On 25th October 2018, WHO member states agreed to the Declaration of Astana – a vow to strengthen their primary health care systems as an essential step towards achieving universal health coverage. This new declaration follows on from Alma-Ata in 1978, a conference held in Almaty, Kazakhstan where world leaders committed to ‘health for all’. This year the Global Conference on Primary Health Care was held in Astana, Kazakhstan. The new declaration focuses on a primary health care approach, as it is the foundation to achieving goals in universal health coverage and health related sustainable development goals. It will also renew political commitment to primary health care from Governments, non-governmental organizations, academia and global health organizations.

Over the last 40 years since Alma-Ata, the goal of ‘health for all’ has not been achieved. The approach to health care has been in silos, focusing on vertical programs that tackle individual conditions rather than a horizontal approach that aims to strengthen the health system in order to treat patients more holistically. The declaration of Astana highlights that deliberate actions will be required to ensure success and that success will be specifically driven by political will, knowledge, technology and people. Despite these factors contributing to the advancement in health since 1978, ‘health for all’ has not been achieved. Furthermore, neither of these declarations suggests how the goal of ‘health for all’ or primary health care can be achieved.

Success will require more than a vow and agreeing to a set of objectives is not enough.

Success is not only dependent on the factors mentioned in the Declaration of Astana. The rapid advances we have seen in technology, knowledge, political will, and people happened over the last 40 years. Although innovation will occur in the next 40, the impact on health may not be as big, as huge advances have already been made. And even though such huge strides have been accomplished, ‘health for all’ has not.  Success will be dependent on something else - accountability. There is a need to hold governments accountable to what they agree to. It is not enough anymore to commit to a declaration. Such a promise requires multilateral institutions such as the UN to develop some sort of accountability mechanism that ensures governments live up to what they committed to. Individual governments need to be made responsible. The UN collects a wealth of information on government health expenditure, health system access, and corruption within government to name a few. However, what good is this data if there is no action that follows?

As well as accountability, governments in the Global South, where primary health care still struggles to surface, need to harness what they already have when it comes to people, knowledge and technology. Countries for example like India have all the ingredients for success - it is now up to the Indian government to channel funding into ensuring the effects of people, knowledge and technology are fully realized.

Hopefully the excitement and intention of accomplishing The Declaration of Astana will not be short lived.


By Shreya Patel

Photo Credit: International conference on Primary Care - Almaty 1978. Wikimedia Commons.

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