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| Dr Carl Taylor: PHC pioneer |
Dr Carl Taylor´s historical overview on Alma-Ata International Conference on Primary Health Care (PHC) highlights a conceptual question about 1978 Alma-Ata Declaration. According to Dr Taylor, firstly, PHC had been concerned as a comprehensive intervention on communities, then, after 1984, forced by donors from international cooperation, this label changed to selective PHC (1). The justification of being “comprehensive” or “selective” was absorbed by new terminology “community-based primary health care”, but the struggle to enhance people health unmasked political will as a critical issue to international cooperation.
Particularly in developing countries, PHC selective approach seems to attend places for “shoe leather epidemiology”, as stated by epidemiologist Pat Rubinstein; or in times of “good old days of infectious epidemics”, as reported by Carl Grant (2). Circumstances like these demonstrate a paradox since PHC had in its origins at Alma-Ata a major focus on prevention and mitigation much more than proposed prescription or treatment. The Conference claimed “health for all by the year 2000” like a fundamental human right and for this purpose introduced integrated scale of services, disseminating the idea of national and international commitment to primary health care supported by governments, WHO, UNICEF and international organizations.
At Alma-Ata states members of United Nations tracked down principles of PHC based in sustainable actions, in spite of Cold War, thinking Earth as a human household, where Medicine and knowledge need to be share worldwide. It can be understood in Declaration by one of many PHC definitions written in the document: “Health care involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors” (3);
Margaret Chan, former WHO`s director general, in her article “Return to Alma-Ata” (4), emphasizes that 30 years before Alma-Ata Declaration “broadened the medical mode to include social and economic factors (…) what “increasingly looks like a smart way to get health development back on track”. She reconfirms the social aims from Alma-Ata and classifies the Conference participants as “visionary thinkers”. Chan argues selective approach in PHC gained strength in international actions not just for being a better methodology but because there was political international affairs and economics crisis that refrain a comprehensive medical insertion.
The spirit of Alma-Ata was welcomed in Millennium Development Objectives to combat epidemic diseases helping stakeholders in monitoring and evaluating “solutions created by communities, owned by them, and sustained by them”. Raj Arole defines appropriately what has been the spirit of Alma-Ata, when he states “knowledge nor only gives power, but that sharing knowledge also increases self-esteem and is important in the development of a team spirit” (5).
Alma-Ata brought to community-based PHC others core functions of public health in terms of assessment, policy development and disease prevention. For example, at community level, communication has become instrument for mobilization and education about disease prevention and disability meanwhile interventions depend upon people organization to accomplish public health diagnoses and treatment. The fact is that community-base strategies, despite selective, also improve wellbeing and life quality stimulating citizenship and engaging people.
It is the case of The Comprehensive Rural Health Project Jamkhed (CRHP Jamkehd) in India (6), established on three pillars that stems from Community, Mobile Health Team and Hospital & Training Center, PHC`s effective service integration supported by health workers provided by community is social changing. This vision was disseminate also by Alma-Ata to NGOs like Tiyatien Health, in Liberia; by SEARCH in which Dr Abhay Bang provides community health care to the tribes of Gadchiroli district in Maharashtra. Carl Taylor`s vision on PHC transform lives anywhere because empowerment communities is the same of giving people a chance to be respect as human beings.
International Relations has a great case in PHC experiences all over the world. Rich and developing countries and many others actors working together in order to improve progress towards social results by empowering communities is something special for mankind. PHC inspire and educate people by working proactively on the basis of local problems. If PHC is considered in any public health strategy, health for all will be more closed to change people`s reality, to a better health and lives.
* I wrote this article in 2013 to Johns Hopkins University`s Health for All Through Primary Health Care
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