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Alma Ata at 40: Midlife crisis or Graceful Maturity?

By and on August 17, 2018

Clara is a researcher at the Health Policy Unit, ITM, Belgium
Button is an Advocacy Coordinator and Policy Writer with the UHC Study Group (UP Manila), and a Health Policy Intern at ITM

In the summer of 1978, Grease, the cult movie opened in theatres, and some weeks later, Louis Joy Brown – the first test tube baby – was born in England. These two facts were momentous enough in themselves, but only a few months later, something else would join them in the annals of global history, and no, it wasn’t Godzilla.

In the autumn of 1978, the world was smack bang in the middle of a cold war that was (again) deteriorating rapidly, yet within the global health community, a different kind of war was being waged. In the battle against ill-health, the rallying cry was “Health for all by the year 2000”, Primary Health Care (PHC) was seen as crucial to achieving that goal, and “Alma Ata” was born.

In the period immediately after the declaration, there was a wave of optimism around this new idea which promised to revolutionise healthcare, unfortunately, it was quickly replaced by a more “pragmatic” view of the concept,  due to a number of reasons. Sounds a bit like the average marriage, doesn’t it? These days, it even seems that the global health community has moved on, as talk has turned to Universal Health Coverage (UHC). The new Alma Ata 2.0 declaration positions PHC very much as a “means towards achieving UHC”, for example.

So 40 years on, and the equivalent of a middle aged human, what can be done to keep the Alma Ata vision relevant?

We have borrowed from the advice given to people who are experiencing a midlife crisis, and tried to adapt it to fit this context.

  1. Appreciate the life you have. A lot has been achieved since the conference in Kazakhstan, and while the goal of health for all is far from being achieved, it is important that we celebrate the progress that has been made all over the world, so far.
  2. Move forward, not backwards. While it is tempting to look backwards and think of what could have been, especially in this anniversary year with all its associated poignancy, it is more important to continue to push forward. Even when there are new concepts like UHC, we must remain cognizant of the fact that primary health care will be central to the achievement of such ideas.
  3. Nurture your friendships. Good networks are important when one needs to push forward a new idea, or breathe new life into a tired one. With all the progress in pursuing PHC, it is easy to forget that people are at the heart of the policy. We must take stock of PHC stakeholders, and strengthen partnerships to continue the Alma Ata momentum. Global actors must be willing to work with more local actors, governments with civil society, and every stakeholder should be given the opportunity to contribute whatever they can to achieving the goal. This must however be done with caution, because while exploring new collaborations with different stakeholders will provide fresh perspective for this four decade policy, one must remember that some “friends” are more trustworthy than others.
  4. Avoid turning to alcohol and drugs. In a world where NCDs have become the major cause of death, it is important that we watch out for them, if we are to achieve the goal of health for all. Primary health care should continue to be the focal point for caring for people suffering from such conditions, however, it should also become more occupied with preventative and health promotion measures.
  5. Journal your experiences. Documenting both successes and failures is crucial. Although no two contexts are exactly alike, sharing experiences and stories from the field could inspire others, and give them ideas about how to improve primary health care in their own particular settings.
  6. Last but not least, stay away from buying that fancy sports car/Harley Davidson and do not succumb to a new crush: in spite of all the talk in global health of the need for ‘innovation’, the old spirit, vision and values of Alma Ata remain very relevant and needed. Unlike for your iPhone and other capitalist toys, when Alma Ata needs an update, you don’t actually have to renew the whole thing.

This piece was written tongue in cheek, but for people like us who were too young to remember, or were born post-1978 and are not personally affected by the loss of the Alma Ata dream, the most obvious thing to do is to focus on the future rather than the past. The truth is giving up is impossible, because after all we still want health for all, even we have had to move the benchmark!

PS: Perhaps ten years from now, when we go through our own midlife crisis, we might think differently : )

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One Response to “Alma Ata at 40: Midlife crisis or Graceful Maturity?”

  1. Willem van de Put

    An excellent way to describe the PHC anniversary…also from the point of view of someone old enough to have the lives experience of the full range of midlife crises (like George Orwell explained the existence of the lower-upper-middle class, there is also the pre-midlife, mid-midlife and post-midlife crisis). I find the most important message that there is no such thing as midlife crises for spirits… the true spirit of PHC is not technical and practical. It is about inclusion and people, and old spirits never die…the just seem to fade away before they come back with a vengeance!

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