The declaration of Alma-Ata

THE DECLARATION OFALMA-ATA On 12 September 1978, at Alma-Ata in Soviet Kazakhstan, representatives of 134 nations agreed the terms of a solemn Declaration pledging urgent action by all governments, all health and develop- ment workers, and the world community to pro- tect and promote the health of all the people of the world . The climax of a major International Conference on Primary Health Care, jointly spon- sored by wHo and UNI CEF, this Declaration stated : 1 The conference strongly reaffirms that health, which is a state of com- plete physical , mental and social wellbeing, and not merely the ab- sence of disease or infirmity, is a fundamental human right and that the attainment of the highest poss- ible level of health is a most impor- tant world-wide social goal whose realisation requires the action of many other social and economic sec- tors in addition to the health sector. 2 The existing gross inequality in the health status of the people, particu- larly between developed and devel- oping countries as well as with in countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries . 3 Economic and social develop- ment, based on a New International Economic Order, is of basic impor- tance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed coun- tries . The promotion and protection of the health of the people is essen- tial to sustained economic and social development and contributes to a better quality of life and to world peace. 4 The people have the right and duty to participate individually and collec- 16 tively in the planning and implemen- tation of their health care . 5 Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social mea- sures. A main social target of gov- ernments, international organiza- tions and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will per- mit them to lead a socially and eco- nomically productive life . Primary health care is the key to attaining this target as part of development in the spirit of social justice. 6 Primary health care is essential health care based on practical , scien- tifically sound and socially accept- able methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and coun- try can afford to maintain at every stage of the ir development in the spirit of self-reliance and self-deter- mination . lt forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. lt is the first level of con- tact of individuals, the family and community w ith the national health system, bring ing health care as close as possible to where people live and FOOD AND NUTRITION The family's food schould be ade- quate, affordable and balanced in nutrients MATERNAL AND CHILD CARE Healthy mothers are more likely to · have healthy children ENDEMIC DISEASES Killer diseases like malaria and schistosomiasis can be prevented ESSENTIAL DRUGS The most-needed drugs should be available and af- fordable by all EDUCATION Literate and in- formed mothers are better moth- ers . The same is true for fathers WATER SANITATION A safe water supply and clean disposal of wastes are vital IMMUNIZATION Many of the dis- eases that kill children by the millions are preventable ILLNESS AND INJURY Treating common ailments and inju- ries - all part of primary health care . WoRLD HEALTH, Aug./Sept. 1988 i i , I work, and constitutes the f irst ele- ment of a continuing health care process. 7 Primary health care : 1. reflects and evolves from the economic conditions and socio-cu l- tural and political characteristics of the country and its communities, and is based on the application of the relevant results of social, biomedical and health services research and public health experience; 2. addresses the main health prob- lems in the community, providing promotive, preventive, curative, and rehabilitative services accordingly; 3. includes at least: education con- cerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an ade- quate supply of safe water and basic sanitation; maternal and child health care, including family planning; im- munization against the major infec- tious diseases; prevention and con- trol of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs; 4. involves, in addition to the health sector, all related sectors and as- pects of national and community de- velopment, in particular agriculture, animal husbandry, food , industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; 5. requires and promotes maximum community and individual self-reli- ance and participation in the plan- ning, organization, operation and control of primary health care, mak- ing fullest use of local, national and other available resources, and to this end develops through appropriate education the ability of communities to participate; 6. should be sustained by integrat- ed, functional and mutually-support- ive referral systems, leading to the progressive improvement of com- prehensive health care for all, and giving priority to those most in need ; 7. relies, at local and referral levels, on health workers, including physi- cians, nurses, midwives, auxiliaries and community workers as applica- ble, as well as traditional practitio- ners as needed, suitably trained so- cially and technically to work as a W oRLD HEALTH, Aug./Sept. 1988 This little Zimbabwean doesn 't appreciate his routine weigh-in, conducted by a mobile PHC team. Photo WHO/L. Taylor health team and to respond to the expressed health needs of the community. 8 All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a com- prehensive national health system and in coordination with other sec- tors . To this end, it will be necessary to exercise political will, to mobilise the country's resources and to use available external resources rationally. 9 All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country . In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and op- eration of primary health care throughout the world. 10 An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's re- sources, a considerable part of which is now spent on armaments and military conflicts . A genuine poli- cy of independence, peace, detente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the accelera- tion of social and economic develop- ment of which primary health care, as an essential part, should be allot- ted its proper share. * * The International Conference on Primary Health Care calls for urgent and effective national and interna- tional action to develop and imple- ment primary health care throughout the world and particularly in develop- ing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. lt urges governments, WHO and UNICEF, and other international organ- izations, 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 calls on all the afore- mentioned to collaborate in introduc- ing, developing and maintaining pri- mary health care in accordance with the spirit and content of this Declaration. • 17