Introduction
The declarations made at the Alma- Ata conference are considered as the greatest declarations of the twentieth century. The declarations were being sourced from research on the existence and quality of primary health care worldwide. The declarations made in this conference were aimed at the promotion of the health of everyone worldwide. During the conference, there was an urgent call for health workers, governments, communities and development workers to promote health care provision. This marked a major milestone for public health.
One of the realisations made during this conference was that primary health care is a key concept if global health care is to be achieved (Cueto, 2004; Hope, Nicholson, & Baguley, 2008). The attainment of such can only be obtained with efforts from various social and economic sectors. The aforementioned organisations were meant to ensure the maintenance of primary health care by providing funding. The health care was supposed to be distributed equally and fairly. At the culmination of the conference, ten declarations were made. This paper analyses the main ideas expressed in these declarations, their constituents and the obstacles encountered when implementing them at a global level.
Declaration One- health is an inalienable human right
The conference recognised that heath is a human right. Health in this concept referred to a complete state of wellbeing. The physical, mental and social realms were included in this definition (World Health Organisation, 2006). To them, disease does not necessarily imply the absence of infirmity. As such, it was of note and necessary to maintain such a state always. It was also necessary to involve other organisation in order to attain this.
The realisation of health as a fundamental and unalienable human right depicts the importance placed in such a concept. Apparently, health care is not just a need. It is an ideal just like freedom or life. The conference also realised that health can be a confusing word, and thus specifying on its definition (Declaration of Alma- Ata, 1978). Another idea expressed in this declaration was that it would require other non- health sectors in order to attain global health. These organisations will be quite useful in restoring, maintaining and protecting the provision of such a right.
Declaration Two- equality and equity in health care
This declaration expressed that there is no uniformity of health care globally. This implies that health is not distributed equally and fairly. These discrepancies were especially recognisable between the developed and developing countries. Furthermore, there were large differences in the provision of health care within countries. According to the human rights, this is unacceptable. The article expressed the need for fostering equality and equity in health care. This will ensure that medical care is given and available to those who require it. Furthermore, those with the expertise will have equal chances of contribution to the attainment of this goal (Declaration of Alma- Ata, 1978).
Declaration Three- contribution of economic and social sectors
The main idea inferred from this declaration is the importance of economic and social sectors to health care. Apparently, the failure of these two sectors would spell doom for health care. On the other hand, economic and social development will go a long way in attainment of the goals of health care postulated in this conference. The economic sector is necessary for the provision of funds and financial advice to the health sector. These finances are to be used in the equalisation of the provision of health based services(Declaration of Alma- Ata, 1978).
The social sector is useful when it comes to creating a rapport in the general stressful scene of health care. It also enhances interpersonal and international relationships, which promote worldly peace. The central concern here is still health care (Declaration of Alma- Ata, 1978). Summarily, the economic and social sectors are indispensable when it comes to protection of health care. For sustained economic growth, this is necessary because a healthy nation is a productive nation.
Declaration Four- personal health care
The principle espoused in this declaration was also borrowed by the World Health Organisation. The idea was that the provision of health care is the responsibility and the right of every individual (Declaration of Alma- Ata, 1978). This raises the fact that people are the ones who seek health. Therefore, they are the main resource of health. Health is of and for the people. They are the ones who will be able to protect and guide their own health situations.
People should be given the authority and capability of taking care of their own health. As such, they should be vested with information that will help them plan and implement matters pertaining to their personal health care. The health workers are the ones who can disseminate such information to the people in order to empower them (Cuerto, 2004).
Declaration Five- role of the state
The main idea expressed in this declaration is the role of the state in the provision of health care. During the conference, it was enunciated that the government has a role to provide health care for its entire population. All governments should have attained a status described as health for all by the year 2000 (Streefland & Chabot, 1994). Here, the phrase ‘health for all’ referred to a situation where all people are healthy to the extent that they can lead successful social and economic lives.
All international organisations and governments were urged to concentrate on primary health care. This was the only way of attaining the situation described as health for all. It should be noted that a productive nation is one that is health. It is almost impossible to separate health, economic and social productivity (World Health Organisation, 2006).
Declaration Six- necessity of primary health care and its components
Several ideas can be identified from this declaration. First, health care that is considered as primary is essential for the survival of every human being. It targets the central part that determines the growth of any society; the community. Secondly, for this kind of health care to be provided, there is a need to involve the community holistically, but from the basic unit which is a family (Declaration of Alma Ata, 1978). Furthermore, this kind of health care is provided using methods that are acceptable, scientifically, socially and technologically.
The importance of primary health care was further expressed by stating that it is an integral part of every society. To reduce confusion on the provision of primary health care, it was stated that this is the inception of the component of health care. All aims towards achieving health care should begin from that specific stage.
Declaration Seven- components of primary health care
This declaration identified all the aspects that pertain to health care. First, healthcare is affected by the political, economic and socio cultural aspects of the nation. It is also affected by the implementation of research based on biomedical and social aspects. By studying all the aforementioned aspects, then it is possible to understand the variations in primary health care provision (World Health Organisation, 2006).
The second component of primary health care is based on what it addresses. Apparently, this form of healthcare is one that provides preventive, curative and rehabilitative care to the community and from the family level (Anderson, 2008). The importance of education was reaffirmed. There is an explicit and intimate relationship between primary health and education. Education should provide knowledge in sectors such as sanitation, nutrition, family planning, immunisation and endemic diseases.
Primary health care also includes other sectors like agriculture, animal husbandry, public works, and communication among others that contribute to community development. Furthermore, primary healthcare is one that provides self reliance. It should be able to provide knowledge that will promote participation, organisation and control primary health care (Streefland & Chabot, 1994).
Another component of primary health care is that it should have supportive referral systems. This is the only way this form of health care will progress and be accessible to those in need. Lastly, the conference reaffirmed the necessity of health workers community and traditional practitioners in primary health care. Generally, this declaration explored and extrapolated on the holistic definition of primary health care (Anderson, 2008).
Declaration Eight- formulation of national policies
The idea behind this declaration is that the government should formulate policies that will enable the achievement of primary health care (Declaration of Alma Ata, 1978). These polices should be formulated together with other shareholders who contribute to the achievement of health for all. All resources and efforts were to be directed towards primary health care in case the health for all policy was to be achieved.
Declaration Nine- spirit of partnership
The idea expressed in this tenet is the importance of the spirit of partnership which is necessary for the attainment of primary health care. This was meant to support the allegation that it is necessary to include other sectors in this endeavour. These other sectors act as supporting pillars to the achievement of health for all and primary health care (World Health Organisation, 2006).
Declaration Ten- sustainable use of resources
This was the last declaration made during the culmination of the Alma Ata conference. Apparently, for any nation to achieve health for all by the stipulated time, it is necessary to consider how the resources of that country will be applied to achieve this. Resources are utilised in other non- important aspects such as military. This is the reason behind the unequal distribution of primary health care. In place of armament, efforts should be directed towards peace initiatives. The available and scarce resources should then be utilised to achieve health for all (Streefland & Chabot, 1994).
The Alma Ata conference declarations gave rise to the ideas discussed above. The declarations made were adopted by all nations (Anderson, 2008). This conference was held as a result of the realisation that health is an urgent component for the development of any country. Furthermore, the achievement of proper and holistic health is as a result of the contribution of resources from various sectors. The conference was aimed towards such an achievement. However, a few obstacles were realised during the implementation of the declarations owing to the diversity of finances and cultures among other factors. Some of the obstacles are discussed below.
Time Limits
Socrates (2002) states that one major problem in the implementation of the declarations made by the Alma Ata conference is the time limit. Apparently, the conference took a total of eight years for the final declarations to be made. According to Socrates (2002), many other aspects had changed during that time span. For instance; other diseases had emerged. The fact that several nations were involved in the conference compounded to this problem. Before the culmination of the conference, several countries seemed to have lost patience. This made it almost impossible to implement the declarations.
Problems in Transfer of Policies
There is a substantial difference between developed and developing countries (Marmot, 2004). This is especially true when it comes to finances and resources available in the two dimensions. Developed countries are by far advantaged in almost all aspects. There was thus a difficulty in implementing similar policies in both countries. A typical example is when there is a requirement that the economic sector be included in the achievement in health for all. The contribution made by such a sector in developed countries is far ahead. As such developing countries find it almost impossible to have achieved health for all status by the stipulated time.
Furthermore Marmot (2004) states that developed countries strive on achieving better curative measures and ignore the preventative measures. This implies that disease and other health related problems will always be reoccurring. Developing countries have available resources to conduct research and to implement the suggestions from this research. Also, some of the technological machinery employed in developed countries may be a little too expensive in terms of maintenance. The lack of trained personnel also contributes to this problem. As such, developing countries shun from using them. To this end, discrepancies will always be evident in the two nations. The accomplishment on health for all is an almost impossible mission.
Lack of Doctors
The Alma Ata conference declared a holistic achievement of primary health care. In as much as this seems possible and achievable Streefland & Chabot (1994) insisted that lack of enough doctors would be a problem. In 1978, it is estimated that there were only one thousand doctors in the world. The case was worse in remote villages and some developing countries. Health workers at this time were also a rare phenomenon. This implies that one doctor had about a thousand patients under his care. The situation has not improved much to this day. This problem was recognised during the Alma Ata conference. They tried to correct this by minimising primary health care to include the immediate community only. However, there were still some difficulties as some places had higher population densities than others. To this end the implementation of the declaration of holistic primary health care was difficult.
High Levels of Illiteracy in Developing Countries
The achievement of health care for all necessitated the need for education. This form of education would provide knowledge on aspects that control health (Blakey, 2008). The education would provide knowledge on prevention, nutrition, sanitation and hygiene among many other aspects. Nevertheless, it should be noted that even up to date, basic education has never been a necessity in some communities.
Consequently, the implementation of this premise proved to be a little complicated owing to the fact that illiteracy was and still is wide spread. This is especially true in most developed countries. It would prove to be impossible to communicate the importance of such health related factors in most communities. Furthermore, there was the very evident problem of language barriers to educate remote communities.
Financial Difficulties
For the implementation of all of the declarations, a lot of funds would be required (Socrates, 2002: Marmot, 2004; Streefland & Chabot, 1994). The lack of funds in most developing countries would make the health for all status impossible and unrealistic. The Alma Ata conference was accused of making many assumptions in the collective approach of issues. In fact, many authors insist that it would be necessary to find a way of supporting needy countries if the achievement of such declarations were to be met. The appraisals for the conference were mainly based on minor contributions like the identification of the problems facing the health sector (Socrates, 2002). However, the deficiencies of the conference were just but precedence for other conferences that would delve further into the problems facing the health sector, and how to alleviate them.
References
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Declaration of Alma- Ata. (1978). International Conference on Primary Health Care. Held in Alma-Ata, USSR, 6-12 September1978. Conducted by the public health agency.
Hope, R., Nicholson, B., & Baguley, D. (2008). Establishing a Workforce of Globally Aware Health Professionals Alma Ata and Alma Mata Global Health Network. Global Social Policy, 8(2), 161-164.
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