Focus shifts from fighting disease to health for all
ASTANA: Multi-sectoral action that includes technology, scientific and traditional knowledge, professionals who are well trained and compensated, and the participation of people and communities are needed to strengthen primary health care and provide continuous, integrated and quality services to achieve “health for all”, according to World Health Organization’s (WHO) Astana Declaration on Primary Health Care at the Kazakhstan capital on Thursday.
The Astana Declaration marks the 40th anniversary
› We must acknowledge that we haven’t achieved that vision. Instead of health for all, we have achieved health for some. On one hand, we have made enormous progress – over the past 40 years, life expectancy has increased, maternal mortality and child mortality have halved
DR TEDROS A GHEBREYESUS, Director general, WHO
of the 1978 Alma-Alta Declaration (in what was then the Soviet Union) that said health was a human right for all and not just for a privileged few, and urged the world to make primary health care the mainstay of universal health coverage.
Forty years on, almost half the world’s population still lacks access to essential health services, and 100 million people are pushed into poverty because of catastrophic health expenditure each year.
Primary health care can provide 80-90% of a person’s health care needs in their lifetime. “We must acknowledge that we haven’t achieved that vision. Instead of health for all, we have achieved health for some. On one hand, we have made enormous progress – over the past 40 years, life expectancy has increased, maternal mortality and child mortality have halved...” said Dr Tedros A Ghebreyesus, director general, WHO.
“We have turned the tide on HIV, malaria deaths have halved... We can list many success. But progress has been uneven and unfair between countries and within countries,” he said.
“We have been too focused on fighting specific diseases, too focussed on treatment, at the expense of preventing diseases. We must recommit to making primary health care as the foundation of universal health care... Health is not a political toy, it must be used for advancing health, not impending it,” said Dr Ghebreyesus.
The declaration, which has all 194 WHO member states on board, including India, urges countries to use high-quality, safe, effective and affordable medicines, including “appropriate” traditional medicines, vaccines, diagnostics and other technologies to improve access to health while “protecting personal data.”
Primary health centres must provide a comprehensive range of services and care, “including but not limited to vaccination,” said the declaration, which marks a move away from targeted health programmes that work in silos to an integrated health approach.
It underlines the growing need for prevention, control and management of non-communicable diseases like diabetes and heart disease, among others, which now account for more years of ill health and deaths in most parts of the world, including India.
“The resurgence of global commitment to comprehensive primary health care resonates well with India’s National Health Policy of 2017. The high priority accorded to Health and Wellness Centres opens the pathway to universally accessible, integrated, continuous care,” said K Srinath Reddy, the president at Public Health Foundation of India.
India, which was represented by Union health minister JP Nadda at Astana, has already made a start with the launch of health and wellness centres under Ayushman Bharat that offer health promotion, and disease prevention and management at the community level. The treatment of simple fevers, infections and pain using safe and non-prescription medicines, screening for hypertension and blood sugar for timely referral to hospitals, and nutrition advice are also provided by a new cadre of technologically enabled community health officers (CHOs) trained as mid-level providers, who are working with the support from auxiliary nurses, midwives, community workers (Asha) and male health workers.
“The role of non-physician health care providers, especially technology-enabled community health workers and mid-level care providers, is pivotal for the success of primary health care as envisioned at Astana.
India has to prioritise this investment in health workforce to achieve the health targets of the sustainable development goals (SDGs),” said Dr Reddy.