Health care for All through primary Health care In developing countries
1. HEALTH CARE FOR ALL AND THE ALMA-ATA DECLARATION/MDG IN
DEVELOPING COUNTRIES- A ROAD MAP
1.0 INTRODUCTION
The Alma-ata declaration of 1978 was signed in order to achieve Health for All through Primary
Health Care (PHC) by the year 2000 through linking horizontal and vertical approach to provide
cost-effective health for those who are in greatest need of healthcare services, however 14 years
down the line developing countries especially in Africa have worsening health conditions, this
much has been observed as most countries in Africa are facing slow, no progress and worsening
mortality rate in achieving targets set for the Millennium Development Goals even though most
of these deaths are preventable and treatable conditions. Presently, Eritrea is the only African
country among 68 developing countries globally on-track to achieve the Millennium Development
Goal (4)-reducing child mortality by two-thirds in the year 2015(1). Therefore I will like to give
specific action needed as well as challenges likely to be faced by developing countries as they
aim to achieve health for all through Primary Health Care including the way forward.
1.1 THE SPECIFIC ACTIONS INCLUDE:
1.1.1 COMMUNITY BASED APPROACH : involves a process of integrating health services
and communities to improve their well-being and control diseases by promoting strategic
behaviours at the household level as well as the provision of affordable healthcare and health
services at the community level. This approach involves providing support to households
embedded in the community to actively participate in activities and in decision making process of
identifying key health problems, collect vital information about the problems and seek
ways/solution to solve the problem by linking available resources and developmental capacities
to address health needs (2),this much was stated by Dr Carl Taylor of John Hopkins University,
thus, “there is no universal solution, but there is a universal process to find appropriate local
solution”. Therefore, the community based approach if adapted can be used by developing
countries to find local solutions to tackle health challenges in the community.
The use of Community Health Workers (CHWs) should form an integral part of the community
based approach, as part of a health team which includes physicians, nurses and midwives, as
they help to address the scarcity of health personnel in developing countries and deliver basic
priority services to the community. Such services include nutrition, education and agriculture,
living standards which directly or indirectly impacts on health of individuals in the community.
The CHWs have an important role in outreach and in health promotion including disease
prevention by modifying their roles as patterns of diseases and health needs changes, further,
they are to act as community change agents by building networks, partnership and trust with their
clients, for example in Bangladesh CHWs adapted a procedure of doing home visitation to teach
women how to prepare the Oral Rehydration Solution(ORS) from ingredients at home to help
improve health of children and reduce child mortality arising from diarrhoea (3). Therefore
2. introducing and integrating community based approach into primary health care programs will
help provide equity in health delivery to the poor communities in developing countries.
1.1.2 INNOVATION AND TECHNOLOGICAL APPROACH: is a process whereby new
and appropriate technologies are adopted and adapted to improve health by enhancing
knowledge and increasing availability and access to healthcare at cost-effective rate for
communities who are in greatest need of healthcare services in developing countries. These
innovations started after the alma-ata declaration and are relevant to the communities to help
tackle their health needs and ranges from design of community based family planning programs
and development of new technologies such oral rehydration solution which was driven by need
and achievability in developing countries(4) . This approach requires routine monitoring and
result-based evaluation process to determine the progress and the success likely to be achieved
when introduced in developing countries, this is necessary in order to increase scale-up across
the community and country based on success recorded from the approach, Further by
prioritising technologies and effective corporation between communities and stakeholders in
primary healthcare, gaps in health service delivery among poor people will be addressed making
sure such innovative solutions is equitably distributed among them(4).
Innovation research is a key component of this approach and is needed to improve health
status among communities in developing countries and aid decision making process among
stakeholders, researchers and policy makers on how intervention from innovations best affect the
people. The scope intervention should be backed up by evidence of how successful such
innovations have had a measureable impact in a prior developing country and research findings
should be well circulated among community, stakeholders, policy makers and the country.
Primary healthcare services and approaches in developing countries need to entrench
innovative research so that locally produced evidence (local content in health care innovation)
and solutions can support the need for scale-up of interventions needed by communities.
1.1.3 INTEGRATION OF PRIMARY HEALTH SERVICES (Vertical and Horizontal
Approaches to healthcare): is a concept which involves Government of developing countries
and international organisation in collaboration with the communities to provide healthcare for
based on article 5 of the alma-ata declaration which states that “Governments have a
responsibility for the health of their people which can be fulfilled only by the provision of adequate
health and social measures. A main social target of governments, international organizations and
the whole world community in the coming decades should be the attainment by all peoples of the
world by the year 2000 of a level of health that will permit them to lead a socially and
economically productive life. Primary health care is the key to attaining this target as part of
development in the spirit of social justice”(5).It is thus necessary for government and international
donors to harmonize healthcare policies and avoid policy preferences among groups under-
3. represented in healthcare governance which undermines the development priorities of
traditionally marginalized groups such as women. There is need for adequate representation
among gender groups especially for women and donor funds needs to be channelled through
budget support which will holistically help to improve healthcare delivery systems in communities.
The government of developing countries need to link the private and public healthcare providers
into a comprehensive healthcare system and provide accountability to communities which in the
long term will improve healthcare outcomes. Further, providing key priority intervention in PHC
settings by both government and donors to key most at risk population is of critical importance,
such key interventions include maternal, newborn and child health including an integrated
equitable approach to manage mental health and chronic diseases such as diabetes is
achievable in PHC settings in developing countries e.g Malawi has successfully systematically
administered tuberculosis care and adapted it to deliver anti-retroviral HIV services (6).
1.2 CHALLENGES
1.2.1 RESOURCES : The resources to achieve healthcare for all through PHC in developing
countries both human and financial resources are inadequate which most times affect the
activities of CHWs due to the fact that they are not properly remunerated and trained to manage
acute disorders to increase stability in healthcare delivery in communities. The lack of financial
resources has also contributed to lack of support from government and donor agencies to
holistically apply the principles of alma-ata declaration based on a comprehensive approach
which has further led to the neglect of emerging chronic diseases such as diabetes and mental
illness due to scarce resources placing more constraints on developing countries.
1.2.2 GOVERNMENT AND DONOR PARTNERSHIP : Most developing countries are
affected by issues due political instability, poor governance, lack of political commitment and the
vertical approach to strategies employed by donor agencies who focus on particular healthcare
challenges such as HIV/AIDS. This has led to lack of progress for the MDG goals. This further
has affected scale-up and coverage of PHC services including intersectoral linkage between
health and development which affects the progress likely to be achieved in education, water and
sanitation, and nutrition.
1.2.3 INNOVATION : There is the need for more innovative approach that are cost-effective for
developing countries in order to improve health and tackle the emergence of chronic diseases
and mental illness, there is a clear neglect among PHC providers in local communities about
chronic diseases with most of them focusing innovation on other diseases such as HIV/AIDS,
Malaria and Tuberculosis. Therefore, with a shift in the pattern of diseases in developing
countries, new innovative approach to fight chronic diseases is needed in PHC settings,this
4. should be integrated in partnership with other innovative approaches for communicable diseases
to provide a holistic approach and achieve health for all through PHC.
1.3 CONCLUSION
A stable and robust PHC that is cost-effective will help in the future will further reduce deaths
caused by preventable and chronic diseases among members of communities in countries with
limited resources. There should be the will from government, donors, civil societies to increase
and expand access to priority basic health services among key population and also scale-up
successful innovative practices and policy across communities, this will lead to a decline in
mortality arising from preventable conditions and help manage health challenges for the future.
Further, there is need for increase resources for health aimed towards evidence based
intervention and cohesive system of care among developing countries with greatest health
needs. These resources will help strengthen PHC in the community, encourage active
community participation and empowerment of priority population such as women.
Finally, in order to achieve goals set by alma-ata declaration for PHC, there is need for a shift
from short-term vertical/single approach to initiating integrated multi-sectoral long-term
horizontal/holistic approach that is sustainable in developing countries.