Astana Declaration: Not just health, but affordable health for all

UN’s 192 member countries agree to strengthen primary healthcare on the 40th anniversary of Alma Ata Declaration

By Banjot Kaur
Published: Thursday 25 October 2018
Health care
The Astana declaration also says that public healthcare should not function in vacuum. Credit: Getty Images The Astana declaration also says that public healthcare should not function in vacuum. Credit: Getty Images

In an event that marked 40 years of the historic Alma Ata Declaration, which declared health a human right for all, all the 192 member countries of the United Nations, including India, signed the Astana Declaration. This declaration is meant to take the earlier agreement forward, strengthen the primary healthcare (PHC) systems and realise the idea of universal healthcare (UHC).

Taking a critical note of the developments after first such declaration was signed, Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said, “Today, instead of health for all, we have health for some.” But, the Alma Ata declaration had precisely envisaged making health available for all.  He added, therefore, the declaration was signed on the first day of the two-day global conference on primary healthcare.

While the Alma Ata declaration talked about availability of healthcare for one and all, the Astana declaration goes a step ahead and expresses concern about growing cost of healthcare machinery.  “We must save millions from poverty, particularly extreme poverty, caused by disproportionate out-of-pocket expenses on health. We can no longer underemphasise the crucial importance of health promotion and disease prevention, nor tolerate fragmented, unsafe or poor-quality care. We must address the shortage and uneven distribution of health workers and act on the growing costs of medicines and vaccines. We cannot afford any waste in healthcare spending due to inefficiency,” reads the declaration.

The declaration also touches upon the crucial aspect that PHC should not function in vacuum and there has to be a cohesion between all tiers of healthcare so that the services given to patients are not limited. “We will strive to avoid fragmentation and ensure a functional referral system between primary and other levels of care,” the document reads.  The declaration also takes into cognizance the growing threat of lifestyle and non-communicable diseases. The declaration asks all member states to make “bold political choices” for health across sectors.

The WHO, UNICEF and health ministry of Kazakhstan said that while the 1978 declaration did lay a foundation for strong primary healthcare, half the world’s population still lacks access to essential health services, including care for non communicable diseases, maternal and child health, mental health and sexual and reproductive health.

“Although, the world is a healthier place for children today than ever before, close to 6 million children die every year before their fifth birthday mostly from preventable causes, and more than 150 million are stunted,” said Henrietta Fore, UNICEF’s executive director.

“The new declaration will renew political commitment to primary health care from governments, non-governmental organisations, professional organisations, academia and global health and development organisations. It will be used to inform the UN General Assembly high-level meeting on UHC in 2019,” reads a WHO note.

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