From Primary Health Care to Universal Coverage – the “Affordable Dream”

Three decades after the 1978 Health for All declaration, WHO called for a renewed focus on primary health care with the launch of the 2008 World Health Report. When countries sought guidance on financing health care, we commissioned a 2010 report on universal health coverage, a concept we then pioneered as central to the Sustainable Development Goals and the ambition to leave no one behind.

The 1978 Declaration of Alma-Ata, which set out primary health care as the way to achieve health for all by the year 2000, launched a revolutionary movement that did great good but eventually faltered, partly because it was so profoundly misunderstood. It was a radical attack on the medical establishment. It was a standoff between proponents of basic versus specialized care. It was hopelessly utopian; a selective approach, based on just a few inexpensive interventions that brought rapid results, had a better chance of success.

With its reliance on community health workers, it looked cheap: third-rate care for the Third World. For some countries, a declaration associated with a Soviet city raised suspicions that the call was a veiled attempt to push governments towards socialized medicine.

By the mid-1990s, a WHO review of changes in the development landscape bleakly concluded that the goal of health for all by 2000 would not be met. The emergence of HIV/AIDS, the related resurgence of tuberculosis, and an increase in malaria cases moved the focus of international public health away from broad-based programmes and towards the urgent management of high-mortality emergencies.

Image: WHO/Yoshi Shimizu

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