The Alma Ata declaration strongly reaffirmed that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity and that it is a fundamental human right.
The declaration further affirmed 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.
Further more, it brought to light the existing inequality in the health status of the people, mainly between developed and developing nations, and within countries.
This inequality was deemed politically, socially and economically unacceptable and hence was presented as a source of common concern to all nations of the world.
Based on this premise, I would like to begin by saying that the achievement of health for all is a collective responsibility and its realization depends on the cooperation of individuals and families within communities, community leaders, governmental sectors, governmental and non governmental organizations within the globe.
All hands must be on deck for the full realization of this goal.
It is obvious that we have come a long way in the journey towards the achievement of health for all over the last three to four decades, however, a lot still needs to be done.
Perhaps it can be said that there has never been a time in history as this, wherein the resources to achieve this goal has been this available together with competent minds and hands who can drive this move as well as adequate demographic and health statistics to help us make informed decisions.
In 2013 an estimated 5.6 million children still died from preventable causes. Most of these deaths as stated occurred in Subsaharan Africa, India and Pakistan. While some other nations of the world like Brazil have succeeded in reaching the under five mortality goal set by the WHO for 2035. (Millennium Developmental Goal 4).
This is a pointer to the inequality described in the Alma Ata declaration and further exposes the need for equity in terms of access to health and the dispensing of health across the globe.
In the Brazilian system of health, primary health care was prioritized and highly funded by the government.
The community health care worker was prioritized and well remunerated,which made the job more attractive and increased the commitment of the workers.
Currently Brazil serves as a model for South Africa, and other low and middle income nations.
Equity within the population has been achieved in the following categories :
- Skilled attendants at birth
- The disappearance of the disparity in stunting amongst the under five population, based on socio economic class.
Significant progress was also made in the following areas:
- The reduction of under five mortality, family planning, antenatal care, Highly Active Anti Retroviral Therapy (HAART) and childhood immunizations.
Brazil also had fourth of the most rapid decline in under five mortality rates in the world between 1990 and 2006.
It can then be deduced from the Brazil experience that investing in Primary health care can help achieve health for all at an affordable cost.
In Ethiopia however, the under five mortality is still about 400000 annually and this is largely from preventable causes such as diarrhea, pneumonia and malaria.
Health care centers are located far from the people, and resources are insufficient to meet the health needs of the people.
The situation is similar in Nigeria and other Subsaharan African nations, India and Pakistan.
This brings to life the statement made by Margaret Chan in 2008, in her speech on the Return to Alma Ata that "Gaps in health outcomes are not a matter of fate—they are indicators of failure in policy"
Clearly many nations of the world including my home country Nigeria are experiencing a failure of the policies that have been used in running their health systems. This has culminated in the stalling of the attainment of health for all ......
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