From primary health care to universal health coverage—one step forward and two steps back

Abstract

Primary health care (PHC), codified at the historic 1978 Alma Ata Conference, was advocated as the means to achieve health for all by the year 2000. 1 WHOUNICEFDeclaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR. https://www.who.int/publications/almaata_declaration_en.pdfDate: 6–12 September 1978 Date accessed: June 28, 2019 Google Scholar The principles of PHC included universal access and equitable coverage; comprehensive care emphasising disease prevention and health promotion; community and individual participation in health policy, planning, and provision; intersectoral action on health determinants; and appropriate technology and cost-effective use of available resources. 2 Bryant JH Richmond JB Alma-Ata and primary health care: an evolving story. in: International encyclopedia of public health. Academic Press/Elsevier, Cambridge, MA2008: 152-174 Crossref Scopus (8) Google Scholar These principles were to inform health-care provision at all levels of the health system and the programmatic elements of PHC that focused primarily on maternal and child health, communicable diseases, and local social and environmental issues. PHC emphasised community participation through a network of workers at all levels who would be trained both “socially and technically”. 1 WHOUNICEFDeclaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR. https://www.who.int/publications/almaata_declaration_en.pdfDate: 6–12 September 1978 Date accessed: June 28, 2019 Google Scholar