Revisiting Primary Health Care in 2018

Achill Island, Mayo, Ireland

This summer began early for me with a holiday in Ireland for a wonderful family wedding in Donegal and a chance to visit the beautiful West of Ireland full of stunning scenery, quiet byways and national parks. It was a memorable time exploring the coastal countryside at a leisurely pace and enjoying Irish hospitality along the way.

International travel is a great opportunity to gain perspectives on the world and to reflect on current events in different contexts. At home in Canada, I follow developments in both national and global health policy and politics.

Global health is in the spotlight this year with the 40th anniversary of the Alma-Ata Declaration on Primary Health Care (PHC). The philosophy and approach of PHC guided governments in many countries during the past four decades. To mark this anniversary, the Global Conference on Primary Health Care will be held in Astana, Kazakhstan this October co-sponsored by the World Health Organization, UNICEF and the Government of Kazakhstan.

In revisiting PHC in the current era, the conference will make the link to the Universal Health Coverage (UHC) movement and the Sustainable Health Goals. It will be fascinating to follow the event on social media and to read the final declaration. The draft version has been circulated for comment and will undergo changes before endorsement by conference participants. I like the attention to political will, knowledge for health systems improvement, effective use of technology and greater social accountability. There is recognition of the role of youth in contributing to PHC achievement and attention to equity and determinants of health. I wonder if the notion of political will has gone far enough and how this will be handled in a high-level global assembly.

Critical perspectives are coming forward in response to the proposed declaration. The organization Women in Global Health has pointed out the declaration’s failure to note the importance of gender equality in achieving UHC and PHC. As highlighted in its statement, “effective health systems must ensure gender parity at all levels of decision making to harness women’s perspectives and talent.”

Nursing Now and the International Council of Nurses have issued a joint statement on the draft declaration. A key point is recognition of the “central role” of nurses and midwives in PHC. The joint statement concludes with a strong endorsement:

We strongly agree that political will and sustainable financial resources will be vital to delivering the ambitions of the Astana Declaration. Insufficient investment, the lack of long term planning and political commitment in health services and the workforce continues to be a major impediment to progress. We resolutely support a declaration that will deliver change and achieve UHC through PHC.

My own conclusion is that this is an exciting time for global health with renewed energy in the PHC movement and opportunities for critical commentary in the months leading up to the Global Conference on Primary Health Care. This is most definitely a time to stay tuned!

By Nora Whyte – August 2, 2018