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Marking a significant milestone in the history of primary healthcare with a call for action

Next month marks the 40-year anniversary of the Alma-Ata Declaration on Primary Health Care, which outlined a vision for comprehensive primary health care.

A series of related events will be held in Australia, including the launch of a plan for reforming primary health care, as reported below by Dr Helen van Eyk, Dr Toby Freeman and Professor Fran Baum from the Southgate Institute for Health, Society and Equity, at Flinders University.


Helen van Eyk, Toby Freeman and Fran Baum write:

Forty years ago, WHO presented a progressive vision for comprehensive primary health care including action on the social determinants of health in its Alma-Ata Declaration on Primary Health Care.

The Alma-Ata Declaration emphasised health promotion, intersectoral collaboration on social determinants of health, local, accessible and multi-disciplinary health care, community participation, and the need for a new economic order if health for all was to be realised. Health was presented as a basic human right and a means to realise social justice.

However, this comprehensive vision was quickly overtaken by a depoliticised selective primary health care that promoted treatment for specific diseases and dropped the broader social and economic reform agenda of the original document.

While comprehensive primary health care has rarely been fully implemented, there have been pockets of excellence in Australia (including Aboriginal Community Controlled Health Services and community health services in various states) and globally, and it continues to be promoted as an ideal approach to health care and health promotion by many.

The Alma-Ata Declaration will be reaffirmed at the WHO Global Conference on Primary Health Care, where nations will come together to recommit to strengthening primary health care to achieve universal health coverage and the Sustainable Development Goals.

It is questionable, however, whether the reaffirmation will support the original comprehensive vision. Civil society organisations have expressed their disappointment in the draft document for the conference and called for more adherence to the original Alma-Ata vision.

The principles of comprehensive primary health care make it clear why its relevance today is undiminished. Because of its focus on the social determinants of health and equity, and on ensuring a continuum of care from prevention and health promotion to treatment and rehabilitation, comprehensive primary health care holds a key to reversing spiralling health costs and growing health inequities, and to closing the gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians through upstream preventative and promotive action.

Flinders University’s Southgate Institute for Health, Society and Equity has been leading primary health care research and evaluation for many years, underpinned by the comprehensive primary health care vision of the Alma-Ata Declaration.

Our recent and current primary health care research programs focus on comprehensive primary health care in local communities in Australia; how government policies can work more effectively to address the social determinants of health to improve health and reduce health inequities; and population health planning in Australian regional primary health care organisations, and the extent to which regional primary health care organisations incorporate equity, community participation and the social determinants of health.

Our research program has used forensic examination of primary health care services, interviews with many policy makers and practitioners and careful document analysis to offer insight into the primary health care policy environment, current primary health care practices and how they have changed over time, current opportunities and challenges. On the basis of our research we make recommendations for improved primary health care planning and practice.

The 40th anniversary of the Alma-Ata Declaration provides an opportunity to revive the comprehensive vision of primary health care set out in the Declaration. To mark this significant milestone, the Southgate Institute is calling for renewed and visionary thinking about primary health care to build on the Alma-Ata Declaration.

We have brought together key findings from our primary health care research program in a Ten Point Plan for Reform of Primary Health Care in Australia, providing a vision for comprehensive primary health care in Australia. The Southgate Ten Point Plan for Reform of Primary Health Care in Australia will be launched at a Primary Health Care Policy Symposium being held in Canberra on 12 September 2018 and repeated in Adelaide on 17 September 2018.

The symposium will feature Professor David Sanders from the University of Western Cape in South Africa, Professor James Macinko from the University of California, Los Angeles, Professor Fran Baum, Director of the Southgate Institute, and Professor Michael Kidd from the University of Toronto. Federal Minister for Health Greg Hunt, will also present a video address and the South Australian Health Minister Hon Stephen Wade will open the Adelaide Symposium. The symposium is designed to stimulate debate about primary health care policy in Australia among health stakeholders, policymakers and politicians and highlight the value of the comprehensive model.

Interested participants in this event can register for free for the Canberra or Adelaide symposium here.

• Dr Helen van Eyk, Dr Toby Freeman and Professor Fran Baum are from the Southgate Institute for Health, Society and Equity, at Flinders University.