Ten principles of health

nursing leadership has been gener- ally responsive to the problems and possibilities represented by HFA, and this is reflected in their litera- ture and programmes. In the field, where there is a public health and PHC orientation, nursing is often the mainstay of the service. Ten years since Alma-Ata It is now clear that the concepts and principles of HFA elaborated at Alma-Ata in 1978 provided the world with ethical precepts, politi- cal imperatives and technical direc- tions that have since become criti- cal guidelines for the health and development community world- wide. What has been surprising is how widely HFA has been accepted and used, in whole or in part, by health policy-makers, programme plan- ners, funding organizations, poli- ticians, health personnel, school teachers, newspaper reporters, pro- fessors, mothers, schoolchildren. A further surprise is how influential it has been in the policies and pro- grammes of the developed coun- tries, given the initial concern that the more affluent part of the world would consider HFA as applying to poor countries only. Less surprising, but no less grati- fying has been the general accep- tance of the HFA strategy by the poorer countries as they have used it in formulating their national and regional strategies. Here is the acid test of HFA. The quest for HFA will not end, not at the year 2000, nor at the year 2100. No country solves all of its health problems, and new prob- lems continue to emerge in every country. So while the goal of HFA remains unchanging, the targets will shift, from those suited for the decade preceding the year 2000 to those relative to future times and places. Here, at the midpoint be- tween Alma-Ata and the year 2000, our goals should be: - to identify the critical challenges to be met between now and the turn of the century; - to show that headway can be made against the most solution- resistant problems; - to lay the groundwork for appro- priate changes of strategy neces- sary to consolidate the pursuit of HFA beyond the year 2000. • W ORLD HEALTH, Aug ./Sept. 1988 Ten principles of health The 22 senior health experts who met at Riga renewed their commitment to the principles of Health for all (HFA), and recommended that - in order to acceler- ate progress towards that goal - coun- tries should : 1. Maintain HFA as a permanent goal of all nations up to and beyond the year 2000 Reaffirm Health for all as a permanent objective of all nations, as stressed in the Alma-Ata Declaration, and establish a process for examining the longer term challenges to Health for all that will ex- tend into the 21st century. 2. Renew and strengthen HFA strate- gies Each country should continue to moni- tor its own health problems and develop its own health strategies in the spirit of . Health for all. This will reveal its most pressing health problems and identify the most seriously underserved and vulnerable populations. Programmes should be directed towards those popu- lations in the spirit of equity, inviting their active participation . in the development and implementation of the strategies. 3. Intensify social and political action for HFA Intensify social and political actions necessary to support shifts in policy and allocation of resources required to pro- ~ gress toward Health for all, including the involvement of other sectors, non-gov- ernmental organizations, communities and other interested groups. Seek mech- anisms for promoting new partnerships for health among them and with government 4. Develop and mobilize leadership for HFA Give strong emphasis in every country to developing and stimulating the inter- Motorbike transport for a midwife in Thailand - a potential "leader" in the drive for Health for all. est and support of current and potential leaders in health and other sectors, at community district and national levels, in order to bring creativity, advocacy, com- mitment and resources to bear on the challenge of health development. 5. Enable the people to share in deci- sion-making and action for health Empower people by providing infor- mation, technical support, and decision- making possibilities, so as to enable them to share in the opportunities and responsibilities for action in the interest of their own health. Give special atten- tion to the role of women in health and development 6. Make intersectoral collaboration a force for HFA Support the creation of sustained in- tersectoral collaboration for health by in- corporating health objectives into sec- toral policies and activating potential mechanisms at all levels . 7. Strengthen district health systems based on PHC Strengthen district health systems based on primary health care, as a key action point for focusing national poli- cies, resources and local concerns on the most pressing health needs and un- derserved people. 8. Plan, prepare and support health manpower for HFA Change educational and training pro- grammes for health personnel empha- sising relevance to health services requirements by locating learning experiences in functioning health sys- tems based on primary health care. F;iro- vide strong moral and resource support for personnel, particularly those working in remote or difficult circumstances. 9. Ensure development and rational . use of science and appropriate technology Emphasise the applications of science and appropriate technology to the critical health problems that threaten popula- tions in all parts of the world, and strengthen research capacities of Third World countries, with emphasis on re- search aimed at improving the health of the most deprived people. 10. Overcome problems that con- tinue to resist solution Establish priority programmes aimed at overcoming serious problems where underdevelopment or disturbances of development are major contributing fac- tors and progress has been very limited, such as: high infant, child and maternal mortality rates ; substance abuse, such as tobacco and alcohol ; and the imbal- ance between population growth and environmental and socio-economic re- sources. Develop improved approaches through primary health care emphasising intersectoral action . • 15