From Alma Ata to the year 2000: reflections at the midpoint

168 Pages·2013·2.92 MB·English

The World Health Organization is a specialized agency of the United Nations with
primary responsibility for international health matters and public health. Through this
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From Alma-Ata to
the Year 2000:
Reflections at the midpoint
World Health Organization
Geneva 1988
ISBN 92 4 156124 6
© World Health Organization 1988
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Contents
Preface by Dr John H. Bryant v
Alma-Ata: the beginning
The background to Alma-Ata 3
Address by Dr H. Mahler, Director-General of WHO,
to the International Conference on Primary Health
Care, Alma-Ata, 6 September 1978 4
Declaration of Alma-Ata 7
Riga: Alma-Ata revisited
The background to Riga 13
From Alma-Ata to the year 2000: reflections at the
midpoint on progress and prospects 14
Introduction 14
Health for all-principles and imperatives 15
Health for all-wistful dream or living reality? 18
Health for all-successes and failures, gains and losses 20
Looking ahead-priority choices 29
Fresh strategies for a new era 34
Dr Mahler's eight questions asked at Alma-Ata 60
Conclusions 62
Alma-Ata reaffirmed at Riga 72
Preface 72
Introduction to the actions at Riga 72
The permanence of health for all 74
Intensifying social and political action for the
future-Agenda 2000 75
Accelerating action for health for all-Agenda 2000 81
Special priority initiative in support of the least developed
countries by WHO and the international community 86
Forty-first World Health Assembly
The significance of the Forty-first World Health Assembly 89
World health-2000 and beyond 91
Address by Dr H. Mahler, Director-General, to the World
Health Assembly, 3 May 1988 91
iii
From Alma-Ata to the Year 2000
Remarks by Dr H. Mahler, Director-General, to the World
Health Assembly on the fortieth anniversary of WHO,
4 May 1988 98
Remarks by Dr H. Nakajima, Director-General Elect, to the
World Health Assembly, 4 May 1988 101
Technical Discussions on Leadership Development for Health
for All, 5-7 May 1988 104
The background of the Technical Discussions 104
Report of Dame Nita Barrow, General Chairman of the
Technical Discussions, to the World Health Assembly,
9 May 1988 (extracts) 106
Round table debate on the tenth anniversary of Alma-Ata,
9 May 1988 (extracts) 110
Farewell remarks by Dr H. Mahler, Director-General, to the
World Health Assembly, 9 May 1988 126
To the year 2000 and beyond
The tasks before us 131
Actions recommended at Riga: focal points for future
concern and action 133
Special priority initiative by WHO and the international
community in support of the least developed countries 143
A twofold agenda for the year 2000 and beyond 145
A new form of international dialogue? 148
References 149
Annex 1. Resolution WHA41.34: Strengthening primary health care 152
Annex 2. Resolution WHA41.26: Leadership development for
Health for All 155
iv
Preface
The International Conference on Primary Health Care, held in Alma-Ata,
USSR, in 1978, was convened in response to an international sense of despair
over the widespread inequities in health and health care that afflicted all nations
of the world, developed as well as developing. The conference responded with
a call for radical change in both the content and design of health services, so
that there would be equity in health services through primary care, thus giving
rise to the highly symbolic goal of WHO - Health for All by the Year 2000.
The pronouncement from Alma-At a had an immediate effect on the global
strategies of WHO and has dominated its policies and programmes ever since.
There was a somewhat delayed but nevertheless substantial impact on the
health policies of the Member nations, other international organizations and
nongovernmental organizations. What has been less certain is whether or not
there have been improvements in health following these policy changes. What
in fact has been the effect of Alma-Ata on the health of the people of the
world? Have the pronouncements of Alma-Ata, the strategies of WHO, and
the commitments to health for all of the Member States had a significant impact
on health? Or has there been more rhetoric than reality, more ceremony than
commitment?
This is far more than academic questioning. The health conditions of the poor
and deprived, who exist in virtually all countries, and the costs in terms of
human suffering and national underdevelopment are so extreme that the ques
tion of whether the global public health movement that began in Alma-Ata
is viable or not is of the highest international significance.
The year 1988, ten years after Alma-Ata, is roughly half-way to the turn of
the century. WHO, UNICEF and other interested parties decided that it was
an appropriate time to review what has happened since Alma-Ata and what
the prospects appear to be for the year 2000 and beyond. The Government
of the Soviet Union agreed to host a return meeting, this time in Riga, capital
of the Latvian Republic of the USSR. The meeting at Riga was undertaken
as an assessment: "From Alma-Ata to the Year 2000 - a midpoint perspec
tive". That meeting was held in March 1988, and its conclusions were forward
ed to the World Health Assembly in May of that year.
The Forty-first World Health Assembly, to which all the Member countries
of WHO were invited to send delegates, took place in May 1988 and included
several relevant events:
v
From Alma-Ata to the Year 2000
• The document from Riga was received and considered by the
Assembly.
• The Assembly celebrated the fortieth anniversary of the World Health
Organization.
• A round table debate took place on the tenth anniversary of Alma-Ata,
bringing together a distinguished group of people to make their obser
vations on issues that followed from that historic meeting.
• The Technical Discussions held during the World Health Assembly
were on the subject of Leadership for Health For All, a question close
ly related to the principles and the prospects of Alma-Ata.
The outcome of these discussions together with background materials form
a substantial documentation of the views of many countries, organizations and
individuals, as well as of the staff of WHO, UNICEF and other organizations
within the United Nations system.
The purpose of this publication is to bring together the relevant papers, ideas,
comments and questions pertaining to Alma-Ata and the problems and pros
pects associated with it. Efforts have been made to identify key ideas, problems
and trends that might help those committed to the spirit of Alma-Ata not
only to understand what has been happening but also to look ahead to the
prospects for health for all through primary health care.
Many people within and outside WHO assisted the development of this
publication. It found its roots in Riga, grew to maturity during the Forty-first
World Health Assembly, and developed further in the weeks thereafter. The
inspiration and the source of many of the most important ideas described here
was, of course, Dr Halfdan Mahler, Director-General of WHO from before
Alma-Ata to 1988. Important contributions were made by Dr E. Tarimo,
Dr J. D. Martin, Dr D. L. Smith, and other staff of the WHO Headquarters
Division of Strengthening of Health Services, including Mrs A. G. Pollinger,
Mrs C. Allaman and Mrs C. Riley.
I also wish to express my appreciation to my colleagues from the Aga Khan
University, Karachi, who were part of our working group at the World Health
Assembly, and contributed in so many ways: Dr Mumtaz Husain, Dr Rafat
Hussain, Dr Shireen Noorali, Dr Farid Midhet and Dr Asif Aslam, and our
staff in Karachi, Gulshan Rajani and Darvesh Ali.
John H Bryant, MD.
Professor and Chairman
Department of Community
Health Sciences,
Aga Khan University,
Karachi, Pakistan
vi
Alma-Ata: the beginning