Primary Heealth Care Development: Where is Nepal after 30 years of Alma Ata Declaration??

N Jha,R Karkee

doi:10.31729/jnma.130

Abstract

The year 2008 has witnessed the global conversation to return to tenets of Alma-Ata and to review its 30 years of journey. We reviewed Nepal's journey on Primary Health Care development: policy formulation, structure development, progress and constraints. Though Nepal has institutionalised the PHC approach in health policy, strategy and health care delivery system, this has not been effectively translated into actions, and the results are mixed. Nepal has gained impressive achievements in selective primary health care markers: 45.43% maternal mortality and 62.34% child mortality reduction during 1990-2005. But gain in comprehensive health care markers is not impressive: 18.7% Skilled Birth Attendant (4% in poorest quintile and 45% in richest quintile), 39% having access to improved sanitation and 55.7% of females are literate as compared to males. Socio-political environment until recently was not favourable for comprehensive primary health care, allowing limited health sector decentralisation and community empowerment. Health activities were focussed more on selective health care strategy in the form of disease control, immunisation, vitamin A supplementation, oral rehydration solution use and contraceptive use. Nepal's rural hilly geography posed great challenge on logistic supply, communication and retention of health workers rendering public health centres of low quality with negative perceptions of consumers. Nepal is on the pathway to build equitable comprehensive primary health care.

Highlights

There is worldwide voice to return to tenets of Alma Ata as a solution to current crisis in health: increasing demands, rising costs, weak health systems and increasing disparity in health across globe and within country among rural/urban, male/female, and rich/poor.[5,6]
Primary health care strategy is once again reaffirmed as the best methods to achieve equitable, affordable and sustainable health care and promising way to achieve millennium development goals locally, nationally and globally.[6,7]. This renewed interest in comprehensive primary health care (PHC) has obviously recognised the importance of contents of Alma Ata declaration: the basic eight elements of essential health care, which can result a quality of life by fostering social development of any community and nation
We reviewed Nepals journey on PHC development: policy formulation, structure development, progress and constraints with recommendations for future

Summary

INTRODUCTION

The year 2008 has witnessed the plethora of events to analyse three decades of PHC activities.[1,2] During the 30 years of primary health care (PHC) journey, the movement has seen many up and downs, success and failure and criticisms and favours.[3,4] There is worldwide voice to return to tenets of Alma Ata as a solution to current crisis in health: increasing demands, rising costs, weak health systems and increasing disparity in health across globe and within country among rural/urban, male/female, and rich/poor.[5,6] Primary health care strategy is once again reaffirmed as the best methods to achieve equitable, affordable and sustainable health care and promising way to achieve millennium development goals locally, nationally and globally.[6,7]. The ratio of doctors, nurses and health volunteers are more in Thailand and Sri-Lanka than in Nepal

Health Policy Inclination towards PHC

Mixed Progress

Creating and Retaining Health Workers

Intersectoral Effort and Integrated Approach

Findings

SUMMARY