Alma Ata Declaration

Health Systems Trust publishes its
13th edition of the South African Health Review
PRIMARY HEALTH CARE IN SOUTH AFRICA: A REVIEW OF 30 YEARS SINCE ALMA ATA

We, the members of the National Consultative Health Forum, representing government, public and private health sectors, statutory bodies, academic and research institutions, community organisations, civil society, non-governmental organisations and organised labour, in our meeting at Birchwood conference centre, Gauteng Province, held on 10-11 April 2008, on Primary Health Care to commemorate the 30th anniversary of the Alma Ata Declaration, hereby:

Managing the Politics of Equity and Social Determinants of Health - the title of the informal briefing the Commission held at the 59th World Health Assembly.

Since the Alma Ata declaration of 1978 primary health care has gained acceptance as a strategy for making basic health services universally accessible. Enormous efforts have been put towards improving the health status and living condition of people in developing countries by NGO's and government departments.

This conference which celebrated 25 years since the Alma Ata Declaration and the primary health care approach, was well attended by national, provincial and district level Department of Health representatives, civil society representatives and international guests. The poorest districts (rural development nodes) were all represented. Health Systems Trust made several key contributions to the conference by assisting with presentations to the rural development nodes, as rapporteurs and facilitators for sessions and through presentations of the work and research supported by HST. Two presentations by HST staff were awarded best in their section place. The objectives of the conference included: * revisiting the Alma Ata Declaration and reviewing progress * placing the spotlight on the primary health care apporach and re-dedicating South Africa to the Primary Health Care Approach * Celebrating achievements and sharing lessons * Developing key priorities for Primary Health Care for the next 5 years. An important output of the conference was the Kopanong Declaration on Primary Health Care, which attempts to chart the way forward on the future of primary health care in South Africa. KOPANONG DECLARATION ON PRIMARY HEALTH CARE 26 AUGUST 2003 We, community members, academics, members of NGOs and CBOs, representatives of government, officials and guests meeting at Benoni, Gauteng on the eve of the 25th anniversary of the signing of the Alma Ata Declaration in the former USSR, having assessed South Africa’s achievements and challenges in implementing primary health care using the primary health care approach Noting: 1. The progress made in implementing primary health care nationally; and 2. The challenges that remain. Hereby resolve that the key focus of the agenda for strengthening primary health care over the next five years will include: 1. Concrete strategies and processes, with clear targets, to reduce inequities in the allocation of resources for primary health care with a focus on both horizontal and vertical equity over the next 10 years. 2. Committed funding and budgets for sustaining community involvement in health through, inter alia regular area summits leading to provincial summits. 3. Strengthening the health system by focusing investment of resources on priority health programmes and by accelerating the implementation of the DHS including its various components. 4. Develop, implement and monitor the implementation of coherent human resource plans at district, provincial and national levels based on national guidelines including the strengthening of recruitment and retention strategies. 5. Re-invigorated committed to the principles of the PHC approach by all partners with effective national and provincial leadership. 6. strengthening of PHC through the development of intersectoral forums at every level but especially at the facility and district levels. We will use the performance management system of government and the accountability mechanisms in each municipality, province and nationally to assess and report on progress each year on the six areas listed above.

The purpose of this document is to describe the concept and key principles of an Equity Gauge, and to provide guidelines for putting the concept and principles into action. GEGA’s ultimate goal in disseminating the document is to contribute to the creation of an effective global alliance of Equity Gauges bound by shared principles and common approaches. Concern about equity in health is not new. International health and development agencies, researchers, and activists have been pointing to inequities in health between different countries, between rich and poor people, between racial/ethnic groups, and between men and women, for many years. Equity was one of the key principles of the 1978 Alma Ata Declaration on Health for All. However, despite evidence of wide and sometimes widening disparities between and within countries on every continent, few countries routinely monitor equity in health, health care, the underlying determinants of health, or the social consequences of illness. Equity is an urgent public health issue today. An Equity Gauge places health equity squarely within a larger framework of social justice. While some health inequalities are inevitable and acceptable (for example, elderly people generally have poorer health than young adults), many health inequalities are avoidable and unjust (for example, lower rates of immunization coverage among girls than among boys, or higher mortality rates among some racial/ethnic groups compared to others). Equity Gauges are concerned with health-related inequalities that are unfair.

Publication Webpage http://www.gega.org.za