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Friday, September 12, 2008


We all have our 9/11 memories.

In Manila, at around 9pm, seven years ago, we were in the UP’s Pharmacology laboratory, preparing materials for an experiment. We were busy chopping narra leaves to teensy bits when my sister sent me a text message saying a plan crashed into the World Trade Center. It was quite a shock because in May of the same year, I was strolling atop WTC, soaking in the sights of New York. Then another message- this time that the Twin Towers were no more. I remember feeling a bit numb, then a shard of fear set in: that if America, a superpower, has been hit hard by such brazen attacks, how much more puny Philippines.

I was in the International Center of Photography in New York City last May. They had a very interesting exhibit on the September 12, 2001 frontpage and headlines of about 100 leading dailies the world over. The photos and text captured permutations of grief, shock, anger, and disbelief as the Twin Towers were in various stages of being toppled and the plume of smoke and ash rose in their stead.

Save for this exhibit perhaps, 9/12 is seemingly lost in the annals of history, obscured by the day that precedes it.

Yet for those in the know, 9/12 is an equally momentous day, more so this year because 9/12/2008 is the 30th Anniversary of the Declaration of Alma Ata.

In 1978, some 200 health experts met in what is now Alma Ata in Kazakhstan to seek solutions for what ails the world. At the end of the International Conference on Primary Health Care, they came up with a 10-point declaration detailing the major strategies through which Health For All can be faster and more feasibly attained. The ten points of the Declaration of Alma Ata follows but beyond the jargon, its spirit can be summed as:

1. Health is a right. It is not merely the absence of illness but the complete wellbeing of the body, mind, spirit, and community.

2. The current inequity in health, the gap between what the more affluent enjoy in terms of health care versus those in lower income settings, is unacceptable and should be addressed right away.

3. The citizens have the right and duty to participate in all activities relating to their health…

4. …But government must play the lead role in advancing all health and development initiatives…

5. …And lay groundwork for an environment that will encourage multi-sectoral socio-cultural-political involvement.

This Declaration is as close a panacea as possible to the health and development concerns of the world. It is the guiding principle by which the UP College of Medicine carries out its mandate of directing all education, research, and training pursuits to the underserved. It underscores how everyone is responsible for each other’s health and the inextricable relationship of health to aspects of development like economics, governance, culture, among others.

Thirty years hence the same challenges remain. But with a new breed of leaders, citizens with more heightened social consciousness, and a renewed sense of urgency in the face of still unbridled inequity, the Declaration of Alma Ata (unfortunately) remains relevant.

Declaration of Alma-Ata
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration:

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.

The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

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 to maintain at every stage of their development in the spirit of selfreliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

Primary health care:
1. reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;

2. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;

3. includes at least: education concerning prevailing health problems and the methods of
preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

4. 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;

5. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;

6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;

7. relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.

All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world's resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allotted its proper share.

The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries. The Conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration.

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