This document summarizes a presentation on primary health care given in Vientiane, Laos in 2010. It discusses the definition and principles of primary health care established in the Declaration of Alma-Ata in 1978, including its focus on essential, affordable care that is integrated within communities and national health systems. It also reviews achievements and ongoing challenges of primary health care. Finally, it provides examples of primary health care in practice in countries like Thailand and its response to emerging diseases in Southeast Asia.

1. “Primary health care: back
to Alma-Ata in early 21st
century"
Dr Jean-Jacques BERNATAS, MD, MSc – Medical Regional Coordinator
– Institut Pasteur/SISEA Project.
jjbernatas@gmail.com

2. Plan
1. Definition – Declaration of Alma-Ata
2. 2008 vision of PHC
3. PHC in practice
4. Conclusion
5. References
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Feb. 21st 2010

3. DEFINITION – Declaration of
Alma-Ata (Sept. 1978): core
principles.
1. Essential health care, based on:
1. Evidence-based approach
2. Social acceptability
3. Accessibility of technology
4. Participatory approach involving communities
5. Affordability of services
2. Integration in the national health systems,
3. Integration in the social and economic development of the community
4. Bringing services a close as possible to the people
5. First contact with health care system as the main point of entry
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Feb. 21st 2010

4. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): content (1)
1. Relevance: soco-economic context, sound scientific
content (EB-M/PH)
2. In line with the existing local situation
3. Providing:
Health promotion services
Preventive services
Curative services
Rehabilitation services
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Feb. 21st 2010

5. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): content (2)
4. Including:
Education for health (prevention and control)
Promotion of better nutrition
Safe water and “watsan”
MCH
Immunization
Prev&control of endemic diseases
Appropirate TTT of common diseases&injuries
Essential drugs supply
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Feb. 21st 2010

6. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): content (3)
5. Involving all related sectors: agriculture, animal
husbandry, education, industry, communication, …
6. Community and individual self-reliance& participation
from planning to implementation of PHC activities
7. Comprehensive health care services:
Integration
Referral system
Best offer (quality) for all
Prioritizing those most in need
8. Wide range of health workers (physicians to community
worker; including traditional practitioners)
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Feb. 21st 2010

7. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): content (4)
9. Government leadership in implementing national policies
strategies, and plans of actions, …
10. International cooperation: bilateral, multilateral, NGOs.
Strong support from WHO/UNICEF
11. “Health for all by year 2000” …..
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Feb. 21st 2010

8. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): achievements
and limitation (1)
1. Awareness of political leaders and stakeholders in putting
people at the centre of health care
2. People are healthier
BUT: what is the PHC’s
input? Global economic
Longer life expectancies
develoment could also
(mainly?) explain these
Lower infant mortality rate achievements …
Better access to safe water
Etc …
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Feb. 21st 2010

9. DEFINITION – Declaration of Alma-
Ata (Sept. 1978): achievements
and limitation (2)
BUT …..same problems remains active + discrepancies between
high-income and low-income countries, and within countries
More financial resources available now than never before even if health
financing comes at the top of political agenda
Human resources for health comes up as a key issue everywhere,
Common shortcomings in health care delivery: inverse care,
impoverishing care, fragmented and fragmenting care, unsafe care,
misdirected care ….
New paradigms tighly linked with health issues: new communication
(web), climate change, ageing and growing demography …
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Feb. 21st 2010

10. 2008 vison of PC – 2008 WHO
report. Change of questionning health issues
From : « focus of small number of selected diseases, primarily
infectious and acute »
To: « A comprehensive response to people’s expectations and
needs, spanning the range of risks and illness
From : « concentration on mother and child health »
To: « dealing with the health of everyone in the community »
From : « simple technology for volunteer, non-professional
community health workers »
To: « teams of health workers facilitating access to and appropriate
use of technology and medicines »
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Feb. 21st 2010 And so on …

11. 2008 vison of PC – 2008 WHO
report. The 4 sets of PHC reforms
1. Universal coverage reforms to improve health
equity
2. Sevice delivery reforms to make health
systems people-centred
3. Public policies reforms to promote and protect
the health of communities
4. Leaderships reforms, to make health
authorities more reliable
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Feb. 21st 2010

12. PHC in practice - Thailand
1. Health promotion as a key activity
2. Huge health volunteers commitment,
especially the Buddhist monks
3. Universal coverage scheme providing
health care for its 64 million people.
4. Strong government involvement, f.i.
supporting the Thailand’s health
promotion Temple project from 2003.
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Feb. 21st 2010

13. PHC in practice – Emerging
diseases in SEA
1. Consequence of the « famous » changing
world.
2. Typical obvious exemple of the inefficiency of a
vertical fragmented approach.
3. Multisectoral response came up as a part of an
evidence-based plan of action.
4. Key of the success related to the community
participation and appropriation of this long-
term issue.
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Feb. 21st 2010

14. PHC in practice – TB control
1. Began early as a typical vertical approach of
disease control but in line with PHC’s
principles (free and afordable high-quality
services, essential drugs, community
involvement, …)
2. Was included at the vey beginning in the PHC’s
« package »
3. Had to face with unexpected issues (HIV/AIDS;
health financing; MDR-TB) that force this
vertical approach to strenghten multisectoral
and transversal links
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Feb. 21st 2010

15. CONCLUSION
1. PHC is definitely not an old and ineffective
bureaucratic concept …
2. On the contrary, it is a modern, comprehensive
and updated tool, providing drafts of plans for
actions for improving health for all, through a
holistic (individual and people-centred) and
realistic (addressing financial and political
issues)
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Feb. 21st 2010

16. REFERENCES
1. The World Health Report 2008 - primary Health Care (Now More
Than Ever). http://www.who.int/whr/2008/en/index.html
2. Declaration of Alma-Ata, International Conference on Primary
Health Care, Alma-Ata, USSR, 6-12 September 1978.
www.who.int/hpr/NPH/docs/declaration_almaata.pdf
3. Carol Perks,a Michael J Toole,b & Khamla Phouthonsyc. District
health programmes and health-sector reform: case study in the
Lao People’s Democratic Republic
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Feb. 21st 2010