Primary Health Care Remains Key

Health ministers from throughout the Americas marked the 25th anniversary of the First International Conference on Primary Health Care by renewing their countries' commitment to "Health for All" and reaffirming the importance of primary health care as an orienting strategy for public health.

A special session of the 45th Directing Council meeting was held as part of a series of events organized by the Pan American Health Organization (PAHO) in observance of the anniversary of the 1978 conference in Alma-Ata, Kazakhstan, in which health leaders from around the world endorsed primary health care as a strategy for achieving greater equity in health.

In introductory remarks, PAHO Director Mirta Roses noted that the push for health sector reform in recent decades had led some countries of the Americas to lose sight of the importance of primary health care. She emphasized that the strategy remains as relevant today as ever in a region where there are major gaps in health status among different population groups.

"This anniversary is more than a historical event. It is an opportunity to gain from the experiences of those who have worked in and advocated for primary health care during these 25 years," she said.

Minister of Health of Jamaica John Junor said his country had embraced the principles of primary health care even before the Alma-Ata conference. He attributed important health gains such as increased life expectancy and the eradication of polio to the implementation of the strategy.

"All of CARICOM countries have benefited from the primary health care strategy," said Junor.

He added that the major challenge for the Caribbean today is to adapt the primary health care strategy to newer health problems such as chronic diseases.

"We must redouble our efforts and reconfirm our commitment to primary health care as an essential strategy for delivering promotive, preventive and rehabilitative health care to the population," said Junor.

Secretary of Health of Mexico Julio Frenk described "Health for All" as "a vision, an aspiration, an orientation for public health policy." But also, "Primary health care is a concrete strategy and therefore open to debate." For example, the slogan of "Health for All" might be improved by adding the word better, he said. "'Better health for all' is a more dynamic concept. We should be capable of updating and critically evaluating our successes without giving up our commitment to basic principles."

Frenk emphasized that the basic principles underlying primary health care—that is, universal coverage, community participation, and multisectoral action—are just as valid today as they were during the 1970s.

"Primary health care is not primitive health care, as some have seen it, but rather health care that deals with the primary issues of health," he said.

Argentina's health minister, Ginés González García, said that his country's Federal Health Plan gives a central role to primary health care and that the strategy was key in restoring Argentina's health status following its financial crisis.

"The main problem is not poverty," said González García. "The main problem is injustice…and there is no better strategy to employ than primary health care to fight injustice in the health sector."

During the original Alma-Ata conference, 134 countries and 67 international organizations endorsed the primary health care strategy as a way of reaching the goal of "Health for All by the Year 2000."

The conference's final declaration defined primary health care as care "based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people's full participation and at a cost that the community and country can afford, in each and every stage of development, with a spirit of self-responsibility and self-determination."

PAHO has appointed a working group to develop a draft for a new regional declaration on primary health care and the future of public health. A special issue of the Pan American Journal of Public Health on primary health care is scheduled for 2005.