Introduction to the history of primary healthcare.

The history of primary healthcare.
From the small efforts of various groups to promote accessible and affordable health to all, the first significant step in the history of primary healthcare was the World Health Organization (WHO)’s “Health for all by the year 2000” initiative of 1977 which promoted UHC.
Although it was deemed impossible, atleast it led to the Alma Ata declaration in 1978 where various leaders established primary healthcare as the most practical and effective was of achieving the goal “Health for all by year 2000”.
30 years down the line, in 2008, the World Health Organisation launched the “Primary healthcare: now more than ever” report which highlighted several reforms necessary to make primary healthcare effective.
Then in 2018 was the Astana Declaration which traced the progress of primary healthcare since the Alma Ata declaration and established ways of strengthening primary healthcare to achieve universal health coverage.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Policy Framework for primary healthcare in Africa” which outline the goals to be met by Africa to achieve effective PHC for UHC in Africa.

Health for all by the year 2000

“Health for all by the year 2000” was a global health initiative launched by the World Health Organization (WHO) in 1977.
The initiative had three main objectives:
1. To achieve a level of health that would permit all individuals to lead a socially and economically productive life.
2. To reduce the gap in health status between developed and developing countries.
3. To provide essential health care to all individuals and families in the community.

Unfortunately, the goal of “Health for all by the year 2000” was not achieved but it did help in raising awareness of the need for accessible and affordable health for all, and this led to the establishment of primary healthcare in the 1978’s Alma Ata declaration.

The Alma Ata Declaration of 1978

The Alma-Ata Declaration is a health policy document that was adopted at the International Conference on Primary Health Care held in Alma-Ata, Kazakhstan in 1978.
The Declaration has had a profound impact on global health policy and practice. It has been a driving force behind the development of primary healthcare as a central component of health systems around the world.
It defined primary healthcare as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”
And it also emphasized the importance of community participation, health promotion, and disease prevention in addition to curative services. It recognized the need for a comprehensive approach to healthcare that addressed not just physical health, but also mental, social, and spiritual well-being.

WHO’S “Primary Health Care: Now More Than Ever” Report of 2008

The report “Primary Health Care: Now More Than Ever” was published in 2008 by the World Health Organization (WHO). The report emphasized the importance of primary health care as the foundation of any effective health system and called for a renewed global commitment to primary health care as a means of achieving better health for all.
It highlighted four key reforms necessary to strengthen primary healthcare:
1. Strengthening health systems: The report called for a comprehensive approach to strengthening health systems, including investments in health infrastructure, health workforce education and training, and health information systems.
2. Improving access to primary health care: The report emphasized the need to improve access to primary health care services, particularly for underserved populations, through strategies such as expanding health coverage and reducing financial barriers to care.
3. Enhancing the quality of primary health care: The report called for efforts to improve the quality of primary health care services through initiatives such as strengthening health workforce capacity, promoting evidence-based practice, and implementing quality assurance systems.
4. Fostering community participation and empowerment: The report highlighted the importance of engaging communities in primary health care planning and decision-making to promote health equity and social justice.
Overall, the report called for a coordinated and sustained effort to strengthen primary health care systems worldwide, with a focus on addressing the health needs of the most vulnerable populations.

The Astana Declaration of 2018

The Astana Declaration is a global commitment to achieving universal health coverage (UHC) through primary health care (PHC). The declaration was adopted at the Global Conference on Primary Health Care in Astana, Kazakhstan in 2018, which marked the 40th anniversary of the historic Alma-Ata Declaration of 1978.
The Astana Declaration reaffirms the principles of the Alma-Ata Declaration, which recognized primary health care as the key to achieving health for all. The Astana Declaration goes further by emphasizing the need for a renewed commitment to primary health care as the foundation of health systems, and as a means of achieving universal health coverage.
The Astana Declaration calls for a series of actions to strengthen primary health care systems, including:
1. Investing in primary health care as the cornerstone of health systems
2. Strengthening health systems through increased funding and resources
3. Ensuring access to essential health services for all, including through community-based approaches
4. Empowering individuals and communities to participate in their own health and health care
5. Strengthening health workforce education and training to ensure a skilled and motivated health workforce
6. Strengthening health information systems to improve decision-making and accountability
7. Strengthening partnerships and cooperation between different sectors and actors to achieve shared health goals.

AfroPHC’s Policy Framework for PHC and UHC in Africa

This week we have been looking at the history of primary healthcare.
At the present time, as we also create and contribute to the history of primary healthcare, in 2023 AfroPHC will be launching the “Building PHC Teams for UHC in Africa” which underscores the crucial role of the PHC workforce within a team based approach. It also outlines the key actions that need to be met by Africa to achieve effective PHC for UHC in Africa.
This policy framework was funded by Primary Health Care Performance Initiative (PHCPI) and echoes the voices of frontline primary healthcare workers and leaders across, Africa, collated through a series of virtual policy workshops and group discussions. The final workshop was held in October 2022 in Johannesburg, South Africa where a cohort of about 30 multicountry multiprofessional delegates met in person to finalise the policy framework.
In summary, the policy calls to Africa to pay heed to the call of its health professionals, to seize opportunities to overcome African challenges, to embrace the World Health Organisation’s Report of 2008 and Astana Declaration of 2018 by prioritizing integrated, resilient, person-centred and high quality PHC within UHC, re-organising UHC around PHC service delivery, integrating public health with primary care, and bringing private PHC providers into a regulated PHC system for UHC in Africa.