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​​​​​​Alma Ata 30 years on: “Health for all need not be a dream buried in the past”. This quote, on the front page of a recent issue of The Lancet, is as pertinent to South Africa as it is internationally, and it is very apt that this year’s South African Health Review is dedicated to the revitalisation of Primary Health Care.

The Alma Ata Declaration was signed in 1978 and had the ambitious target of achieving ‘Health for All’. Representatives from 134 countries gathered in what is now Kazakhstan. They declared that Primary Health Care “based on practical, scientifically sound and socially acceptable methods and technology made universally acceptable through people’s full participation” was key to delivering ‘Health for All by the year 2000’.b South Africa was not one of the countries that signed the declaration, as in 1978 our country was a pariah state,
driven by a political ideology that was the complete antithesis of the principles of Primary Health Care, and faced with looming social upheaval in the aftermath of the 1976 Soweto uprising. This was ironic, as in the late 1940s and early 1950s, Dr Sydney Kark and other pioneers had established a number of community health centres that were prototypes of the Primary Health Care approach, only for their efforts to be undermined and destroyed by the proponents of apartheid.

The new democratic government lost no time in making Primary Health Care the centrepiece of its health strategy. Both the White Paper on the Transformation of the Health System, formally endorsed by Parliament in 1997, and the National Health Act of 2004, envisaged that the focus of the national health system would be Primary Health Care, delivered through the district health system.

This 13th edition of the South African Health Review focuses on the development of the health system over the past 14 years and looks at various components through the Primary Health Care lens. Although there is much to be pleased about compared to 1978, there is evidence that the implementation of the health system with regard to Primary Health Care has not been fully realised. By assigning resources in the right areas, South Africa can bridge the remaining gap. It is for this reason that this year’s Review contributes to highlighting some of the areas of success of Primary Health Care, as well as pinpointing areas of weakness and the ongoing new challenges that face our relatively new democracy.

This is my first year as Chairperson of the Board of Trustees of the Health Systems Trust, and I can think of no better theme for the South African Health Review than the revitalisation of Primary Health Care. On behalf of the Board, I thank all the authors, contributors and reviewers for their voluntary efforts for a noble cause. The Board also acknowledges the input and guidance of the South African Health Review Advisory Committee, and we especially thank the editors and the Health Systems Trust staff who worked extremely hard to tight deadlines to produce this Review. Although this publication is independent of the national Department of Health, we are extremely appreciative of the access they give to their data sources. The chapter on health and related indicators in the Review has become well-known as an authoritative source of public health information in South Africa.
Publication Documents

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