International primary care and the RCGP: the College’s role in global health

Abstract

In 1978 the World Health Organization (WHO) made a public declaration in Alma-Ata advocating the use of primary healthcare systems globally.1 Twenty-two years later the United Nations (UN) agreed eight Millennium Development Goals (MDGs) to be attained by 2015.2,3 Core to the delivery of them, although not explicitly mentioned, is the primary healthcare model as set out in the Alma-Ata Declaration. In 2008 the WHO Regional Office for Europe reiterated that effective primary health care was essential to the delivery of quality health services for individuals and populations by publishing the Talinn Charter.4 This too included a commitment to attain the Charter’s targets by 2015. As we approach the 2015 deadlines for both the MDGs and the Talinn Charter, governments and policy makers are increasingly interested in primary health care. At the Royal College of General Practitioners (RCGP) we observe this by a steadily growing number of international requests to support primary care development. We are entering a critical window of political activity in health funding and global health systems reform. The MDGs committed world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The goals related to the eradication of disease specifically drew international attention to communicable diseases (including HIV/AIDS, malaria, and tuberculosis) and focused resources on vertical models of health care for disease-specific diagnoses and treatment. This diverted attention away from the implementation of a horizontal model of primary health care with its less immediate yet longer-term benefits as demonstrated so clearly by Barbara Starfield.5 This imbalance in systems reform was recognised in 2012 when the UN General Assembly published a political declaration on the prevention and control of non-communicable diseases (NCDs).6 The document acknowledges the need to address the …