Alma Ata Declaration Research Articles

The future of AVS, dizziness, and vertigo in emergency departments Part IV: Priorities for universal healthcare after COVID

The future of AVS, dizziness, and vertigo in emergency departments Part IV: Priorities for universal healthcare after COVID In the fourth article of this five-part series, Dr Millie Nakatsuka discusses how reform must be integrated into the broader context of the public health landscape. 2024 marks the 46th anniversary of the Alma-Ata Declaration, which identified primary healthcare as the key method of achieving ‘Health for All’. OECD analysis, however, continues to show that substantial chronic underinvestment in preventive healthcare and chronic disease management persists, reflecting a global failure to adopt coherent coordinated health policies, and to rationally plan cost-effective healthcare aligned with population health priorities. Instead, governments regularly misallocate and waste resources on ad hoc politically motivated projects, all too often catering to the lobbying power of vested interest groups.

Características metodológicas de la enseñanza del razonamiento profesional en kinesiología: Estudio cualitativo

Background. The initial training of healthcare professionals has exhibited persistent declared dysfunction since the Alma Ata declaration, which exposed the difficulties of conditioned reasoning due to mimetic assimilation in problem-solving. Objective. To understand the methodological characteristics of the processes used by teachers in teaching professional reasoning (PR) to kinesiology students. Methodology. A qualitative interpretive study was conducted using a purposive sampling method, through semi structured interviews (SSI) with 9 expert teachers (ET) in PR from accredited universities. The interviews were recorded on the Microsoft TEAMS® platform. Data were collected during 2020-2023 in 5 selected Chilean Kinesiology schools based on curricular evidence and ranking. Results. The emerging themes identified in the interviews with teachers were transcribed and coded using the Atlas.ti® software. It was found that the characteristics of case study analysis in different applications stood out as the predominant methodology in teaching PR, while the most recurrent assessment instrument was the Rubric. Conclusions. There is a wide range of strategies used by ETs to teach PR. These strategies consist of both traditional methodologies and more student-centered active resources, with theoretical and practical aspects characterized by the formative moment, the selected model, and the imprecise taxonomic articulation of strategies and assessment instruments. This highlights the need for a greater integration of factors for the learning of PR.

Global Surgery: The Challenges and Strategies to Win a War That Must Be Won.

Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author. The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline. A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground. Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.

Reimagining the role of community health workers in SAARC countries.

Following the Alma Ata declaration, SAARC countries have established their workforce of community health workers (CHWs) to address primary healthcare needs. Initially focused on maternal and child health, the countries now confront a changing healthcare landscape characterized by noncommunicable diseases (NCDs), mental health issues, and surgical conditions. These developments have led to the emergence of specialized CHWs tasked with managing NCDs and mental health concerns, prompting a reevaluation of the balance between specialization and maintaining a generalist approach. The effectiveness of CHWs during crises hinges on critical factors such as standardized training, opportunities for career advancement, and equitable compensation. This viewpoint makes a call to introduce a specialist category of CHW to align with evolving healthcare requirements in SAARC countries.

Primary Healthcare Under One Roof: Way Out of Primary Healthcare Dilemma

The adoption of the Primary Health Care Under One Roof (PHCUOR) initiative serves as a crucial approach to tackle the complex challenges encountered by primary healthcare systems worldwide. This paper explores the historical background, present difficulties, and possible remedies related to primary healthcare in Nigeria, with a particular emphasis on the PHCUOR model. By referencing important papers like the Alma Ata Declaration and current research, we highlight the importance of Primary Health Care (PHC) in public health systems. This emphasis how PHC helps to promote health equity and achieve universal health coverage. The PHCUOR model is a progressive approach to healthcare delivery that promotes the consolidation of different services under a single administrative entity in order to enhance the coordination and comprehensiveness of care. The effectiveness of the strategy in improving access, boosting coordination, and delivering cost-effective treatment is demonstrated by several case studies from Anambra and Lagos States. In order to fully harness the potential of PHCUOR (Primary Health Care Under One Roof) in Nigeria, it is crucial for policymakers, healthcare providers, and stakeholders to give utmost importance to the establishment of policy frameworks that are supportive, the development of infrastructure, the enhancement of capacity, and the implementation of sustainable finance mechanisms. Nigeria may enhance its primary healthcare system, enhance health outcomes, and promote health equity for all its residents by adopting these initiatives and proposals.

PRIMARY HEALTH CARE AND THE NEW FAMILY HEALTH MODEL SINCE THE REFORM HISTORICAL CONTEXT AND REGIONAL

This paper provides an overview of developments in Primary Health Care (PHC) in the Americas during the 21st century. It draws on a report created in collaboration with the Pan American Health Organization (PAHO) for the 40th anniversary of the Alma-Ata Declaration(1) and docu­ments from major international health organizations for the post-pandemic period. The report highlights that Primary Health Care is a key proposal for addressing post-pandemic challenges and promoting sustainable development in healthcare systems. These findings support Chile’s efforts to transform its healthcare system towards universal Primary Health Care.

Better Together: Opportunities to Integrate Global Surgery and Primary Health Coverage

There has been recognition of the importance of strong, people-centered primary health care (PHC) with heightened focus beginning with the Declaration of Alma-Ata, now nearly 50 years ago. When designed and delivered well, PHC re-orients health systems around individuals, families, and communities, offering comprehensive, continuous, and coordinated care. It is for this potential that a PHC-grounded approach is cited as instrumental for achieving universal health coverage (UHC) and the health-related objectives for sustainable development.

Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada.

The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible.

The National Health Policy, 2017: Health Seeker’s Profile and Accrued Benefit Analysis

The landscape of health is fast changing in developing countries. India being a signatory to the Alma Ata Declaration on “Health for All” has transformed the landscape of health in the country through Constitutional guarantees, plans, and policy measures. Constitutional bindings like those like Art 21, 38, 39(A) and the Directive Principles of State Policy have put compulsion on the Government of India to take measures for the universalization of health care and this is one of the ambitious targets of the 12th five-year plan aimed at comprehensive health care security to all. It mandates the country to ensure affordable, accountable, appropriate promotive, preventive, curative, and rehabilitative health care services and equitable access to health care to all citizens of India despite their caste, class, gender, religion, etc. In this context. In 2017, the Government of India introduced its health policy to provide coverage to the entire population of the developing country, i.e., India. It was a welcome initiative on the part of the country. After 6 years, the present article tries to map the health seekers' profile and how far benefits of health reform have been accrued by them. The researchers in this article have employed descriptive design with quantitative methods of data collection in the city of Bhubaneswar. The study concludes that the 2017 Healthcare policy has undoubtedly addressed the discrepancies in healthcare services to the population in terms of gender, age, and economic status, but still finds private healthcare services to cover more commoners and ensure services to them.

Brazil, Russia, China, India, and South Africa (BRICS) - Partnership for Sustainable Development and Inclusive Multilateralism: A new alternative for implementing the 1978 Alma Ata Declaration on primary health care.

Brazil, Russia, China, India, and South Africa (BRICS) - Partnership for Sustainable Development and Inclusive Multilateralism: A new alternative for implementing the 1978 Alma Ata Declaration on primary health care.

Invisibility in global health: A case for disturbing bioethical frameworks.

In recent years, the global health community has increasingly reported the problem of 'invisibility': aspects of health and wellbeing, particularly amongst the world's most marginalized and impoverished people, that are systematically overlooked and ignored by people and institutions in relative positions of power. It is unclear how to realistically manage global health invisibility within bioethics and other social science disciplines and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Building from the shared lessons of case study presentations at an Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative (GLIDE), we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more 'disturbing' framework, challenging the narrow comforting solutions which take as a given the sociomaterial inequalities of the status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. Insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning have long been disturbing to grand narratives of people and their conditions. To rediscover the ethos of the WHO Alma Ata Declaration-a vision of "health for all by the year 2000"-these thinking tools will be necessary aids in developing cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health.

AN OVERVIEW OF THE PRIMARY HEALTHCARE SYSTEM IN NIGERIA

This paper describes the structure and operation of the primary healthcare system in Nigeria, the sequence of its evolution from inception to what is obtainable now and the effectiveness of the system. Prior to that, a detailed description of the WHO targets through its Alma-Ata declaration in 1978 was explained and evaluated in comparison with the Nigerian healthcare system. Emphasis was laid on the concept, principle and element of the primary healthcare system as well as the challenges and the current state of the system. In conclusion, Primary healthcare in Nigeria, particularly in rural areas, has come a long way, but more work is undoubtedly still needed to realize the objective of universal health now and in the future. Priority should be given to improving people's living conditions beyond the current poverty level in order to promote healthier living. Local governments, as well as all other levels of government, must increase their allocations to the health sector among other things.

Critical Analysis of Health Indicators in Primary Health Care: A Brazilian Perspective

This paper examines the importance of health indicators in the context of primary care, considering the evolution from the Declaration of Alma-Ata to the present, with a particular focus on the Unified Health System (SUS) in Brazil. The need for an intersectoral perspective in health management is highlighted, recognizing that health problems go beyond the mere treatment of diseases. It discusses how primary health care (PHC) acts as the first point of contact with the health system, emphasizing the importance of comprehensive and person-centered care. In addition, the challenges and advances in the implementation of public health indicators in the context of SUS are examined, highlighting the need for effective management and continuous evaluation of system performance. Obstacles related to decentralization and regionalization of health services are discussed, as well as the importance of community participation and empowerment in health promotion. In this regard, the relevance of close collaboration between academia and administration to develop effective strategies to improve the quality of health services is emphasized. This analysis underlines the importance of health indicators as fundamental tools to guide public policies, evaluate system performance, and guarantee equitable and universal access to quality health services

The Alonissos Study: Cross-Sectional Study of the Healthcare Access and User Satisfaction in the Community of a Non-Profit-Line Greek Island.

Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.

Characterizing Therapeutic Pluralism Policies in Latin America: A Qualitative Content Analysis.

Introduction: The 1978 Alma Ata Declaration initiated international recognition of non-biomedical healing systems and their relevance for primary health. World Health Assembly (WHA) resolutions have called for the study and inclusion of traditional and complementary medicine (T&CM) into national health systems through policy development. The increased public, political, and scholarly attention given to T&CM has focused on clinical efficacy, cost-effectiveness, mechanisms of action, consumer demand, and supply-side regulation. Although >50% of WHO member states have T&CM policies, scant research has focused on these policies and their public health implications. This paper defines a novel term "therapeutic pluralism," and it aims at characterizing related policies in Latin America. Methods: A qualitative content analysis of Latin American therapeutic pluralism policies was performed. Policies' characteristics and the reported social, political, and economic forces that have made possible their development were assessed. Pre-defined policy features were categorized on an MS-Excel; in-depth text analyses were conducted in NVivo. Analyses followed the steps described by Bengtsson: decontextualization, recontextualization, categorization, and compilation. Results: Seventy-four (74) policy documents from 16 of the 20 sovereign Latin American countries were included. Mechanisms for policy enactment included: Constitution, National Law, National Policy, National Healthcare Model, National Program Guideline, Specific Regulatory Norms, and Supporting Legislation, Policies, and Norms. We propose a four-category typology of policy approaches in Latin America: Health Services-centered, Model of Care-based, Participatory, and Indigenous People-focused. Common themes countries used when justifying developing these policies included: benefits to the health system, legal and political mandates, supply and demand, and culture and identity. Social forces these policies referenced as influencing their development included: pluralism, self-determination and autonomy, anticapitalism and decolonization, safeguarding cultural identity, bridging cultural barriers, and sustainability. Conclusion: Policy approaches to therapeutic pluralism in Latin America go beyond integrating non-biomedical interventions into health services; they offer perspectives for transforming health systems. Characterizing these approaches has implications for policy development, implementation, evaluation, international collaboration, the development of technical cooperation tools and frameworks, and research.

Primary Health Care and Foreign Aid: A Tale of Two Germanys.

The Declaration of Alma-Ata remains one of the momentous documents of public health. Its origins lie both in postwar efforts to improve population health in low-income countries and in social medicine promoted decades earlier in Europe. For industrialized countries in East and West, Alma-Ata, therefore, should have provided health-related guidelines both for domestic and foreign policy, though political interpretations of the social components of medicine and health differed. Due to its unique history of ideologically informed division after 1945, Germany forms a fascinating case study. Important German contributions to the early social medicine discourse fed into ideas of primary health care, the basis of the Alma-Ata process. However, the concept found little resonance in domestic policies. After World War II, the two Germanys chose different paths for health systems but were similarly reluctant to address the social dimension of health in their cooperation with Africa, Asia, and Latin America. In the 1970s, new international health concepts and civil society discussions about "development aid" caused changes in West German policies. No such discussions took place in the German Democratic Republic (GDR), where Alma-Ata was interpreted as a confirmation of the domestic health system. Thus, ironically, West German health workers pursued a keener policy of principles of social medicine in their partner countries than the GDR government, which considered its role in the global transformation of health care mainly fulfilled by serving as a model.

Assessment of antenatal care services and nutritional status of pregnant women-a cross sectional study in tribal blocks of Nanded district

Background: Maternal and child healthcare is one of the eight basic components of primary healthcare (PHC) in the declaration of Alma-Ata. There is an excellent system of primary health care services for the delivery of maternal and child health services through a network of sub-centres and PHC centres in rural India. Aim and objectives of the study to assess antenatal care (ANC) care services and MCH schemes given to tribal women in Nanded district. Objectives- To study status of ANC care services among tribal ANC mothers. To assess various schemes associated with mother and child health in tribal area. Methods: Study design was a cross-sectional study. Study conducted at tribal blocks in Nanded district. Sampling and sample size: Convenient purposive sampling was used. Study population was 100 ANC mothers of tribal blocks in Nanded district. Results: Total number of families belonging to BPL category were 67% and families belonging to APL were 33%. Maximum of 60% were housewives, 39% of ANC mothers were working in the farm, while only 1 ANC mother was Govt. servant. Conclusions: Addressing the physical and financial barriers of tribal women to access maternal health services, catering the services to their socio-cultural needs, building in trust between beneficiaries in the community and health care delivery system should be the priority.

Questioning global health in the times of COVID-19: Re-imagining primary health care through the lens of politics of knowledge

The advent of the COVID-19 pandemic and the inequitable response to it has created a space for rethinking the knowledge translation that informs current health policy formulation and planning. Wide recognition of the failure of global health governance and national health systems has led to calls for reviving the Primary Health Care (PHC) agenda for post-COVID health systems development. Despite the joint international declaration on PHC made four decades ago, it has had limited application. This paper argues that the recent attempts to rethink PHC will prove inadequate without analysing and learning from the politics of knowledge (PoK) underlying global health policy and planning. Even with the growing relevance of the spirit of the Alma-Ata Declaration (1978) and its operationalisation as detailed in the report of conference proceedings, reassessment of reasons for its limited implementation continues to be located largely in the political economy of the medical establishment, the international economic order or in national governance flaws. Failure to address the dominant knowledge paradigm in the Alma Ata articulation of PHC has contributed to its limited application. This calls for expansion in the analysis from knowledge translation to generation and hierarchisation of knowledge. The paper discusses how the application of PoK as an analytical lens helps understand the power equations underlying the process of knowledge generation and its translation into policy and practice. Beneath the techno-centric and commodified health system is the dominant ‘knowledge’ system whose foundations and assumptions ought to be interrogated. By following a PoK approach, a reorientation of thinking about the relationship between various forms of knowledge and knowledge holders is anticipated. A new health service system design is outlined—translating the spirit of PHC of 1978 into a ‘PHC Version 2.0’—that addresses the PoK gap in operational terms, with an approach to guide all levels of healthcare. It suggests how the world can be empowered to respond better by engaging with diverse ontologies and epistemologies to conceptualise knowledge and frame policies. Further, in the contexts of Asia, Africa and Latin America, it can contribute to the development of self-reliance to democratise general health policy and planning in the post-pandemic period.

Common Risk Factors for Non-communicable Diseases in 30 Subjects Aged over 35 in the City of Lubumbashi in the DRC

Promoting and protecting health is essential to human well-being and to sustainable economic and social development. This was recognized more than 30 years ago by the signatories of the Alma Ata Declaration, who stated that Health for All would contribute to a better quality of life as well as peace and security in the global scale. Education, housing, food and employment all have an impact on health, which led us to ask ourselves the question of exploring common risk factors for non-communicable diseases. The objective is to determine the prevalence and analysis of knowledge on common risk factors for non-communicable diseases among 30 subjects aged over 35 in the city of Lubumbashi. This is a cross-sectional descriptive study which took place from June 30 to July 30, 2021 in the city of Lubumbashi. The calculations of prevalence and general characteristics were carried out by descriptive analysis. Then followed the analysis of knowledge and risk factors of non-communicable diseases, we used Stata 16.1 and QDA Miner Lite 1.4.3 software. The prevalence of Non-Communicable Diseases was 1 (100%). The age group of 35 to 40 years old constitutes the modal class with 36.70%, the male sex was equal to the female sex with a sex ratio of 1. Respondents consuming less than 4 to 5 fruits per day are represented with only 20 samples out of a total of 30 i.e. 66.67%, consumption of alcoholic beverages in 26 cases, i.e. 86,67%, non-consumption of tobacco is poorly represented 3.33%, physical exercise is practiced less with a number of 21 cases or 70% among the respondents. The modes of contamination of non-communicable diseases are relatively well known among these actors who often cite the use of alcoholic beverages, smoking (tobacco leaf). At the end of this cross-sectional descriptive study, we note the reflection of insufficient health education exposing to the risk of non-communicable diseases, as well as for provide quality care and services to the Lushoise population, sufficient resources must be allocated to nutrition programs for proper awareness of the nutritional transition.

Invisibility in global health: A case for disturbing bioethical frameworks

In recent years, the global health community has been increasingly reporting the problem of ‘invisibility’ as aspects of health and wellbeing that are often overlooked and ignored, and predominantly affects the most marginalized and precarious people. However, it is unclear how to realistically manage global health invisibility and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Moving forward, we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more ‘disturbing’ framework, challenging the narrow comforting solutions and sociomaterial inequalities of the sociopolitical status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. In doing so, we call for taking seriously insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning that have long been disturbing the grand assumptions about people and their conditions, and, practically, to rediscover the ethos of the WHO Alma Ata Declaration, calling for cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health.