Fund) strategy that focused on four inexpensive interventions (growth monitoring, oral rehydration, promotion of breastfeeding and immunisation, known as GOBI).
While some of these interventions had impressive results, they didn’t address the underlying causes of ill health. For example, clean water is a pre-requisite for safe and effective oral rehydration therapy.
How did the two approaches sit alongside each other?
The rise of the ‘selective approach’ led to tensions. Some regarded it as complementary to the spirit of Alma-Ata but others felt it to be contradictory. Personal leadership played a part. WHO Director-General Halfdan Mahler was a champion of the comprehensive approach. But after he stepped down from office in 1988 his successors proved less fond of this approach. The trend grew towards more narrow, technology-focused, disease-based activities – and less politically sensitive work.
Learn more about the World Health Organisation.
Last modified: 12/01/2011
