Address to the Meeting of Ministers of Health of the Newly Independent States, on the occasion of the celebration of 25 years of Primary Health Care
Honourable Ministers, Secretary of State,
I am honoured to be with you here in Almaty, to celebrate the 25th Anniversary of the Declaration of Alma-Ata. I would like to thank the Ministry of Health of the Government of Kazakhstan for sponsoring such an important event. Together, we are celebrating one of the most significant milestones for global public health of the last century.
I am sure that very few of us here today were at the original conference, which was held from the 6th to the 12th of September 1978. Many other events of global significance took place around the same time.
Louise Brown, the world’s first test tube baby, had been born only six weeks earlier, bringing new hope to infertile couples. Since then, over a million babies have been born through in-vitro fertilization and similar techniques.
A week after Alma Ata, Egypt and Israel signed the Camp David agreement, bringing hopes of peace to the region. Sadly, that hope has yet to be fully realized.
And, on October 16th, one month after Alma Ata, Cardinal Karol Wojtyla of Poland became Pope John Paul II.
Arguments concerning primary health care then were similar to those now. What is the role of the state in providing health care? Should the sick pay for their health, or should health services be free? Vertical versus integrated health care? Socialism versus capitalism?
Although we date primary health care back to the Alma-Ata conference, its history goes back much further. In fact, it was the May 1970 World Health Assembly that adopted a resolution, proposed by the Soviet Union, on Basic Principles for the Development of Health Services, and it was 1974 when the conference was first proposed, by the Soviet Union.
Alma-Ata was not the first venue proposed. In fact, Egypt, Costa Rica and Geneva had also been considered, but each was abandoned in favour of Alma Ata.
Looking back over the last quarter of a century, we have achieved a lot and we have learnt a lot. Experience with smallpox eradication is being successfully applied to polio. Earlier this year we stopped a global outbreak of SARS. Immunization programmes have reduced many infectious killers of children.
But significant work still lies ahead. The world has changed significantly over the last 25 years and the challenges to global health are even more complex than in 1978.
First, health systems have changed. Some health systems are failing due to economic crises and conflict. Different approaches to financing health care have been tried with mixed results, while costs of health care and out-of-pocket expenditures continue to rise. The private sector is playing an increasingly visible role in health care provision, and the growth of NGOs has created new opportunities for implementation.
Second, the burden of disease is changing. No-one had heard of AIDS in 1978, yet HIV is now the single greatest threat to health, social stability and economic development in much of sub-Saharan Africa.
Third, we have learnt that some health problems are more responsive to our efforts to control them than others. We have made progress in controlling several communicable diseases, such as leprosy, measles, onchocerciasis and guinea worm. But we have had little or no impact in reducing deaths in pregnancy and childbirth which kill over half a million young women every year.
Fourth, demographic trends are influencing the needs of populations for health care. There are two billion more people alive today than in 1978. Industrialization, urbanization, migration and ageing populations are putting new pressures on health systems.
Fifth, globalization poses another set of challenges. Back in 1978, few would have imagined the information revolution that has been brought about through the internet and telecommunications. But, increased mobility can also have negative effects on the health of people. Issues of food safety and bio-security are examples.
Ladies and Gentlemen,
WHO has also changed over the last 25 years. Thirty countries have joined the organization since Alma-Ata. We continue to change, with new structures, new ways of working and new priorities.
Last month, we declared a global public health emergency. This emergency is due to the failure to deliver AIDS medicines to the millions of people who need them immediately. WHO is committed to the goal of ‘3 by 5’ – getting three million people in developing countries onto antiretroviral treatment by 2005.
‘3 by 5’ is an ambitious target, which illustrates five ways in which we can adapt primary health care to meet the demands of the 21st century.
We will focus on results. Our measure of success will be health outcomes for the poor. We must, therefore, improve our tools and systems for measurement, and use these measures to improve our management.
We will work with greater speed and determination. There are only 800 days remaining to the end of 2005. But the SARS epidemic was stopped in less than four months. Emergencies and outbreaks force us to work in different ways. We must apply these important lessons more widely. We will link prevention and care. All too often, prevention and care are seen as conflicting approaches to disease control, and are often competing for resources. Some have argued that spending money on ARV treatment will reduce investments in prevention. This argument fails to recognize how availability of treatment increases the uptake of counselling and testing services and, therefore, strengthens prevention strategies.
We will mobilize more resources. Human and financial resources are the pillars of any health system. Lack of them is the main obstacle to progress. Health care budgets remain inadequate in most developing countries, and the financial burden on the poor is unacceptable. Many skilled workers are leaving the public health services in search of better career prospects.
A recent report released by the Stop TB Partnership showed that 17 of the 22 high-burden countries reported that their efforts to reach the 2005 targets are being hampered by staffing problems. But, during a recent visit to Kenya by a ‘3 by 5’ team from WHO, we discovered 4000 nurses who are currently unemployed due to macro-economic policies that have restricted the recruitment of health workers into the public sector. ‘3 by 5’ is the catalyst that can mobilize these nurses. This provides the framework within which these hidden community resources can be effectively utilized.
We will coordinate our work. Many new players are making a huge contribution to primary health care. However, the trend of passing on social responsibilities to civil society can go too far. Civil society must play a key role but leadership in applying the principles of Health for All and primary health care must continue to come from governments.
Ladies and gentlemen,
During the last two years, WHO has been reviewing primary health care in order to better understand its successes and failures, and its place in tackling current and emerging health problems. We have learnt the importance of diversity in the implementation of primary health care. We have learnt that, in order for us to keep up with the speed of change, primary health care has to be adaptable and flexible, while being responsive to local needs.
We will present a progress report on primary health care at the next World Health Assembly. That report will not just be a celebration of the last 25 years. It will reflect on the lessons of the past, and propose future directions in primary health care. Your discussions over the next two days will be an important contribution to this process.
It is my privilege, as Director-General of WHO, to work together with you in making this same goal a reality for the sick and poor of this world. To meet people’s health needs immediately and effectively. And primary health care is the means to this end.
Thank you.