Alma Ata Declaration Research Articles

Pharmaceutical Policies from 1978 Alma Ata to 2018 Ebola: A Critical Interpretive Synthesis

More than 40 years after the Alma-Ata Declaration on Primary Health Care, it is time to take stock. A look back at the evolution of pharmaceutical policies reveals the extent to which international health has transformed in the last four decades. The imperative of equitable access to healthcare, reaffirmed in Astana in 2018, has still not been achieved in many countries across the globe, whereas recent Ebola epidemics have opened up new political spaces for pharmaceutical development. In response to a gap in the literature with regard to the politics behind global pharmaceutical policymaking, we offer a critical interpretive synthesis of the literature on pharmaceutical policies, in English and French, from 1978 to 2018 inclusively. Our search strategy and inclusion criteria enabled us to select and review 134 papers and books on pharmaceutical policies. Building upon the seminal works of K.S. Rajan, we review the literature under the following assumption: pharmaceutical policies reflect or enact different conceptions of knowledge, political spaces, and value. We then critically discuss our findings in light of the contemporary debates, particularly in the wake of recurring Ebola epidemics. We thereby challenge the mainstream perspective according to which pharmaceuticals and pharmaceutical policies must be viewed as value-free, apolitical instruments.

Global health activists\u2019 lessons on building social movements for Health for All

BackgroundThe People’s Health Movement (PHM) was formed in 2000 and drew inspiration from the Alma Ata Declaration on Primary Health Care’s ‘Health for All’ (1978). Since then PHM has been an active part of a global counter-hegemonic social movement. This study aimed to gain insights on social movement building, drawing on the successes and failures reported by activists over their experiences of working in the Health for All social movement to improve health, justice and equity.MethodsQualitative research methods were employed in this study to capture complex and historical narratives of individual activists, through semi-structured interviews and subsequent thematic analysis of transcripts. The research design and analysis were informed by social movement theory and literature on health activism as a pathway for social change. In this study we examine the semi-structured interviews of 15 health activists who are part of the PHM, with the aim of deriving lessons for strengthening movements for Health for All.ResultsThis study locates the activists’ narratives within a socio-political analysis of the global trends of late modern individualism and capitalist neoliberalism. This highlights the challenges faced by civil society groups mobilising collective action and building social movements for Health for All. The study found that within the constraints of the neoliberal socio-political and economic conditions which have caused the rise in social and health inequities, this group of long-term health activists have been nurturing alternative approaches to structuring society and building collective agency to improve health.ConclusionThe practical long-term experiences of the PHM activists examined in this study contribute to a better understanding of the processes and motivations that lead to and sustain health activism, and the dilemmas, strategies, impacts and achievements of such activism.

Task Shifting: A High-Level Analysis of Scholarship

Introduction With changing patterns of disease and significant demographic shifts, governments and the nursing profession are examining how services can be delivered to pursue and deliver universal health coverage. Consequently, there have been considerable discussions on task shifting, sharing, and delegation. Aims The purpose of this study was to identify underlying thematic structures of task shifting research, provide information on the most prolific authors, illuminate connections between peers, and map the general investigated themes and how they have changed over time. Methods A mixed-method bibliographic analysis of the scholarship contributions of both the medical and nursing professions on task shifting was performed using bibliometrics. Results A total of 1,833 unique articles contributed to the corpus of literature with increased rates of scholarship on task shifting being associated with the publication of the declaration of Alma Ata and the World Health Report of 2006. Scholarship on the topic is widely dispersed globally and illustrates that groups of authors regularly collaborate on (a) the application of task shifting to populations/groups (both disease and condition oriented), (b) the various human resources for health and care intervention reform, (c) the underpinning regulatory changes and, (d) the pursuit of universal health coverage. Conclusions This analysis identifies key areas of strength in the current literature and the role of regulation in the delivery and redistribution of responsibilities within nursing and across disciplines. Up until this point, the work on task shifting has given only limited consideration to the use of technology as a means of generating more comprehensive solution sets. The need to include technology solutions as part and parcel of future research studies should be pursued.

Artificial intelligence: a disruptive tool for a smarter medicine.

Although highly successful, the medical R&D model is failing at improving people's health due to a series of flaws and defects inherent to the model itself. A new collective intelligence, incorporating human and artificial intelligence (AI) could overcome these obstacles. Because AI will play a key role in this new collective intelligence, it is necessary that those involved in healthcare have a general knowledge of how these technologies work. With this comprehensive review, we intend to provide it. A broad-ranging search has been undertaken on institutional and non-institutional websites in order to identify relevant papers, comments and reports. We firstly describe the flaws and defects of the current R&D biomedical model and how the generation of a new collective intelligence will result in a better and wiser medicine through a truly personalized and holistic approach. We, then, discuss the new forms of data collection and data processing and the different types of artificial learning and their specific algorithms. Finally, we review the current uses and applications of AI in the biomedical field and how these can be expanded, as well as the limitations and challenges of applying these new technologies in the medical field. This colossal common effort based on a new collective intelligence will exponentially improve the quality of medical research, resulting in a radical change for the better in the healthcare model. AI, without replacing us, is here to help us achieve the ambitious goal set by the WHO in the Alma Ata declaration of 1978: "Health for All".

Disease in a Debt Crisis: Financing Global Health, Development and AIDS between WHO and World Bank, 1978–87

This article examines how international organisations with mandates in health and development interpret global economic crises and respond to disease. It contributes the perspective of World Bank to emerging scholarship on the various factors leading to the decline of the World Health Organization (WHO) and its Health for All (HFA) mission during structural adjustment. It does so by telling a story of collaboration and conflict between WHO and World Bank’s Population, Health and Nutrition (PHN) Department following the ambitious Alma Ata Declaration in 1978 until the initial global AIDS response. As debt crises emerged in Latin America in the early 1980s, WHO tried to find a way forward for HFA. However, the African crisis of 1985 fractured the international community’s support, causing WHO and PHN to dialogue more closely regarding health sector financing. As AIDS became a global crisis, this culminated in their 1987 joint research on the disease’s macroeconomic and demographic impact. However, observing WHO’s continued hesitance regarding financing and its decision to act as a donor gatekeeper, the Bank ultimately opted to work separately in AIDS. Thus, the themes of the Alma Ata versus Selective Primary Health Care debate of the late 1970s continued throughout the 1980s into the early years of the global AIDS response: a perennial conflict of financing within resource constraints and the appropriate role of donors in the grand project of health and development.

Underlying Equity Discourses of the World Health Organization

Background: Globally, increasing attention has been paid to the concept of equity in the context of health, largely stemming from the work of the World Health Organization (WHO) beginning in the late 1970s with the Declaration of Alma-Ata (WHO, 1978) and more recently following the Commission on the Social Determinants of Health (CSDH, 2008) and their final report in 2008. Despite increasing attention to this issue, there is global ambiguity on the true definition of “health inequity”, “health inequalities”, or “health disparities” (Braveman, 2006, p. 167; Braveman & Gruskin, 2003).
 Methods/Design: This original scoping review clarifies how the WHO conceptualizes equity. It also identifies the theoretical underpinnings guiding the WHO’s approach to equity and its broader implications. This protocol followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018), with details discussed in the full protocol.
 Discussion: To date, much of the research on health equity globally has been restricted to chronological discussions over time or specific research fields (Borde & Hernández, 2018, p. 3). Therefore, researching the WHO’s approach to equity in terms of alignment with theory and broader normative standpoint(s) becomes increasingly important in addressing a gap in the literature. In addition, because the definition of equity in the context of health has practical implications for its operationalization (Guerra, Borde, & Salgado De Snyder, 2016), this work seeks to clarify in the concept of equity used by the WHO in hopes of moving towards a shared understanding to bridge action [e.g. in measurement and accountability (Braveman & Gruskin, 2003)].

Forty years after Alma-Ata: how people trust primary health care?

BackgroundPrimary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran.MethodsThe present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression.ResultsThe mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R2 = 0.14383.ConclusionsPublic trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual’s variables and experiences but also by health system and health providers’ characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.

From Alma Ata to the SDG s

Abstract The Alma Ata Declaration of 1978 proclaimed “health for all by the year 2000.” In 2019 health is mainstreamed through the United Nations’ 2030 Sustainable Development Goals (SDG s) initiative. Contributing to critical analysis of global health governance (GHG), this article reconstructs the normative premises of the Alma Ata Declaration, the political project it represented, and the successful cases it was inspired by. It contrasts this with an account of the emergence and gradual consolidation of the GHG agenda that is today reflected in the SDG s. The calls for a return to the Alma Ata Declaration resonate strongly among human rights advocates, community activists, and the medical profession. This is because of the socially exclusionary effects of the dominant health governance agenda shaped by distinctively neoliberal premises. The article argues that in the final analysis the two different approaches reflect very different ideas and ideals about “who global health governance is for.”

Atención integral a la salud de trabajadores de la terminal terrestre de Ambato, y áreas de transferencia las Américas y Cashapamba.

Introducción: Los principales aspectos del primer punto de la Declaración de Alma-Ata fueron la definición de salud y considerar la salud como un Derecho Humano Fundamental. La Atención Primaria va un paso más allá y es capaz de dispensar una atención integral y continuada, centrándose en la prevención, la promoción de la salud y en las necesidades de las personas, las familias y las comunidades a lo largo de toda su vida.&#x0D; Objetivo: Detectar los problemas de salud más frecuentes en el ámbito clínico, y social en las personas de servicio el terminal terrestre y en las diferentes áreas de transferencia.&#x0D; Material y métodos: Estudio explicativo observacional, de cohorte prospectivo, la población estuvo conformada por el universo de conductores terrestres durante el período septiembre 2019 – enero 2020, la muestra representada por 51 trabajadores que aceptaron ser incluidos en la investigación.&#x0D; Resultados: Se demostró que existe un elevado índice de trabajadores con predisposición a diferentes enfermedades crónicas, y con estados nutricionales inadecuados los cuales pueden constituir factores de riesgo para su calidad de vida.&#x0D; Conclusiones: Predominaron las enfermedades de Diabetes, hipertensión arterial, hipercolesterolemia, como predisponentes a alteraciones del equilibrio salud enfermedad, además el índice de factores nutricionales inadecuados se evidenció en el estudio.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Dialogues between the Astana Declaration, the Right to Health and Family and Community Medicine training in Rio de Janeiro, Brazil.

This paper discusses and fosters concerns in light of the repercussions of both the 40th anniversary of the Alma-Ata Declaration and the Astana Declaration, discussing the possible influence on Family and Community Medicine training, as per the lenses of two Residency Programs of three public institutions, namely, State University of Rio de Janeiro, Federal University of Rio de Janeiro, and the Oswaldo Cruz Foundation. These are inserted in a historical and social context, between the world of work, public policies, international organizations, the population and subjects involved in the construction, maintenance, and consolidation of the Brazilian PHC. Thus, in a brief historical revival, we contextualized which Primary Care was a practice setting and where we might be headed. We concluded that the willingness to ensure the Right to Health would be threatened by the concept of Universal Coverage, advocated by the Astana Declaration, which leads to essential discussions: ensuring state-provided services, advocating for equity and integrality of actions, reaffirming the risk of generating inequality by creating multiple service offerings for different segments of the population, reiterating the relevance of access to health, and valuation of territorialization.

Performance management methods and practices among nurses in primary health care settings: a systematic scoping review protocol

BackgroundNurses make up the largest constituent of the health workforce. The success of health care interventions depends on nurses’ ability and willingness to provide quality health care services. A well-implemented performance management (PM) system can be a valuable asset in ensuring that nurses are motivated, promoted, trained and rewarded appropriately. Despite the significant benefits of effective PM such as improved motivation, job satisfaction and morale, PM systems are highly contested. Therefore, it is important to examine evidence on PM methods and practices in order to understand its consequences among nursing professionals in primary health care (PHC) settings.MethodsThe search strategy of this systematic scoping review will involve various electronic databases which include Academic Search Complete, PsycARTICLES. PsycINFO, Cumulative Index to Nursing and Applied Health Literature, Medline and Cochrane Library from the EbsocHost Database Platform. Electronic databases such as PubMed and Google Scholar, Union catalogue of theses and dissertations via SABINET online and WorldCat dissertations will be incorporated. A grey literature search will be conducted on websites such as the World Health Organization and government websites to find relevant policies and guidelines. The period for the search is from 1978 to 2018. This time period was chosen to coincide with the Declaration of Alma-Ata on PHC adopted in 1978. All references will be exported to Endnote library. Two independent reviewers will begin screening for eligible titles, abstracts and full articles. During title and abstract screening, duplicates will be removed. The Mixed Method Appraisal Tool will determine the quality of included studies. Thematic analysis will be used to analyse the included articles.DiscussionEvidence of preferences on PM methods and practices will generate insight on the use of PM systems in PHC and how this can be used for the purpose of improving nurses’ performance and in turn, the provision of quality health care. We hope to expose knowledge gaps and inform future research.

Ageing in Asia: Beyond the Astana Declaration Towards Financing Long-term Care for All Comment on "Financing Long-term Care: Lessons From Japan".

The Astana Declaration on primary healthcare in 2018 was the attempt to revive the ideals of the World Health Organization (WHO) Alma-Ata Declaration 40 years later, together with a call for the political will to provide adequate financing at acceptable quality of care. This approach is taken to achieve the past ideals of Health for All, given the new challenges of universal health coverage. The economic case for primary healthcare is justified against the growing demand due in part to the growing costs of chronic conditions and the rise of ageing population, other than the supply-side factors of the healthcare industry. Past healthcare systems have evolved greater roles of the state versus the market, but few have involved the Third Sector or civil society in more integrated ways to provide and finance long-term care (LTC) with population ageing. From the extremes of the communist state to capitalist free markets, an optimal public-private system has to reach a balance in access, cost and quality for health and LTC. Recent studies of health and LTC have distilled newer developments in public-private mixes of provision, financing and regulation, in response to the needs of fast-ageing Asian societies. While Japan was the oldest country in the world, other countries in Asia have caught up and are now acknowledged where innovative models of integrated eldercare under economic limits, hold great promise of their transferability to the rest of ageing societies. Besides other forms of integrated LTC delivery with traditional systems, newer forms of financing like savings funds and superannuation have been developed, with participation from government, industry and civil society. There is much to learn from the new Asian models of financing, using appropriate technology and social innovations, and integrating health and social systems for LTC.

Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

ABSTRACT Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving ‘Health for All.’ The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana’s flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15–24. Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women’s health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal.

Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia.

The 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.

Health Transformation Plan in Iran: A New Return to the Declaration of Alma-Ata

Health Transformation Plan in Iran: A New Return to the Declaration of Alma-Ata

Disaster management in rural and remote primary healthcare settings: a scoping review protocol.

This scoping review aims to systematically identify and map the roles of primary healthcare professionals in rural and remote areas during natural, man-made and pandemic disasters. Disasters can be caused by natural events, man-made incidents or infective agents resulting in a pandemic. Healthcare practitioners working in primary care settings have important roles during disaster prevention, preparedness, response and recovery. When rural and remote settings are affected by disasters, there are unique challenges for healthcare professionals. This review will aim to contribute to disaster management knowledge within rural and remote primary health care, and assist in the development of practice-based disaster preparedness and future policy discussion. This review will consider studies that include primary healthcare professionals, defined as having first-level contact with patients in the community, in rural or remote areas only. The role of the healthcare professional will also be discussed within the paper. Research from Australia, Canada, the USA, New Zealand and the UK will be included. Databases to be searched include CINAHL (EBSCOhost), PubMed, Scopus and Embase (Elsevier), as well as gray literature within Trove, MedNar and OpenGrey. The search will be limited to articles written in English and published from 1978 to the present. Titles and abstracts will be screened by two independent reviewers, and full-text studies will be retrieved and assessed against the inclusion criteria. Results will be recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Data will be extracted and presented as a tabular summary with supporting narratives and figures.

40 years of Alma Ata Malaysia: targeting equitable access through organisational and physical adaptations in the delivery of public sector primary care.

This paper illustrates the development of Primary Health Care (PHC) public sector in Malaysia, through a series of health reforms in addressing equitable access. Malaysia was a signatory to the Alma Ata Declaration in 1978. The opportunity provided the impetus to expand the Rural Health Services of the 1960s, guided by the principles of PHC which attempts to address the urban-rural divide to improve equity and accessibility. The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and infrastructure developments in Malaysia. The Public Primary Care Health System has evolved progressively through five phases of organisational reforms and physical restructuring. It responded to growing needs over a 40-year period since the Alma Ata Declaration in 1978, keeping equity, accessibility, efficiency and universal health coverage consistently in the backdrop. There were improvements of maternal, infant mortality rates as well as accessibility to health services for the population. The PHC Reforms in Malaysia are the result of structured and strategic investment. However, there will be continuing dilemma between cost-effectiveness and equity. Hence, continuous efforts are required to look at opportunity costs of alternative strategies to provide the best available solution given the available resources and capacities. While recognising that health systems development is complex with several layers and influencing factors, this paper focuses on a small but crucial aspect that occupies much time and energies of front-line managers in the health.

Primary oral health care in Nigeria; four decades after the Alma Ata declaration

It´s over 4 decades since the Alma-Ata declaration of comprehensive health care for all by a congregation of leaders from 67 nations across the world. Though this step was revolutionary, Primary Oral Health Care delivery is still lacking in many Primary Health Centres in Nigeria. The delivery of essential health services in the country has undergone many transitions. From a spread in just 52 local governments areas in the 80s to a ward system coverage in all the 774 local governments with over 30,000 facilities by the 90s. Despite this progress, only 20% of these facilities are functional and the delivery of primary oral health care in these centres is grossly limited. State governments have thus been encouraged to seize ownership and expand health care delivery. The burden of oral diseases remains high and has been linked with systemic conditions like diabetes, HIV and even delayed gravidity. The integration of oral health care with existing primary health care has been challenged by the limited number of human resources especially available at the rural communities. Poor funding has also hindered oral health care delivery because of the specialized nature of oral care. The National Oral Health Policy issued in 2012 stipulates the need for the integration of oral health services but lacked proper implementation guidelines and a revised edition is expected in 2020. Experts have advocated the need to have a higher proportion of dental auxiliaries to complement the demand for human resource for dental care delivery. Similarly, encouraging task-shifting at the grassroots will also provide an efficient route to expanding the coverage for oral health care in the Nigerian population. Finally, the goal of universal health coverage in Nigeria can be better served by prioritizing Primary oral health Care and full implementation of the National Oral Health Policy in Nigeria.

The Bit Part of Universal Health Coverage in Controlling the COVID-19 Pandemic in Africa

The COVID-19 pandemic, particularly in Africa establishes the necessity of contextualized inclusive, comprehensive, and harmonious Universal health coverage (UHC) for individual and collective health security. Universal coverage is firmly based on the World Health Organization (WHO) constitution of 1948 declaring health a fundamental human right and on the Health for All agenda that was set by the Alma-Ata declaration in 1978.