The document discusses the history and evolution of people-centered primary health care (PHC) from before the 1978 Alma-Ata Declaration to recent developments. It describes how early PHC models in India in the 1940s-1970s emphasized community participation through village health committees and community health workers. The Alma-Ata Declaration enshrined people-centered PHC principles. However, globalization in the 1990s distorted PHC away from communities. In response, civil society groups have advocated for revitalizing PHC with a focus on equity, rights, gender, and social determinants of health.

1. People Centered PHC: Empowering Communities, enhancing participation and advocating for and stewarding intersectoral action Dr. Ravi Narayan ,Community Health Advisor, Society for Community Health Awareness, Research and Action – Bangalore & Global Steering Council of People’s Health Movement International conference- 30 th anniversary of the Alma- Ata Declaration on Primary Health care (WHO/UNICEF) Almaty, Kazakhstan 15-16 October 2008

11. The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000. The Primary Health Care Movement towards Health for All by 2000AD Alma Ata, 1978 People Centered Primary health care - Alma Ata -1978 -III

13. People Centred Primary health care- evolving guidelines People Centered Primary health care - Alma Ata -1978- V

17. Researching levels of analysis and solutions: Addressing the societal determinants of health (A SOCHARA Researcher) Source: Narayan T.,1998 Levels of analysis of tuberculosis Casual understanding of tuberculosis Solutions / Control strategies for tuberculosis Surface phenomenon (medical and public health problem) Infectious disease / germ theory BCG, case finding and domiciliary chemotherapy Immediate cause Under nutrition/ low resistance, poor housing, low income / poor purchasing capacity Development and welfare – income generation / housing Underlying cause (symptom of inequitable relations) Poverty / deprivation, unequal access to resources Land reforms, social movements towards a more egalitarian society Basic cause (international problem) Contraindications and inequalities in socio-economic and political systems at international, national and local levels More just international relations, trade relations etc.

21. Less Food, No water, No jobs!!! Listening to the people!

24. INDIAN’S PEOPLE HEALTH CHARTER- DEC 2000 “ … . A Health Care system which is gender sensitive and responsive to the people’s needs and whose control is vested in people’s hands and not based on market defined concepts of health care…..” “… .. Village level health care based on village health care workers selected by the community and supported by the gram sabha / panchayat and the government health services which are given regulatory powers and adequate resource support”.

29. The People’s Charter for Health (1454 people from 75 countries) Dec 2000 “ Promote, support and engage in actions that encourage people’s power and control in decision making in health at all levels including patients and consumer rights…… … ..Build and strengthen people’s organizations to create a basis for analysis and action….”

30. The People’s Charter for Health (1454 people from 75 countries) Dec 2000 “ Promote, support, and engage in actions that encourage people’s involvement in decision making in public services at all levels….. …… Demand that people’s organizations be represented in local/ national and international fora that are relevant to health”

32. People’s Charter on HIV/AIDS 2004 released at Bangkok 2004 “ HIV and AIDS is a development issue that calls for social and political action. It is also a public health issue that requires people-oriented health and medical interventions. Such responses require democracy, pro-people inter-sectoral policies, good governance, people’s participation and effective communication. They should be rooted in internationally accepted human rights and humanitarian norms.”

34. Corporate led globalization, Neo-liberal economic reforms, Negative macro-policies Adversely affect the social majority, nationally & globally Livelihoods, Incomes, Food security, Increased conflict, War and violence, Access to water, Access to health care, Environmental degradation, The New Challenge to Primary Health Care and People Centered PHC in 2000 AD

35. Right to Health Movement : India 2003 Primary health care and Health for All

41. Rediscovering People-Centred PHC thru Civil Society engagement , India NGO- CHW Experience 1980’s – Health Workers The Janata Experiences The JSR’s of Madhya Pradesh The Mitanins of Chattisgarh National Rural Health Mission ASHA’s ; VHSC’s; Community Monitoring NGO- CHW Experience – 1990’s – Health Activists Lessons in Community Participation through Community Health Worker Programmes in India The Sahiyas Jharkhand PHM India

43. The new Health Worker as Health Activist ASHA Training Programme of NRHM- India 2004 “ A new band of community based functionaries named as Accredited Social Health Activists (ASHA ) who would be a health activist and mobilize the community towards local health planning and increase utilization and accountability of existing health services”.

44. Accredited Social Health Activist Training Manuals ASHA – Workers of Hope!

47. Redefining People centred PHC– Experiences from the Global South Central American Networks Guatemala/ Nicaragua and Ecuador The Thai National Health Movement, Thailand HIV/AIDS Patients Networks ( TAC) and other initiatives South Africa Health Campaigns, Struggles, and Community mobilization efforts from many parts of the World Global PHM as learning Network India Brazil Philippines Nepal IRAN Others

48. PEOPLE CENTRED PHC – RECOGNISING THE PARADIGM SHIFT – 2000AD and beyond Source: CHC 2008 Approach Biomedical, deterministic, techno managerial model Participatory social/ community model Link with community As passive client or beneficatory As active and empowered participant Dimensions Explored Physical and technical (Mostly Medical) Psycho- social, cultural, economic, political, ecological (intersectoral) Focus of Participation Resources, Time/ Skills Leadership, Ownership, direction setting, Monitors. CHW Role Service provider, educator, organiser, data collector Mobilisor, activist, empowerer, social auditor, monitor. Research Policy Community participation as means Patient Centredness and market /system orientation Community participation as ends People centred Empowerment strategy as the central theme

53. Recognition for a new form of community participation as globalization of health solidarity from below “ This movement is engaged in what amounts to ‘globalization from below’ as it builds support for its global ‘Health For All Now’ strategy, lobbies at the global level and mobilizes a grassroots based campaign to realize the vision and achieve the goals of the People’s Charter for Health.” Richard Harris and Melinda Seid, 2004, The Globalization of Health

54. Recognizes the PHM role in evolving the new health and human rights approach to Primary Health Care – with the necessity of tackling the broader social and political determinants of health Recognition for a new approach to Primary Health Care with a human rights approach: New challenges for community participation PAHO paper on Primary Health Care

58. ALMA ATA – 30 YEARS ON People - centred PHC -The policy imperative of the future! Poverty / Inequality Building the bridge through People-centredness: Are we ready?

59. Health for All, Now ! THANK YOU

60. For further information visit www.sochara.org www.phm-india.org www.phmovement.org www.ghwatch.org http://www.phmovement.org/iphu/ http://mohfw.nic.in/NRHM.htm