Three decades of primary health care: reviewing the past and defining the future

The year 2008 marks the 60th anniversary of the World Health Organization and the 30th anniversary of the Alma-Ata Declaration advocating primary health care as the main strategy for achieving health for all by the year 2000. At the turn of the century it was clear that the health for all target was not fully achieved. Despite a 34% reduction in global infant death rates between 1975 to 1995 huge improvements in immunization coverage for children less than one year old (from 20% to 80%) between 1980 and 1990 and improvement in population access to safe water and sanitation health for all fell short of resolving health inequities. New medicines and vaccines were developed but prices were out of reach of poor countries and delivery systems were often inadequate. The HIV epidemic in the 1990s reversed 30 years of gains in life expectancy particularly in sub-Saharan Africa. Global health inequities persist - infant mortality and skilled birth attendances vary with income quintiles. Catastrophic health-related expenditure and subsequent impoverishment show the failure of health financing policies to build safety nets for poor populations. There are many other examples of unacceptable and avoidable disparities among and between countries which will need to be overcome. (excerpt)