The evolution of global health policies from Alma Ata to Public Private Partnerships

Author: Adriano Cattaneo
Submitted: Friday 4th of November 2011 12:54:47 PM
Submitted by: egf
Educational levels: expert, qc1, qc2, qc3


The need to go beyond medicine and public health to promote improved nutrition, housing, health, economic, occupational, recreational and other conditions is established in the WHO constitution and is enshrined in the Universal Declaration of Human Rights.12 In 1975, WHO and UNICEF, in a joint document, emphasized the role of poverty and other social factors in the origin of diseases and proposed alternative approaches to meet the health needs of populations in developing countries.3 This approach became official in 1976, when the World Health Assembly launched the idea of Health for All by the Year 2000, and was carved in stone in the Declaration of Alma Ata, approved on 12 September 1978 by over 3000 delegates representing 134 governments and 67 international and non-governmental organizations.4 The strategy outlined in the Declaration of Alma Ata to achieve the goals of Health for All in the Year 2000 was Primary Health Care (PHC), based on principles of equity, political commitment, community participation, intersectoral collaboration, promotion of health and use of appropriate technologies. The so-called comprehensive PHC was defined as “essential health care based on practical, scientifically sound and socially acceptable methods and technologies made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford at each stage of their development in a spirit of autonomy and self-determination.” A little over a year later, on 1 November 1979, the New England Journal of Medicine published an article on selective PHC.5 The authors were associated to the University of Harvard and worked for the Rockefeller Foundation. Starting from the observation that resources are limited, that the clock is ticking and that one can not do everything, and after explaining the result of some questionable calculations of cost/effectiveness of various medical interventions, they concluded that PHC should be selective and focus on vaccination against measles, diphtheria, pertussis and tetanus, treatment of malaria and diarrhea, and promotion of breastfeeding. In assuming the role of Executive Director of UNICEF on 1 January 1980, James Grant married immediately the concept of selective PHC. With his enthusiasm, he quickly convinced governments and donors, but also the WHO, to launch vertical programmes inspired directly from the New England Journal of Medicine article, an initiative known throughout the world by the acronym GOBI (Growth monitoring, Oral rehydration, Breastfeeding, Immunization). This will be the progenitor of a long series of similar initiatives, the most popular nowadays being GFATM (Global Fund Against AIDS, Tuberculosis and Malaria). 1 World Health Organization. Constitution. UN, New York, 1946 2 United Nations. Universal declaration of human rights. UN, New York, 1948 3 Djukanovic V, Mach EP. Alternative approaches to meeting basic health needs of populations in developing countries: a joint UNICEF/WHO study. WHO, Geneva, 1975 4 WHO/UNICEF. Declaration of Alma Ata. WHO, Geneva, 1978 5 Walsh JA, Warren KS. Selective primary health care: an interim strategy for disease control in developing countries. N Engl J Med 1979;301:967-74


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Adriano Cattaneo. The evolution of global health policies from Alma Ata to Public Private Partnerships. EUROGENE portal. November 2011. online:

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