Describe primary health care and the Alma-Ata declaration.

Primary Health Care and the Alma-ata Declaration

• Its definition should be quoted: primary health care is "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"
• Every phrase in that definition does work, and unpacking it is what distinguishes a good answer
• The four principles (pillars) of primary health care:
• 1. Equitable distribution — services must reach all, particularly the rural and the poor, correcting the concentration of resources in cities
• 2. Community participation — involving the community in planning, implementation and maintenance, not merely as recipients. In India this principle produced the village health worker and ultimately the ASHA
• 3. Intersectoral coordination — because health depends on agriculture, education, housing, water, public works and communication, which lie outside the health sector
• 4. Appropriate technology — technology that is scientifically sound, adaptable to local needs, acceptable to those who use it, and affordable. Oral rehydration solution is the classic example — simple, cheap, effective and usable in a village
• The eight essential components (elements) are examined verbatim, and the mnemonic elements is commonly used:
• 1. Education concerning prevailing health problems and their prevention
• 2. Promotion of food supply and proper nutrition
• 3. Adequate supply of safe water and basic sanitation
• 4. Maternal and child health care, including family planning
• 5. Immunisation against the major infectious diseases
• 6. Prevention and control of locally endemic diseases
• 7. Appropriate treatment of common diseases and injuries
• 8. Provision of essential drugs
• Two further elements are commonly added — mental health and dental and oral health
• The criticisms and what followed — comprehensive primary health care was criticised as too broad, too expensive and unachievable, and selective primary health care was proposed, concentrating on a few high-impact interventions — the GOBI package (Growth monitoring, Oral rehydration, Breastfeeding, Immunisation), later GOBI-FFF (adding Family planning, Female education and Food supplementation)
• The debate between comprehensive and selective approaches is the central tension in the topic — selective approaches achieve measurable gains quickly but leave the underlying determinants untouched and can fragment services
• Health for all by 2000 was not achieved, and it is honest to say so; but the principles remain the foundation of health system design
• Its successors — the millennium development goals (2000-2015); the sustainable development goals (2015-2030), with SDG 3 for health; and the ASTANA declaration (2018), which reaffirmed primary health care on its fortieth anniversary and linked it explicitly to universal health coverage
• Universal health coverage means that all people receive the health services they need, of sufficient quality, without suffering financial hardship — and the financial protection element is what matters most in India, where out-of-pocket spending impoverishes millions annually
• In INDIA the primary health care structure is the sub-centre, primary health centre and community health centre, now being reorganised as health and wellness centres under ayushman BHARAT to deliver comprehensive primary health care including non-communicable disease