Alma-Ata and Primary Health Care: An Evolving Story

The story of how Alma-Ata and Primary Health Care gained the attention of the world’s health leadership must be seen as one of the most intriguing in the history of health and development. The postcolonial years in the developing world saw health care that was largely hospital-based and curative in its orientation, whichmeant, of course, that most people who needed health care had little or no access to it. The shift to community-orientedcarewithoutreachbeyond hospitals to health centers and even to households called for dramatic changes in all aspects of the health sector. It was during those years that WHO was shifting its concerns from issues such as malaria eradication (which could not be accomplished) to the development of basic health services. In the cluster of years prior to Alma-Ata, 1978, WHO went through an exploratory process, partnering with interested organizations, conceptualizing various aspects of health care, culminating in the notion of primary health care, which was refined for and fully accepted at the Alma-Ata Conference. Thiswas the era ofHalfdanMahler, who became director general of WHO during these years and provided charismatic leadership that led to the planning for and remarkable outcomes of Alma-Ata. The WHO staff was initially mixed in its perceptions of this process, but then turned in the direction of strong support of what turned out to be one of the signal events in the history of the organization. The Conference in Alma-Ata was a splendid event, well planned, widely attended, and focused on problems of major importance, with the policy-related product of Primary Health Care and Health for All by 2000. It was seeking ways to translate the emerging knowledge base into health care for people all over the world. Following Alma-Ata, a major interest, reaching to present times, has been to follow implementation of the concepts, policies, and actions integral to primary health care in various parts of the world, and also to note conflicting concepts, policies, and processes. Here follows a listing of major relevant events, preceding and following Alma-Ata, up to the present, including relevant documentation (the time period that is the focus of each of the referenced materials will be noted, followed by the reference):