Primary health care: the time is now

Forty years since the historic Declaration of Alma-Ata identified primary health care as the key to health for all, world leaders gather this week in Kazakhstan. They will reflect on achievements since 1978 and endorse a new declaration to revitalize primary health care for the 21st century.

“We still face an unfinished agenda to provide universal access to quality care through a primary health care approach. The 40th anniversary of the Declaration of Alma-Ata provides an opportunity we must take advantage of to reaffirm and commit to the values we still hold today. This is especially important in the new context of the 2030 Agenda for Sustainable Development,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

Reflecting on the past, transforming for the future

The WHO European Region has experienced significant changes over the last 4 decades, presenting systemic challenges that health systems must address: the European population is ageing; noncommunicable disease risks factors must be curbed; injuries and disabilities dominate the disease burden; inequalities in health are widening; citizens have greater expectations regarding comprehensive, people-centred and responsive care; and the global financial crises continue to have an impact.

Regional health policies, strategies and resolutions such as the Ljubljana Charter (1996); the Tallinn Charter (2008); the European health policy, Health 2020 (2012); and “Priorities for health systems strengthening in the WHO European Region 2015–2020: walking the talk on people centredness” (2015), have catalysed the development of innovations to promote equitable, effective, efficient and responsive primary health care.

Some examples of innovations adopted by several countries to address these systemic challenges in the European Region include:

• In more than 10 countries across the Region, nurses and midwives are able to prescribe medicines.
• In Bulgaria, Croatia, Denmark, Estonia, Hungary, the Republic of Moldova, Slovenia, Sweden, Ukraine and the United Kingdom patients are able to exercise choice with the right to select their family doctor.
• Denmark, Finland, Norway, Sweden and others, working to enhance the role of municipalities, have integrated health and social services locally and put innovative organization and governance arrangements into practice.
• Both regionally, as in Veneto, Italy, and across regions as in Lithuania and Norway, countries have worked to prioritize integrated public health services delivery, tackling both population and individual health needs together.
• In many countries across eastern Europe and central Asia, such as Kyrgyzstan, the Russian Federation and Tajikistan, investments in establishing quality improvement loops in clinical practice signal quality as a continuous learning and improvement process.
• Countries across central Asia have transformed the training and education of generalist medical practitioners, taking it from a retraining model to an established initial training and practical learning degree programme.
• Belgium, France, Germany, Turkey and the United Kingdom offer financial incentives such as higher remuneration, allowances or bonus payments to encourage family doctors to work in underprivileged areas.
• In many countries across eastern Europe and central Asia, such as Kazakhstan, diverse telemedicine initiatives have proliferated to reach underserved and remote areas with specialized cardiology, pulmonology and neurology care.
• Denmark, Estonia, Israel and Spain (Catalonia) have established health information exchange systems that connect health records across health providers to enable the provision of integrated care.

The report, “From Alma-Ata to Astana: Primary health care – reflecting on the past, transforming for the future” accounts for the progress made in primary health care in the European Region over the past 4 decades and shares examples of national innovations in delivering primary health care. It provides the context for and base upon which discussions at the Global Conference on Primary Health Care will take shape.

The Global Conference on Primary Health Care

Heads of state; ministers of health, finance, education and social welfare; health workers and patient advocates; youth delegates; and representatives of bilateral and multilateral institutions, civil society, academia, philanthropy, media and the private sector come together in Astana on 25–26 October 2018 for the Global Conference on Primary Health Care.

Themes on the agenda include advancing equitable health outcomes, meeting the needs of marginalized populations and addressing the determinants of health, preventing and responding to emergencies, integrating services across providers and settings, strengthening the health workforce, building on new technology and innovation, and fostering multisectoral action plans and partnerships.

As in 1978, the Conference is cohosted by WHO, the United Nations Children’s Fund (UNICEF) and the Government of Kazakhstan.

To kick-off the 40th anniversary celebrations, 2 events are taking place in Almaty: the “Scientific conference: crossroad of policy, research, education and practice in primary health care” and the “WHO Healthy Cities Summit of Mayors”.