Alma-Ata Conference Research Articles

Health in All Policies and intersectorality in Latin America and the Caribbean, 2011 - 2021: a scoping review

Introduction: Intersectoriality, since the Alma Ata Conference in 1978, has become a fundamental part of the political discourse on public health, social determinants, and health promotion to address health problems in society. Following the above, it is important to identify the research carried out in Latin America and the Caribbean on this topic in the last decade. Metodology: A scoping review was carried out on the scientific evidence published between 2011 and 2021 in countries of the Latin American region on experiences and intersectoral actions between health and other sectors to address joint public health problems. Results: 15 studies were included; mostly from Brazil, with predominantly qualitative designs and local character. In addition, some analyses highlight the hegemony of the biomedical model, as well as the conflicts and tensions at the ideological level in certain health issues and traditional practices that limit effective intersectoral collaboration. Conclusions: Intersectoriality is not a strictly technical issue, but ideological elements converge that determine its scope and limitations. Studies in countries such as Colombia should be expanded to have evidence that allows an understanding of the barriers and facilitating aspects of intersectorality.

The Primary Health Care Approach: Rhetoric or Policy? - A Review of National Health Policies in 8 Countries in Southern Africa

INTRODUCTION: The Primary Health Care approach (PHC) can contribute towards universal health coverage (UHC). However, implementing the PHC approach in Africa remains suboptimal. One way to ascertain political commitment to the PHC approach is its reflection in the national health policies (NHP). Several PHC initiatives have helped define and guide the PHC definition, implementation, and evaluation. These include the Alma Ata PHC conference, the Ouagadougou Declaration on PHC in Africa, and the Astana conference. The aim of this paper is to explore to what extent the guidance and characteristics of the PHC approach have been reflected and integrated into the National Health Policies (NHPs) in countries in the Southern African Development Community (SADC). 
 
 METHODS: The READ approach was undertaken to analyze eight publicly available NHPs. A 12-point checklist was developed to extract relevant data from the policy documents.  The WHO Health Systems building blocks are used as the analytical framework to understand the key features of the PHC approach mentioned in the policies.
 
 RESULTS: All the NHPs were developed after the Alma Ata conference in 1978. Six of the eight NHPs reviewed were updated after the Ouagadougou declaration on PHC in Africa in 2008. None of the NHPs were updated after the 2018 Astana PHC conference. Based on the checklist, Lesotho had the most integrated PHC elements (n=12), while Eswatini had the least (n=4). Based on the policy review, there seems to be commitment and priority placed on leadership, governance, and access to essential medicines. However, more still needs to be done to improve service delivery in terms of integrated patient centered care (only included in 3 out of the 8), health financing for primary care, integrated health information systems and the community health workers as part of the health workforce. 
 
 CONCLUSION: In conclusion, NHPs should guide implementation, and the NHP is a reference document for many organizations wishing to partner with the government in improving health care services. As such, it should be updated in line with the new evidence and learning and reflect the country’s priorities to help align development actors.

History of primary health care in Iran.

The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.

Social Health Security Program and Poor: A Case Study of Dhangadhi Sub-Metropolitan City

It is a well-known fact that Alma Ata Conference on Primary Health Care held in Kazakhstan in 1978 called for all the countries to implement primary health care for increasing health care access to all the people at affordable cost and achieving the targets of "Health for All" by the year 2000.The conference had also emphasized the provision of preventive, promotive, curative, and rehabilitative services up to the community level for addressing main health problems (Gilllam, 2008). The World Health Organization also affirms that: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” To ensure these rights to its citizens, every state has to invest organizational, human and financial resources to its optimum level.

From the pragmatic use of traditional medicine by the health sector to the ideological exclusion of anthropological perspectives: the case of Mexico (1930-2022)

This article analyzes two general lines of research on traditional medicine used by Mexican indigenous peoples since the 15th century up to the present day. The first - pioneered by anthropologists and physicians with anthropological training - addresses traditional medicine so as to promote biomedicine among indigenous groups, with the purpose of improving their health conditions. This line of research developed between the 1930s and 1960s, reemerged in the mid-1970s with the Alma Ata Conference, and has maintained momentum into the present day, seeking to expand coverage of the health sector in marginalized areas, but while subordinating traditional medicine to biomedical programs in all aspects. The second line of research has been fostered by anthropologists, in particular from the 1960s onward, and seeks to comprehend indigenous cultures through traditional medicine, with a particular focus on healers, who express the cosmovision, identity, sense of belonging, and cultural autonomy of indigenous peoples. However, these enquiries attempt to comprehend and validate the ways in which traditional medicine encapsulates cultural identity, and in some cases to justify political, economic, and above all ideological objectives. These perspectives do not take into consideration information regarding morbility, mortality, and life expectancy, despite the fact that indigenous peoples are the social group with the highest mortality rates and lowest life expectancy.

Proposta de instrumento de avaliação pedagógica da preceptoria para residências em Medicina de Família e Comunidade

Introdução: Desde a Conferência de Alma-Ata, a importância do cuidado centrado na Atenção Primária à Saúde (APS) foi consolidada como objetivo mundial. No Brasil, a Estratégia Saúde da Família (ESF), composta por equipes multiprofissionais, visa à reorganização da APS, sendo o especialista em Medicina de Família e Comunidade (MFC) o médico indicado para atuação neste campo. A residência em MFC é considerada o padrão ouro da formação desse profissional, porém, para expansão da residência é necessário expansão da preceptoria. Preceptores são profissionais que utilizam seu conhecimento e sua experiência profissional para atuação docente junto aos residentes. No município do Rio de Janeiro houve expansão da APS, com aumento da cobertura ESF de 3,5% para 69,43% em 2018, o que trouxe a necessidade de investimento para expansão da residência, e, desta forma, demandou mais preceptores. No entanto, não pôde ser realizada uma capacitação completa em tempo hábil, sendo desejável que os preceptores continuassem sua qualificação concomitante à preceptoria. Dentre as atividades do preceptor, destacam-se os atributos pedagógicos, relacionados à responsabilidade docente no processo ensino-aprendizagem do residente. Objetivo: Apresentar uma proposta de instrumento para avaliação dos atributos pedagógicos da preceptoria das residências em Medicina de Família e Comunidade. Métodos: Para elaboração da proposta de instrumento para avaliação dos atributos pedagógicos foram realizadas entrevistas compreensivas, com preceptores em Medicina de Família e Comunidade da Universidade do Estado do Rio de Janeiro, segundo um roteiro semiestruturado. Resultados: As entrevistas geraram espaços de reflexão sobre as práticas pedagógicas dos preceptores, motivando-os a construírem novos planos pedagógicos e a repensarem as potencialidades e os obstáculos enfrentados no trabalho pedagógico da preceptoria em MFC. Conclusão: A proposta de um instrumento para avaliação pedagógica se apresentou como formativa para a preceptoria em MFC no âmbito da APS do município do Rio de Janeiro, fazendo supor que produziu ressignificação, precursor de motivação e esperança.

Sustaining Tradition and Fulfilling Agreements on Traditional Medicine Since the Alma Ata Conference

Introduction: The implementation of traditional medicine strategies and their integration into the mainstream health systems by African governments has been a difficult process since its recommendation at the Alma Ata Conference of 1978. Objective: This paper seeks to review how traditional medicine has survivedand what various African countries have done to implement traditional healthcare strategies and their integration into the national health systems as recommended by the Alma Alta conference of 1978. Methodology: We purposively selected developed, middle income and African countries for the purpose of this review.We reviewed traditional medicine policies and programs in elevenpurposively selected countries from different political and economic blocks. We conducted a review of published works on traditional medicine implementation with more focus on the African continent. We have used the historical and thematic perspectives to obtain, organize and report data from published documents. Results: There is the public use of traditional medicine in every African country at very high proportions. African governments celebrate African Traditional Medicine Days. But very few African countries have fully implemented Alma Ata recommended traditional medicine strategies and integrated traditional medicine into their national health systems to the latter. Strong adherence to tradition has kept traditional medicine in African alive. However, the coronavirus pandemic (COVID-19) has revealed strong adherence of Africans and their governments to African Traditional Medicine. But the developed world sticks to standard conventional medical practices. This reverence is an acknowledgment of the truism that rather than integrating African medicine into conventional medicine, proponents of African medicine would want to operate parallel to conventional medicine or integrate it into the African medical system. Conclusion: African medicine exists in Africa as a culturally bound practice, therefore, providing solutions to health problems in situations where conventional medicine may not. It exists on its own without a real and strong legal framework to guide its practice because of its conflicting parallel validation methods to conventional medicine.

Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

Community participation in prevention and control of infectious diseases

Historically, the health status of the people of Bangladesh has been greatly influenced by communicable diseases. Infant mortality, maternal mortality, life expectancy and many other health indicators are determined by diseases like cholera, malaria, kala-azar, tetanus and diphtheria. Contamination of water, prevalence of vectors, poor nutritional status and poor hygienic behaviour increase people’s vulnerability to sickness and death when exposed to various communicable diseases. In recent years, however, measures including provision of safe water, better nutritional interventions, vector management, and strengthened immunization efforts brought improvement in health scenario of the country. Health service is a basic requirement for every human being and it is liability of government to ensure adequate medical facilities to the people. People involvement is central to all aspects of human development of which health is one. During the last two decades it becomes obvious that people’s participation is not only beneficial but essential in the pursuit of better health objectives. According to the Alma-Ata conference in 1978, community participation was described as an essential component of primary health care.

Alma Ata: Reflections and future prospects in family health strategy

ABSTRACT The International Conference on Primary Health Care, held in Alma Ata, was one of the most significant public health events in the world, where for the first time the dependency between poverty and health status was discussed and measured. Even after 40 years of its implementation, it continues to influence directly public policies related to the principles of primary care. The aim of the present study was to carry out a review of literature based on PubMed / Medline, Virtual Health Library (BVS / Bireme / WHO-PAHO) and institutional documents of Brazilian Ministry of Health, in order to point out reflections of perceptions about Alma Ata Conference, in Brazilian public policies, tracing an evolutionary profile to the family health strategy and its future perspectives. Although the study found a strong influence of the Alma Ata Conference in Brazilian public health policies it still needs improvement to reach the global goals and objectives agreed by all countries in Alma Ata and reaffirmed in the World Health Organization’s 2030 Sustainability Agenda.

Local production of medicines in Mozambique: at crossroads of pharmaceutical knowledge circulation

In the first years after its independence in 1975, Mozambique had a voluntarist pharmaceutical policy that prioritised essential generic medicines, in accordance with the World Health Organization’s policies at the time of ‘Health for All’ and the Alma-Ata Conference. Several initiatives to install local production of medicines in Mozambique were started in the late 1970s–1980s with International support from United Nations Agencies, bilateral cooperation from European and Socialist countries...

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

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

Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health – a perspective from a middle-income country

A major consequence of all elements of the ‘epidemiological transition’ is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the ‘Alma Ata Conference for Primary Health Care’, it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, ‘healthy’ nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabolism. This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.

Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health - a perspective from a middle-income country.

A major consequence of all elements of the 'epidemiological transition' is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the 'Alma Ata Conference for Primary Health Care', it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, 'healthy' nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed. Major risk factors for NCDs interfere with and alter complex steps within the human metabolism. This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health.

‘Socialising’ primary care? The Soviet Union, WHO and the 1978 Alma-Ata Conference

In September 1978, the WHO convened a momentous International Conference on Primary Health Care in Alma-Ata, capital of the Soviet republic of Kazakhstan. This unprecedented gathering signalled a break with...

Primary health care for the 21st century, universal health coverage, and the Sustainable Development Goals

Good health and wellbeing are fundamental to the prosperity of societies. By many measures, modern humanity enjoys better health than earlier generations. 1 WHOWorld health statistics 2018: monitoring health for the Sustainable Development Goals. World Health Organization, Geneva2018 Google Scholar But the benefits of modern health care are not accessible to all. Even as the incidence of infectious diseases such as HIV, tuberculosis, and malaria are reduced, many countries struggle to cope with the growing burden of non-communicable diseases, and the complex and growing health needs of ageing populations. 2 WHOTime to deliver: report of the WHO Independent High-level Commission on Noncommunicable Diseases. World Health Organization, Geneva2018 Google Scholar , 3 WHOWorld report on ageing and health. World Health Organization, Geneva2015 Google Scholar The Astana Declaration: the future of primary health care?Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge. Half the world's population has no access to the most essential health services. Yet 80–90% of people's health needs across their lifetime can be provided within a primary health-care framework—from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care. As populations age, and multimorbidity becomes the norm, the role of primary health-care workers becomes ever more important. Full-Text PDF Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in HealthIn 2013, the Lancet Commission on Investing in Health published its report, “Global health 2035: a world converging within a generation” (GH2035). The report concluded that a grand convergence in health—a reduction in infectious, child, and maternal mortality to rates seen in the best-performing middle-income countries—is technically and financially feasible for all but the poorest countries by 2035. Mortality from non-communicable diseases could be reduced through inexpensive population-based and clinical interventions, especially fiscal policies such as heavy tobacco taxation. Full-Text PDF Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in EthiopiaWeakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Full-Text PDF Yelzhan Birtanov: leading Kazakhstan to universal health coverageAlthough only a child at the time, Yelzhan Birtanov, Minister of Healthcare of Kazakhstan, remembers the landmark 1978 Alma-Ata conference. His physician parents were attendees. “I recall doing drawings with the pens that they brought back from the meeting, and looking at a lot of photos of the conference; even as a young child, it was clear that something major was taking place in my country”, he says. Full-Text PDF

Positioning Nurses in Primary Health Care in Bhutan

Introduction: Nursing in Bhutan had its beginning in the early 1960s, approximately 20 years prior to the Alma Ata Conference. From basic nursing care and housekeeping roles, Bhutanese nurses have now occupied central place in nursing service, administration and management and education. Nursing education has progressed from certificate level in the 1960s to bachelor, master and PhD levels in 2014. Although nurses have been closely associated with Primary Health Care development in Bhutan, apart from the role of the Auxiliary Nurse Midwives, nurses have rarely been explicitly associated with this area of practice. Therefore, the objective of this study was to find out the role of Bhutanese Nurses in PHC.
 Methods: qualitative case study method was used to carry out focus group and in-depth interviews with 66 respondents that included policy makers, planners, educators, regulators and implementers. Data were analyzed through manifest and latent content analysis.
 Results: The centrality of the nursing role in the area of PHC has not been realized. Discharge of the PHC role was identified more in terms of the place of work and by title or designation of the nurses. Primary Health Care momentum appeared to have slowed down and nurses differed in their understanding of PHC concept.
 Conclusion: Although Nursing in Bhutan has made much progress, the uneven development of the nurses’ role in PHC in Bhutan and globally suggests a need to identify and implement strategies such as standardizing, role profiling, curricula review and leadership improvement to ensure progress in this area.

Critical analysis of interculturality in the National Policy for the Care of Indigenous Peoples in BrazilAnálisis crítico de la interculturalidad en la Política Nacional de Atención a las Poblaciones Indígenas en Brasil

RESUMOA preocupação com um cuidado culturalmente apropriado e intercultural, baseado na articulação e complementariedade entre saberes em saúde, vem sendo uma prioridade para garantir a atenção primária à saúde (APS) dos povos indígenas desde a Conferência de Alma-Ata. No Brasil, país de significativa variedade sociocultural no contexto indígena sul-americano, existe há 16 anos uma Política Nacional de Atenção à Saúde das Populações Indígenas (PNASPI) focada no conceito de atenção diferenciada. Esse conceito, considerado como incompleto e contraditório, é variavelmente operacionalizado na APS de indígenas. Sendo assim, o presente artigo propõe uma análise da formulação e operacionalização desse conceito na PNASPI. Essa análise torna evidente o caráter etnocêntrico da PNASPI, as numerosas contradições e negligências que não contemplam de fato o intercâmbio e articulação com o saber tradicional e as visões êmicas indígenas de saúde e dos processos de padecimento/cura. A reversão dessas limitações exigirá maior reflexividade, questionamento e vigilância epistemológicos tanto das ciências sociais e políticas quanto dos movimentos sociais e de controle social indígenas para redefinir em termos interculturais a APS de indígenas no Brasil.

Primary Health Care and Narrative Medicine.

Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery.

The importance of Leadership towards universal health coverage in Low Income Countries.

Universal health coverage--defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection--was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.