Criticisms of and reactions to the Alma-Ata Declaration

https://en.wikipedia.org/wiki/Alma_Ata_Declaration

The Alma-Ata Declaration generated numerous criticisms and reactions worldwide. Many argued that the slogan “Health for All by 2000” was not possible and that the declaration did not have clear targets. In his article “The Origins of Primary Health Care and Selective Primary Health Care”, Marcos Cueto claims that the declaration was condemned as being unrealistic, idealistic, and too broad. As a result of these criticisms, the Rockefeller Foundation sponsored the Health and Population Development Conference held in Italy at the Bellagio Conference Center in 1979 (a year after Alma-Ata). The purpose of this conference was to specify the goals of PHC and to achieve more effective strategies.

As a result, Selective Primary Health Care (PHC) was introduced. As opposed to PHC of the Alma-Ata Declaration, Selective PHC presented the idea of obtaining low-cost solutions to very specific and common causes of death. The targets and effects of Selective PHC were clear, concise, measurable, and easy to observe. This is because Selective PHC had explicit areas of focus that were believed to be the most important. They were known as GOBI (growth monitoring, oral rehydration treatment, breast-feeding, and immunization), and later GOBI-FFF (adding food supplementation, female literacy, and family planning). Unlike the Alma-Ata Declaration, these aspects were very specific and concise, making global health as successful and attainable as possible. Nonetheless, there were still many supporters who preferred the comprehensive PHC introduced at Alma-Ata over Selective PHC.^[4]

Primary health care, selective or comprehensive, which way to go?

https://www.ncbi.nlm.nih.gov/pubmed/12755235

Conclusion:

Selective PHC programs have improved specific aspects of health, frequently at the expense of other health sectors, but fail to address an individual's health in holistic manner, or the health infrastructure of countries. Selective PHC programs tend to focus only on a small subset of the community. Comprehensive PHC is expensive to implement, however addresses health of individuals more holistically, addresses both preventive and curative health care, and promotes health infrastructure development and community involvement, thereby providing more sustainable improvement of health in the whole community.

Comprehensive Versus Selective Primary Health Care: Lessons For Global Health Policy

• Lesley Magnussen, John Ehiri and Pauline Jolly

• http://content.healthaffairs.org/content/23/3/167.full

  • Abstract

    • Primary health care was declared the model for global health policy at a 1978 meeting of health ministers and experts from around the world. Primary health care requires a change in socioeconomic status, distribution of resources, a focus on health system development, and emphasis on basic health services. Considered too idealistic and expensive, it was replaced with a disease-focused, selective model. After several years of investment in vertical interventions, preventable diseases remain a major challenge for developing countries. The selective model has not responded adequately to the interrelationship between health and socioeconomic development, and a rethinking of global health policy is urgently needed.

ROJ@17may12