Alma Ata finalllllllllll

8/9/2019 Alma Ata finalllllllllll

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Alma AtaAlma Ata


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Why Alma AtaWhy Alma Ata

declaration?declaration?

1960,Health agencies finding1960,Health agencies finding

Unequal distribution of HealthUnequal distribution of Health

Services between DevelopedServices between Developed

&Developing countries, between&Developing countries, between

rich & poor within the same countryrich & poor within the same country Avenues of Health did not changeAvenues of Health did not change

the Health status of peoplethe Health status of people


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The Joint WHO UNICEFThe Joint WHO UNICEF

international conference in 1978international conference in 1978

at Alma-Ata (USSR)at Alma-Ata (USSR)

Alma-Ata Declaration called on all theAlma-Ata Declaration called on all the

governments to formulate nationalgovernments to formulate nationalhealth policies according to their ownhealth policies according to their own

circumstances to launch and sustaincircumstances to launch and sustain

primary health care as a part ofprimary health care as a part of

national health system.national health system.


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T e 30te t Wor Hea tor ea tAssemblyAssembly

in May 1977in May 1977resolvedresolved The main social target ofThe main social target of

governments and WHO in the cominggovernments and WHO in the comingdecades should be the attainment bydecades should be the attainment by

all citizens of the world by the yearall citizens of the world by the year2000 AD of a level of health that will2000 AD of a level of health that will

permit them to lead a socially andpermit them to lead a socially andeconomically productive life.economically productive life.

HEALTH FOR ALL BY 2000 ADHEALTH FOR ALL BY 2000 AD


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Large numbers of the worldsLarge numbers of the worldspeople, perhaps more than half,people, perhaps more than half,have no access to health care at all,have no access to health care at all,and for many of the rest the careand for many of the rest the carethey receive does not answer thethey receive does not answer the

problems they have.problems they have.--John Bryant in his bookJohn Bryant in his book

Health and the Developing WorldHealth and the Developing World

Th J i WHO UNICEF


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The Joint WHO UNICEFThe Joint WHO UNICEF

international conference ininternational conference in

19781978at Alma-Ata (USSR)at Alma-Ata (USSR)

Declared thatDeclared that The existing gross inequalities inThe existing gross inequalities in

the status of health of peoplethe status of health of people

particularly between developed andparticularly between developed and

developing countries as well asdeveloping countries as well as

within the countries is politically,within the countries is politically,

socially and economicallysocially and economically

unacceptable.unacceptable.


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The Alma-Ata conference called for acceptance of the The Alma-Ata conference called for acceptance of theWHO goal ofWHO goal of

HEALTH FOR ALLHEALTH FOR ALL

by 2000 ADby 2000 AD

andand Primary Health CarePrimary Health Careas a way to achieve Healthas a way to achieve HealthFor All.For All.

It has all the hallmarks of primary health careIt has all the hallmarks of primary health care

delivery which was first proposed by Bhoredelivery which was first proposed by Bhorecommittee in 1946.committee in 1946.


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Alma-Ata Declaration called on allAlma-Ata Declaration called on all

the governments to formulatethe governments to formulate

national health policies accordingnational health policies accordingto their own circumstances toto their own circumstances to

launch and sustain primary healthlaunch and sustain primary health

care as a part of national healthcare as a part of national healthsystem.system.


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The Alma-Ata conferenceThe Alma-Ata conference

defineddefinedthatthatPrimary health care is essential health carePrimary health care is essential health caremade universally accessible to individualsmade universally accessible to individuals

and acceptable to them, through their fulland acceptable to them, through their fullparticipation and at the cost the communityparticipation and at the cost the communityand country can afford.and country can afford.

Primary health care is equally valid for allPrimary health care is equally valid for allcountries from the most to the least developed.countries from the most to the least developed.


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The concept of primaryThe concept of primary

health care has beenhealth care has beenaccepted by allaccepted by all

countries as the key tocountries as the key to

attainment health for allattainment health for all

by 2000 AD.by 2000 AD.

It has been alsoIt has been alsoaccepted as an integralaccepted as an integral

part of countrys healthpart of countrys health

system.system.


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Elements of phcElements of phc

E Education concerning health problems and theE Education concerning health problems and themethods of preventing and controlling them.methods of preventing and controlling them.

L Locally endemic disease control and prevention.L Locally endemic disease control and prevention.

E Expanded programme of immunization.E Expanded programme of immunization. M Maternal & child health and family welfare.M Maternal & child health and family welfare. E Essential drug provision.E Essential drug provision. N Nutrition and food supply.N Nutrition and food supply. T Treatment of common diseases.T Treatment of common diseases.

S Safe water supply & basic sanitation.S Safe water supply & basic sanitation.


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Principles ofPrinciples of

primary health careprimary health care1.1. Equitable distributionEquitable distribution

2.2.

Community participation.Community participation.3.3. Inter-sectoral coordinationInter-sectoral coordination

4.4. Appropriate technologyAppropriate technology


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1)Equitable1)Equitable

distributiondistribution Health services must be shared equally by allHealth services must be shared equally by all

people irrespective of their ability to pay andpeople irrespective of their ability to pay andall must have access to health services.all must have access to health services.

At present health services are mainlyAt present health services are mainlyconcentrated in the major towns and citiesconcentrated in the major towns and citiesresulting inequality of care to the people inresulting inequality of care to the people inrural areas. The worst hit are the needy andrural areas. The worst hit are the needy andvulnerable groups of the population are in ruralvulnerable groups of the population are in rural

areas & urban slums.areas & urban slums.


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Primary health care aims toPrimary health care aims to

redress this imbalance byredress this imbalance by

shifting the centre of gravityshifting the centre of gravity

of health care system fromof health care system from

cities to the rural areas andcities to the rural areas andbring this services as nearbring this services as near

peoples homes as possible.peoples homes as possible.


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2) Community2) Community

participationparticipation

The involvement of individualThe involvement of individualfamilies & communities infamilies & communities inpromotion of their own healthpromotion of their own healthand welfare is an essentialand welfare is an essentialingredient of primary healthingredient of primary health

care.care. PHC must be built on thePHC must be built on the

principle of communityprinciple of communityparticipation.participation.

The use of village healthThe use of village healthguides and trained daisguides and trained dais


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3) Intersectoral coordination3) Intersectoral coordination PHC cannot be provided by health sector alone.PHC cannot be provided by health sector alone. Primary health care involves in addition to the healthPrimary health care involves in addition to the health

sector all related sectors and aspects of national andsector all related sectors and aspects of national andcommunity development.community development.

To achieve such cooperation countries may have to reviewTo achieve such cooperation countries may have to reviewtheir administrative system, reallocate their resources andtheir administrative system, reallocate their resources andintroduce suitable legislation to ensure that coordinationintroduce suitable legislation to ensure that coordination

can take place.can take place.The important element of intersectoral approach isThe important element of intersectoral approach is

planning with the other sectors to avoid unnecessaryplanning with the other sectors to avoid unnecessaryduplication of activities.duplication of activities.


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4)Appropriate4)Appropriate

technologytechnology Has been defined as technology that isHas been defined as technology that is

scientifically sound, adaptable to localscientifically sound, adaptable to local

needs and acceptable to those who applyneeds and acceptable to those who apply

it and for those for whom it is used andit and for those for whom it is used and

that can be maintained by the peoplethat can be maintained by the people

themselves in keeping with principles ofthemselves in keeping with principles of

self reliance with resources theself reliance with resources the

community and country can afford.community and country can afford.


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Functions of PHCFunctions of PHC

Medical care.Medical care. MCH including family planning.MCH including family planning. Safe water supply & basic sanitation.Safe water supply & basic sanitation.

Prevention & control of endemic diseases.Prevention & control of endemic diseases. Collection & reporting of vital statistics.Collection & reporting of vital statistics. Education about health.Education about health. National health programme as relevant.National health programme as relevant. Referral services.Referral services. Training of health guides health workers local daisTraining of health guides health workers local dais

and health assistants.and health assistants. Basic laboratory services.Basic laboratory services.


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It must be emphasized that primaryIt must be emphasized that primary

health centers establishment ishealth centers establishment is

valuable national asset.valuable national asset.Their establishment is fruit of severalTheir establishment is fruit of several

years of great efforts to increase theyears of great efforts to increase the

outreach of the health services.outreach of the health services.


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We can say the that primary health care isWe can say the that primary health care is

qualitatively a different approach to dealqualitatively a different approach to deal

with health problems of community.with health problems of community.

Primary health care approach starts withPrimary health care approach starts with

people themselves.people themselves.

PHC has been described as health byPHC has been described as health by

people, placing peoples health inpeople, placing peoples health in

peoples hands.peoples hands.


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National Health PolicyNational Health Policy

-1983-1983 NHP 1983 stressed the need for providingNHP 1983 stressed the need for providing

primary health care with special emphasis onprimary health care with special emphasis on

prevention, promotion and rehabilitationprevention, promotion and rehabilitation

SuggestedSuggested planned time boundplanned time bound attention toattention to

the followingthe following

i) Nutrition, prevention of Foodi) Nutrition, prevention of Food

AdulterationAdulteration

ii) Maintenance of quality of drugsii) Maintenance of quality of drugs


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iii) Water supply and sanitationiii) Water supply and sanitation

iv) Environmental protectioniv) Environmental protection

v) Immunization programmev) Immunization programmevi) Maternal and child health servicesvi) Maternal and child health services

vii) School health programme andvii) School health programme and

viii) Occupational health services.viii) Occupational health services.


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For better programmeFor better programme

planning NHP 1983planning NHP 1983

recommended an effectiverecommended an effectiveHealth Information System.Health Information System.


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National Health PolicyNational Health Policy

20022002Objectives:Objectives: Achieving an acceptable standard ofAchieving an acceptable standard of

good health of Indian Population,good health of Indian Population, Decentralizing public health system byDecentralizing public health system by

upgrading infrastructure in existingupgrading infrastructure in existinginstitutions,institutions,

Ensuring a more equitable access toEnsuring a more equitable access tohealth service across the social andhealth service across the social andgeographical expanse of India.geographical expanse of India.


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Enhancing the contribution of privateEnhancing the contribution of privatesector in providing health service forsector in providing health service forpeople who can afford to pay.people who can afford to pay.

Giving primacy for prevention and firstGiving primacy for prevention and firstline curative initiative.line curative initiative.

Emphasizing rational use of drugs.Emphasizing rational use of drugs.

Increasing access to tried systems ofIncreasing access to tried systems ofTraditional MedicineTraditional Medicine


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Goals NHP 2002Goals NHP 2002

1. Eradication of Polio & Yaws 20051. Eradication of Polio & Yaws 2005

2. Elimination of Leprosy 20052. Elimination of Leprosy 2005

3. Elimination of Kala-azar 20103. Elimination of Kala-azar 2010

4. Elimination of lymphatic Filariasis 20154. Elimination of lymphatic Filariasis 2015

5. Achieve of Zero level growth 20075. Achieve of Zero level growth 2007

of HIV/AIDSof HIV/AIDS


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6.Reduction of mortality by 50%6.Reduction of mortality by 50%20102010

on account of Tuberculosis,on account of Tuberculosis,Malaria, Other vector andMalaria, Other vector andwater borne Diseaseswater borne Diseases

7.Reduce prevalence of blindness7.Reduce prevalence of blindness

20102010to 0.5%to 0.5%


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8. Reduction of IMR to 30/1000 & 20108. Reduction of IMR to 30/1000 & 2010

MMR to 100/lakhMMR to 100/lakh

9. Increase utilisation of public 20109. Increase utilisation of public 2010

health facilities from currenthealth facilities from currentlevel of 75%level of 75%

10. Establishment of an integrated 200710. Establishment of an integrated 2007

system of surveillance,system of surveillance,

National Health Accounts andNational Health Accounts andHealth StatisticsHealth Statistics


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11.Increase health expenditure 201011.Increase health expenditure 2010

by government as a % ofby government as a % of

GDP from the existingGDP from the existing0.9% to 2.0%0.9% to 2.0%

12. Increase share of Central 201012. Increase share of Central 2010

grants to constitute at leastgrants to constitute at least

25% of total health spending25% of total health spending


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13. Increase State Sector 200513. Increase State Sector 2005

Health spending fromHealth spending from

5.5% to 7% of the budget5.5% to 7% of the budget14. Further increase of 201014. Further increase of 2010

State sectorState sector

Health spendingHealth spending

from 7% to 8%from 7% to 8%


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Urban healthUrban health

Migration has resulted in urban growthMigration has resulted in urban growth

which is likely to go up to 33%.which is likely to go up to 33%.

It anticipates rising vehicle densityIt anticipates rising vehicle densitywhich lead to serious accidents.which lead to serious accidents.

In this direction, 2002 NHP hasIn this direction, 2002 NHP has

recommended an urban primary healthrecommended an urban primary health

care structure as under;care structure as under;


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First Tier:-First Tier:- Primary centre cover 1 Lakh populationPrimary centre cover 1 Lakh population

It functions as OPD facilities.It functions as OPD facilities. It provides essential drugs.It provides essential drugs. It will carry out national health programmes.It will carry out national health programmes.

Second Tier:-Second Tier:- General Hospital a referral to primary centreGeneral Hospital a referral to primary centre

provides the care.provides the care. The policy recommends a fully equippedThe policy recommends a fully equipped hub-hub-

spokespoketrauma care network to reduce accidenttrauma care network to reduce accidentmortality.mortality.


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Mental healthMental health

Decentralized mental health serviceDecentralized mental health service

for diagnosis and treatment byfor diagnosis and treatment by

general duty medical staff isgeneral duty medical staff isrecommended.recommended.

It also recommends securing theIt also recommends securing the

human rights of mentally sick.human rights of mentally sick.

I f i Ed i dI f ti Ed ti d


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Information Education andInformation Education and

CommunicationCommunication

NHP 2002 has suggestedNHP 2002 has suggested

interpersonal communication byinterpersonal communication by

folk and traditional media to bringfolk and traditional media to bringabout behavioral change.about behavioral change.

Associations of PRIs/NGOs/TrustsAssociations of PRIs/NGOs/Trusts

are given specific targets.are given specific targets.


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School children are covered for promotion ofSchool children are covered for promotion of

health seeking behavior, which is expectedhealth seeking behavior, which is expected

to be the most cost effective interventionto be the most cost effective intervention

where health awareness extends to familywhere health awareness extends to familyand further to future generation.and further to future generation.


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Health researchHealth research

2002 NHP noted the aggregate annual2002 NHP noted the aggregate annualhealth expenditure of Rs. 80,000 croreshealth expenditure of Rs. 80,000 croresand on research Rs. 1150 crores is quiteand on research Rs. 1150 crores is quite

low.low. The policy envisages an increase in govt. The policy envisages an increase in govt.

funded health resources to a level of 1%funded health resources to a level of 1%total health spending by 2005 and upto 2%total health spending by 2005 and upto 2%by 2010.by 2010.

New therapeutic drugs and vaccines forNew therapeutic drugs and vaccines fortropical disease are given priority.tropical disease are given priority.


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Health statisticsHealth statistics

NHP 2002 has recommended full baselineNHP 2002 has recommended full baseline

estimate of tuberculosis, malaria andestimate of tuberculosis, malaria and

blindness by 2005, andblindness by 2005, and

In the long run for cardiovascular diseases,In the long run for cardiovascular diseases,

cancer, diabetes, accidents, hepatitis andcancer, diabetes, accidents, hepatitis and

G.E.G.E.

It has suggested a national health accountsIt has suggested a national health accounts

conforming to the source to users matrix.conforming to the source to users matrix.


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Women's healthWomen's health

After recognizing the catalytic role ofAfter recognizing the catalytic role of

empowered women in improving the overallempowered women in improving the overall

health standard of the country, NHP 2002 hashealth standard of the country, NHP 2002 has

recommended to meet the specificrecommended to meet the specificrequirement of women in a morerequirement of women in a more

comprehensive manner.comprehensive manner.


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Medical ethicsMedical ethics

In India we have guidelines on professional medical ethics sinceIn India we have guidelines on professional medical ethics since1960.1960.

This is revised in 2001.This is revised in 2001. Government of India has emphasized the importance of moralGovernment of India has emphasized the importance of moral

and religious dilemma.and religious dilemma. NHP 2002 has recommended notifying aNHP 2002 has recommended notifying a

contemporary code of ethics, which is to becontemporary code of ethics, which is to berigorously implemented by Medical Council of India.rigorously implemented by Medical Council of India.

The Policy has specified the need for a vigilant watchThe Policy has specified the need for a vigilant watchon gene manipulation and stem cell research.on gene manipulation and stem cell research.


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NHP 2002 has given a continuum to NHPNHP 2002 has given a continuum to NHP

1983, where primary health care is1983, where primary health care is

adopted as the main strategy throughadopted as the main strategy through

DecentralizationDecentralization

EquityEquity

Private sector/indigenous system participationPrivate sector/indigenous system participation

Rise in public investmentRise in public investment


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The ultimate goal is achieving anThe ultimate goal is achieving an

acceptable standard of good health ofacceptable standard of good health of

people of India.people of India.The commitment of the serviceThe commitment of the service

providers and an improved standard ofproviders and an improved standard of

governance is a prerequisite for thegovernance is a prerequisite for the

success of any health policy.success of any health policy.


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ThankThankyouyou

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Alma Ata finalllllllllll