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date: 18 October 2018

Health for All and Primary Health Care, 1978–2018: An Overview

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

In 1978, at an international conference in Kazakhstan, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) put forward a policy proposal entitled Primary Health Care (PHC). Adopted by all the member states of the WHO, this proposal was the seed by which governments and people began to change their views about how good health was obtained and sustained. The Alma-Ata Declaration (as it is known after the city in which the meeting was held) committed WHO member states to take action to achieve the WHO definition of health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Arguing that good health was not merely the result of biomedical advances, provision of health services, and professional care, the Declaration stated that health was a human right, that the inequality of health status among the world’s populations was unacceptable, and that people had a right and duty to become involved in the planning and implementation of their own health care. It proposed that this policy be supported through collaboration with other government sectors to ensure health was recognized as a key to development planning.

Under the banner call of “Health for All by the Year 2000,” WHO and UNICEF set out to translate into practice their vision of how health could be improved. The task confronted a number of critical challenges to implementation. These challenges included defining PHC and translating PHC into practice, developing frameworks to translate equity into action, experiencing the potentials and limitations of community participation, and seeking finances to support the transformation of health systems. Global, national, and non-governmental organization (NGO) programs attempted to balance the PHC vision and the reality of health service delivery success by monitoring and evaluating health impact and cost effectiveness. After 40 years, PHC policy has retained its commitment to social justice but has reduced its broad advocacy of health in overall development to focus on universal health coverage encompassing commitment to equity and community participation through support of community health workers.