From Alma-Ata to the year 2000 : Reflections at the midpoint

The years since the International Conference on Primary Health Care, Alma-Ata, have seen substantial gains in health and in the pursuit of equity based on the primary health care approach. In country after country, there has been affirmation that the Declaration of Alma-Ata has indeed made a difference. With the affirmation, however, have come hard facts - of unevenness of progress in virtually all countries, of partial successes, unsolved problems, and newly emerging problems. Of central concern are those untouched by health for all and primary health care - the tragic residuum of the poorest of the poor in the least developed countries. A number of problems are proving to be resistant to solution, and new approaches are needed if they are to be tackled effectively. This publication, issued at approximately the midpoint between the Declaration of Alma-Ata and the year 2000, examines the achievements so far and the tasks that lie ahead if the goal of health for all is to be attained. The background to the International Conference on Primary Health Care, Alma-Ata, is considered. Next, there is a review of a meeting held in Riga in 1988 to evaluate the progress made since Alma-Ata. Various relevant aspects of the Forty-first World Health Assembly (May 1988) are covered, including the celebration of WHO's fortieth anniversary, the Technical Discussions on Leadership for Health for All, and the round table debate on the tenth anniversary of Alma-Ata. Finally, future prospects are considered in detail and recommendations are made for further action.