September will mark 40 years of the Alma Ata Declaration, which was adopted in 1978 by over 100 countries which met in Almaty, Kazakhstan (formerly known as Alma-Ata after which the declaration was named) for the International Conference on Primary Health Care. The declaration also set forth the guidelines and precedents for which Health for All by 2000 was planned. As we reach a major landmark year since the declaration was adopted, we look at the progress made so far.
At the conference, the WHOâ€™s stance on health care, particularly public health care policies and the things that the government would have to take responsibility for under the same for the wellbeing of its citizens, was outlined in detail. It was one of the first times that health care and access to affordable health care were truly recognised as a â€˜human right.â€™ As more people began to acknowledge that health care was an important aspect of life that a government had to provide its citizens, precedents were set forth to follow.
The Alma Ata Declaration defined health as not merely the absence of disease, but rather a state of complete mental, physical and social well-being. Under the declaration, officials identified eight categories of public health care which would have to be addressed by governments: Maternal and Child Health, Public Education (including womenâ€™s education), Proper Nutrition, Clean Water and Sanitation, Immunisation, Local Disease Control, Accessible Medications and Drug Provision. While the declaration identified health care as a human right, it also acknowledged that there were several social and economic factors that hamper people from being able to access this right.
All eight factors are in some way interlinked. As seen in the states of Kerala and Tamil Nadu, ensuring better access to education for all, and for girl children in specific, has had a significant impact on citizensâ€™ health. One report even stated that increased female literacy rates resulted in women not getting married at young ages, which further resulted in them opting to have fewer children, and this as an end result ensured that infant and child mortality rates were reduced.
According to a report by The Wire, India currently spends 1.2% of its GDP on public health and health care policies. While many acknowledge that there is a lack of doctors and medical personnel in several parts of the country, in order to successfully carry out the terms of â€˜Health for Allâ€™, it is vital that there are more accurate studies conducted, which include even the most rural and remote parts of the country.
Though the Alma Ata Declaration was challenged in 1979 by the Rockefeller Foundation, which argued that its guidelines were not practical and were too expensive and many countries resorted to adopting watered down versions of the core principles it set, one can see that aspects of the declaration do seem to have an effect.
For example, earlier this year, data released by the Sample Registration System (SRS) showed that Telangana reduced its maternal mortality rate (MMR) from 92 to 81, which singlehandedly brought down the MMR of the entire country from 167 to 130. Several officials from the state confirmed to TNM at the time that the initiative was done after careful implementation of a system that gave expectant mothers even in the remotest of places access to health care. Women in interior pockets, such as Adilabad district that previously had high rates of MMR, were better able to avail medical attention once the government incorporated several methods to ensure that these women were able to access the facilities they required. From setting up call centres, to putting together a registry of all pregnant women and their expected delivery dates, and even providing initiatives through the â€˜Amma Vodiâ€™ programme, the state government left no stone unturned to bring down its MMR.
Though the Alma Ata Declaration was not seen through to its maximum fulfilment, it is evident that its principles do hold true to a certain degree. Even as the public health sector is being met with some resistance through the form of private firms, there is enough evidence to suggest that sticking to the core guidelines of the declaration addresses the larger public health care needs and ensures appropriate measures are taken to tackle these issues.