Daily Times

It was 12 September 1978, when the world’s leading health specialists, organizations and ministers from 134 countries agreed on a very specific goal, ‘Health for All’ (by 2000). This was a decisive point in the history of Primary Health Care (PHC), thanks to some legendary specialists like John B Grant (father of Primary Health Care) who started his work in 1930’s in China, Jim Grant and John Gordon who mentored one of the most important PHC experts of the second half of the 20th century Carl Taylor.

The idea was simple and applicable; however, few were skeptical about its practical application. Later during 1980, the approach was forgotten and selective primary health care option was preferred. This approach emphasized on dealing with specific ailments rather than promoting the overall comprehensive health of the community. This approach gave immediate results in fields like immunization and iron supplements. However, soon most of the experts observed that this approach might have left people dealing with a range of other illnesses that also needed equal attention. World Health Organization (WHO) observed 30th year of Alma Ata Declaration in 2008 giving a clear message i.e. (Time to) ‘Return to Alma Ata’.

Alma Ata Declaration proposed a socio-medical approach to deal with illnesses. Therefore, its focus was more on health rather than illness. Alma Ata also declared that provision and caring for health couldn’t be restricted to the use of medical doctors and hospitals alone. It allows for an integration of conventional practitioners as well as ordinary people from different walks of life, trained in basic health care issues. This was the approach that produced great results in China’s Barefoot Doctors and in Turkey between 1923-33, to fight malaria. In these approaches common people like schoolteachers, farmers, community leaders and even religious clerics were trained to handle common illnesses and to give awareness to people about activities to promote health. With the passing of time, this approach was almost totally forgotten, some people started calling WHO as World Disease Organization around 2000, as WHO mainly focused on illness and disease eradication rather than focusing on promoting health.

In Pakistan, Dr Adeebul Hasan Rizvi established Sindh Institute of Urology and Transplantation (SIUT) in 1972, that provides free and quality treatment to kidney patients

Alma Ata suggested comprehensive approach to sustain and improve health of the community. It mainly emphasized on preventive measures, information sharing and community involvement to create a healthy community. Two prominent NGOs from India and Bangladesh and the Government of Brazil, followed Alma Ata. In India Jamkhed Comprehensive Health Project and BRAC (world’s largest NGO) in Bangladesh created a self-sustainable system to maintain community health. Brazil on the other hand, decided to emphasize on primary health and allocated a reasonable budget for this segment of health care system. In Brazil, Primary Health Care is provided by local authorities that can make it more suitable and appropriate for specific needs. All these three approaches have two things in common, first, they all aim to achieve ‘health for all’ and second, they reduced the pressure on higher tiers of the health system. Higher tiers of health system like specialist doctors and dedicated health facilities need large investments, though they bring big returns also. Most of the multinational pharmaceutical companies and investors choose to invest in such projects. This has left Alma Ata approach as a path not only to be followed but an approach that might really make a difference to attain health for all.

In Pakistan, Dr. Adeebul Hasan Rizvi established Sindh Institute of Urology and Transplantation (SIUT) in 1972, that provides free and quality treatment to kidney patients. This is a good example of selective free health service; however, Alma Ata Declaration also included the idea of informing people about ways to avoid kidney diseases. Since most of the health sector is now concentrating on the provision of selective treatment for specific illnesses, focus on health is almost lost in the debate. The soul of Alma Ata Declaration can only be understood if issues involving health, education and employment are well integrated within a community. Health should be the focus of new approaches rather than illnesses. This, however, does not mean that focused treatments of illnesses should be stopped, what this means is to help the community to avoid common diseases which may lead to chronic ones, which further consume a lot of resources in the future. To summarize, it is very hard to provide consistent and comprehensive information about health management to people because the information campaigns are short-lived, are mostly restricted to photo sessions, which are irrelevant and sometimes boring too.

However, the issue is important and needs a much broader intervention. Therefore, I suggest that primary health care in general should be made a compulsory subject for grade 9-10 preferably along with some practical work. Students studying different subjects should also be provided an opportunity to specialize in PHC in grades 11 and 12.

The Indian government has recently announced the world’s largest publicly funded health care scheme, Ayushman Baharat in February 2018. It aims to cover 500 million people. Main emphasis is on secondary and tertiary treatment with a little focus on primary. Similar initiatives have failed to achieve their objectives and have resulted in increased expenditures. Turkey on the other hand managed its health care transition successfully, as its main pillar was strengthening of family health care system implemented at primary level.

The writer is working as a senior specialist at the Urban Unit Lahore. He has studied and worked in fields of Engineering, Public Health, Ecology, Disaster Management, Change Management and Energy Management. He can be reached at azharuup@gmail.com

Published in Daily Times, October 24^th 2018.