From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine.

Luis Pisco,Luiz Felipe Pinto

doi:10.1590/1413-81232020254.31222019

Abstract

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Highlights

In his book “A textbook of Family Medicine”, McWhinney, the father of Family Medicine in Canada[1,2], states that the profound changes that have occurred in Medicine can only be explained entirely if observed from a historical perspective, as they have always emerged in response to external influences, some scientific and technological, some social
Modern Family Medicine is one of many new disciplines that have developed throughout medical history
World Health Organization (WHO) proposes to achieve the “Health for All by 2000” goal through the implementation and development of “Primary Health Care” worldwide. This is defined as essential health care based on practical, scientifically sound, and socially acceptable 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 country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination

Summary

Introduction

In his book “A textbook of Family Medicine”, McWhinney, the father of Family Medicine in Canada[1,2], states that the profound changes that have occurred in Medicine can only be explained entirely if observed from a historical perspective, as they have always emerged in response to external influences, some scientific and technological, some social. Health centers and home-based services should be organized as per a regional model in which most health problems should be solved by physicians trained in General and Family Medicine.

Results

Conclusion