Public Health AffairPrimary Health Care: 27 years since Alma’Ata declaration [Archives:2005/868/Health]

By Dr. Saleh Al-Habshi
Msc. in Public Health
Alma'ata is a city in Asia, and the former capital of Kazakhistan Republic (former Soviet Union). The city gained international concern since 1978, when the famous international conference of Primary Health Care (PHC) was held there.

After a deep detailed discussions and analysis of different health issues and putting an evaluation of health situation in all world countries in 1977, the World Health Assembly proposed PHC and further application of the concept (Health for all by 2000) as a health strategy. The basic principle of that health strategy was equity of distribution of health resources among world population to ensure achieving a safe health standard.

World Health organization (WHO) defined the concept (Health for all) as: achievement of that health standard, which enables every individual to live a fruitful socio-economic life.

On 1978 Alma'ata International Conference for PHC was held in the capital of Kazakhistan Republic and approved the concept of (Health for all by 2000) as a health strategy, which should come at the top of health priorities in all countries. It was identified that the best way for the introduction of that health strategy is provision of PHC services to world population, especially to the majority in rural and distant areas. The member countries in the conference signed agreement that basic PHC services will be provided to all communities by 2000, while those services should be acceptable, accessible, affordable and with community participation.

Alma'ata Conference called all governments to formulate policies, strategies and put national plans to support and promote the sustainability of PHC as a part of the national health system. Every government was authorized to put criteria for the provision of PHC according to its local circumstances.

On 1981 WHO announced Alma'ata declaration (Health for all by 2000) as a global strategy, and put a task schedule for member countries, which covers all national and regional requirements.

Following Alma'ata declaration 1978 Yemen adopted PHC policy as will. In spite of many local constraints a lot of work was done in both Northern and Southern Yemen at that time, PHC units scheme was built. Mortality and morbidity rates reduced comparing with previous years. Figures were promising until the middle of Eightieth, when unexpected increasing number of cases appeared on the surface due to emerging and reemerging diseases in many countries including Yemen. A change in global and regional health policies took place.

A new global battle against diseases with strong incentives was restarted to repair the damage in previous plans and focus the control activities on targeted countries.

Health is a fundamental human right and for this right the individual, the community, the nation and the Government all have to play their respective role collectively, actively and in constructive manner. From the principles of PHC are: focusing on preventive services and community participation. While major known components of PHC are: 1) Health education. 2) Environmental sanitation. 3) Adequate food supply and nutrition. 4) Safe potable water supply. 5) Control of endemic diseases. 6) Control of communicable diseases. 7) Maternal and child health services. 8) Immunization programme. 9) Provision of essential drugs.

Health awareness in Yemen:

Looking at the previously encountered PHC components, we will find that health education is taking the first priority within the concept of PHC. That fact makes us put a logic question addressing the ministries of concern. How far we reached in educating and disseminating health awareness among Yemeni population?

The illiteracy rate in Yemen is 47.2% of the population (above 10 years) not mentioning children under 10 years, while 50% of population is covered with public health services. These figures make clear how necessary Yemeni community needs to be awarded to utilize available health services.

Health education interferes in all components of PHC. Without promoting the role of health education, the utilization of health services by the population will keep low, not talking about the quality of services provided and the level of staff training and how punctual that staff in performing their jobs honestly.

Perhaps that may explain the recent occurrence of outbreaks of some communicable diseases, while documents indicate a high coverage with targeted control measures.

Community participation:

Health education of the community increases the rates of community participation. Award individual in the community understands his role, and that helps health-workers too much to do their job, for example by participating them or accompanying them especially in rural arias where rough distant roads and local traditions predominate. Also the role of local authority and community leaders is important in enhancing community participation and using their power to stop those who stand against public concern.

So achieving that health standard, which enables every individual to live a fruitful socio-economic life in Yemen, will not be realized until we work together honestly, adopting our health policies, throwing away selfishness and cooperating for the sake of public concern.

And thus health for all will be by . soon!
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