Alma Ata

Why Alma Ata

declaration?

1960,Health agencies finding

 Unequal distribution of Health
Services between Developed
&Developing countries, between
rich & poor within the same country
 Avenues of Health did not change
the Health status of people
The Joint WHO – UNICEF
international conference in 1978
at Alma-Ata (USSR)

Alma-Ata Declaration called on all the

governments to formulate national
health policies according to their own
circumstances to launch and sustain
primary health care as a part of
national health system.
The 30th World Health
Assembly
in May 1977 resolved
 “The main social target of
governments and WHO in the coming
decades should be the attainment by
all citizens of the world by the year
2000 AD of a level of health that will
permit them to lead a socially and
economically productive life.”

 HEALTH FOR ALL BY 2000 AD

“ Large numbers of the world’s
people, perhaps more than half,
have no access to health care at all,
and for many of the rest the care
they receive does not answer the
problems they have.”
-John Bryant in his book
“Health and the Developing World”
The Joint WHO – UNICEF
international conference in
1978
at Alma-Ata (USSR)
Declared that
 “The existing gross inequalities in
the status of health of people
particularly between developed and
developing countries as well as
within the countries is politically,
socially and economically
unacceptable.”
The Alma-Ata conference called for acceptance of the
WHO goal of

HEALTH FOR ALL

by 2000 AD

and ‘Primary Health Care’ as a way to achieve Health

For All.
It has all the hallmarks of primary health care
delivery which was first proposed by Bhore
committee in 1946.
 Alma-Ata Declaration called on all
the governments to formulate
national health policies according
to their own circumstances to
launch and sustain primary health
care as a part of national health
system.
The Alma-Ata conference
defined that
“Primary health care is essential health care
made universally accessible to individuals
and acceptable to them, through their full
participation and at the cost the community
and country can afford.”
Primary health care is equally valid for all
countries from the most to the least developed.
 The concept of primary
health care has been
accepted by all
countries as the key to
attainment health for all
by 2000 AD.
 It has been also
accepted as an integral
part of country’s health
system.
Elements of phc
 E – Education concerning health problems and the
methods of preventing and controlling them.
 L – Locally endemic disease control and prevention.
 E –Expanded programme of immunization.
 M – Maternal & child health and family welfare.
 E – Essential drug provision.
 N – Nutrition and food supply.
 T – Treatment of common diseases.
 S – Safe water supply & basic sanitation.
Principles of
primary health care
1. Equitable distribution
2. Community participation.
3. Inter-sectoral coordination
4. Appropriate technology
1)Equitable
distribution
 Health services must be shared equally by all
people irrespective of their ability to pay and
all must have access to health services.
At present health services are mainly
concentrated in the major towns and cities
resulting inequality of care to the people in
rural areas. The worst hit are the needy and
vulnerable groups of the population are in rural
areas & urban slums.
 Primary health care aims to
redress this imbalance by
shifting the centre of gravity
of health care system from
cities to the rural areas and
bring this services as near
peoples homes as possible.
2) Community
participation
 The involvement of individual
families & communities in
promotion of their own health
and welfare is an essential
ingredient of primary health
care.
 PHC must be built on the
principle of community
participation.
 The use of village health
guides and trained dais
3) Intersectoral coordination
 PHC cannot be provided by health sector alone.
 Primary health care involves in addition to the health
sector all related sectors and aspects of national and
community development.
 To achieve such cooperation countries may have to review
their administrative system, reallocate their resources and
introduce suitable legislation to ensure that coordination
can take place.
 The important element of intersectoral approach is
planning with the other sectors to avoid unnecessary
duplication of activities.
4)Appropriate
technology
 Has been defined as technology that is
scientifically sound, adaptable to local
needs and acceptable to those who apply
it and for those for whom it is used and
that can be maintained by the people
themselves in keeping with principles of
self reliance with resources the
community and country can afford.
Functions of PHC
 Medical care.
 MCH including family planning.
 Safe water supply & basic sanitation.
 Prevention & control of endemic diseases.
 Collection & reporting of vital statistics.
 Education about health.
 National health programme as relevant.
 Referral services.
 Training of health guides health workers local dais
and health assistants.
 Basic laboratory services.
 It must be emphasized that primary
health centers establishment is
valuable national asset.
 Their establishment is fruit of several
years of great efforts to increase the
outreach of the health services.
 We can say the that primary health care is
qualitatively a different approach to deal
with health problems of community.
 Primary health care approach starts with
people themselves.
 “PHC has been described as health by
people, placing peoples health in
peoples hands.”
National Health Policy
-1983
 NHP 1983 stressed the need for providing
primary health care with special emphasis on
prevention, promotion and rehabilitation
 Suggested planned time bound attention to
the following
i) Nutrition, prevention of Food
Adulteration
ii) Maintenance of quality of drugs
iii) Water supply and sanitation
iv) Environmental protection
v) Immunization programme
vi) Maternal and child health services
vii) School health programme and
viii) Occupational health services.
 For better programme
planning NHP 1983
recommended an effective
Health Information System.
National Health Policy
2002
Objectives:
 Achieving an acceptable standard of
good health of Indian Population,
 Decentralizing public health system by
upgrading infrastructure in existing
institutions,
 Ensuring a more equitable access to
health service across the social and
geographical expanse of India.
 Enhancing the contribution of private
sector in providing health service for
people who can afford to pay.
 Giving primacy for prevention and first
line curative initiative.
 Emphasizing rational use of drugs.
 Increasing access to tried systems of
Traditional Medicine
Goals – NHP 2002
1. Eradication of Polio & Yaws 2005

2. Elimination of Leprosy 2005

3. Elimination of Kala-azar 2010
4. Elimination of lymphatic Filariasis 2015
5. Achieve of Zero level growth 2007
of HIV/AIDS
6.Reduction of mortality by 50%
2010
on account of Tuberculosis,
Malaria, Other vector and
water borne Diseases
7.Reduce prevalence of blindness
2010
to 0.5%
 8. Reduction of IMR to 30/1000 & 2010
MMR to 100/lakh
9. Increase utilisation of public 2010
health facilities from current
level of <20% to > 75%
10. Establishment of an integrated 2007
system of surveillance,
National Health Accounts and
Health Statistics
11.Increase health expenditure 2010
by government as a % of
GDP from the existing
0.9% to 2.0%
12. Increase share of Central 2010
grants to constitute at least
25% of total health spending
13. Increase State Sector 2005
Health spending from
5.5% to 7% of the budget
14. Further increase of 2010
State sector
Health spending
from 7% to 8%
Urban health
 Migration has resulted in urban growth
which is likely to go up to 33%.
 It anticipates rising vehicle density
which lead to serious accidents.
 In this direction, 2002 NHP has
recommended an urban primary health
care structure as under;
First Tier:-
 Primary centre cover 1 Lakh population
– It functions as OPD facilities.
– It provides essential drugs.
– It will carry out national health programmes.
Second Tier:-
 General Hospital a referral to primary centre
provides the care.
 The policy recommends a fully equipped hub-
spoke trauma care network to reduce accident
mortality.
Mental health
 Decentralized mental health service
for diagnosis and treatment by
general duty medical staff is
recommended.
 It also recommends securing the
human rights of mentally sick.
Information Education and
Communication

 NHP 2002 has suggested

interpersonal communication by
folk and traditional media to bring
about behavioral change.
 Associations of PRIs/NGOs/Trusts
are given specific targets.
 School children are covered for promotion of
health seeking behavior, which is expected
to be the most cost effective intervention
where health awareness extends to family
and further to future generation.
Health research
 2002 NHP noted the aggregate annual
health expenditure of Rs. 80,000 crores
and on research Rs. 1150 crores is quite
low.
 The policy envisages an increase in govt.
funded health resources to a level of 1%
total health spending by 2005 and upto 2%
by 2010.
 New therapeutic drugs and vaccines for
tropical disease are given priority.
Health statistics
 NHP 2002 has recommended full baseline
estimate of tuberculosis, malaria and
blindness by 2005, and
 In the long run for cardiovascular diseases,
cancer, diabetes, accidents, hepatitis and
G.E.
 It has suggested a national health accounts
conforming to the source to users matrix.
Women's health
 After recognizing the catalytic role of
empowered women in improving the overall
health standard of the country, NHP 2002 has
recommended to meet the specific
requirement of women in a more
comprehensive manner.
Medical ethics
 In India we have guidelines on professional medical ethics since
1960.
 This is revised in 2001.
 Government of India has emphasized the importance of moral
and religious dilemma.
 NHP 2002 has recommended notifying a
contemporary code of ethics, which is to be
rigorously implemented by Medical Council of India.
 The Policy has specified the need for a vigilant watch
on gene manipulation and stem cell research.
NHP 2002 has given a continuum to NHP
1983, where primary health care is
adopted as the main strategy through
– Decentralization
– Equity
– Private sector/indigenous system participation
– Rise in public investment
 The ultimate goal is achieving an
acceptable standard of good health of
people of India.
 The commitment of the service
providers and an improved standard of
governance is a prerequisite for the
success of any health policy.
Thank
you