Achieving Health For All

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.

Having said all of these, the question arises,  What can I do to be a game changer?
How can I be a Carl Taylor or a Henry Perry  within my own sphere of influence?

Health Education:
According to the principles of primary health care, Health Education is key in the attainment of health for all.
Given my background in clinical medicine, I have seen that my knowledge as a medical doctor will be useful in providing Health Education for community health workers, care group leaders and the people within communities.
It can be seen from the lectures that creating awareness on the common causes of childhood mortality, newborn death, HIV and AIDS can go a long way in the attainment of health for all.
I plan to organize health campaigns, seminars and health education classes in local communities around me.
Drawing on the concept of the household production of health as seen in the Jamkhed rural health program in India, my team and I will focus on educating the families through the mothers with the help of community health workers.
Classes will also be organized for different groups of people;
Pregnant women, grand mothers, men, adolescents and single mothers. Female education and the importance of childhood immunization will also be taught.

Mobilization
Leveraging on my position as a key player in the health sector in Nigeria. I plan to mobilize other doctors, nurses, and health workers to join in primary health care projects that can help in attaining health for all. I will also push for more community health projects in my place of work as a medium to reach out to those communities in need. This will also serve as a medium to link the community efforts on health education with an established health center.
We will familiarize ourselves with the culture, the norms, and also the forms of health care already available to the people.
Secondly we will find out their needs and the leading causes of death in their area.
Thirdly we will join in educating the people on the need for hygiene and the elimination of unhelpful traditional practices.
We will then select enthusiastic and willing individuals from amongst the people, to be trained as community health workers, whom will serve as a bridge between the people and the government organized health care centers.
Home visitation by the community health workers and the care group leaders will be emphasized and monitored.

Advocacy:  can be said to be giving the voiceless a voice.
Having been armed with the knowledge of what is going on in my locality, I will approach the government with these facts to see what can be done to integrate the ongoing community efforts with the structured governmental health sector.
Also we will encourage the government to increase the budget allocated to health and show case the need for more support and funding in the remote areas.
We would also clamor for the support of other sectors which would help the communities function better, e.g. Agricultural programs, the provision of safe portable water, power ( solar or electric) ,schools and  well equipped health facilities to improve the quality of life of the people.
We will also seek the support of non governmental organizations (NGOs) that may be interested in what we are doing within the community and may be ready to partner with us and also fund some of our pending projects.
We would also advocate for better living and working conditions for the community health workers to encourage them to stay.

I am well aware that there may be challenges on the journey to the achievement of this dream, health for all through Primary health care.
Some of these challenges may include:

Minimal or zero governmental support : it may be difficult to convince the government on the need to pump more money into primary health care due to lack of sufficient national funds for other sectors also clamoring for attention. Also previous failed  health projects may have left a bitter taste, such that it may be difficult to get the trust of the government that funds allocated will not be mis managed as others.
Without the support of the government, it would be difficult to obtain inter sectoral  participation, which is key for the success of primary health care.

The recruitment of human resource in terms of the right partners and people for the job may also be difficult. How do we get partners and workers who will be committed to the project and do it passionately as a gift to humanity and not just because of the remuneration or benefits?
Without the recruitment of passionate human resource, community projects may experience a lull and then become stagnant.

Adequate funding : one of the reasons for the prior failure of the Alma Ata declaration of 1978 was that governments and non governmental organizations saw it as massive and capital intensive. Hence, were reluctant to pump money into it.
Without adequate funding, it might be difficult to carry out my set objective in my adopted community of interest. Health workers also cannot be adequately remunerated and community projects may be stalled.

I strongly believe that by doing my own part as an agent of change in my community, I will be promoting the achievement of health for all through primary health care.