Today, member states of the United Nations (UN) unanimously agreed to the Declaration of Astana, vowing to strengthen their primary health care systems as an essential step toward achieving universal health coverage. The Declaration of Astana reaffirms the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care.
The Declaration of Alma-Ata
In 1978, a pivotal conference was held in Almaty (then Alma-Ata), Kazakhstan, bringing together health experts and world leaders to commit to health for all. Primary Health Care was accepted as the means to achieve Health For All by the year 2000. Endorsed at that conference, the declaration formed the foundation for the last 40 years of global primary health care efforts.
Why a new Declaration?
While we have made great strides in health outcomes globally over the past 40 years, we face many ongoing challenges. A primary health care (PHC) approach is the most effective way to sustainably solve today’s health and health system challenges.
The PHC approach is foundational to achieving our shared global goals in Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs).
The new declaration will renew political commitment to primary health care from Governments, non-governmental organizations, professional organizations, academia and global health and development organizations. It will be used to inform the UN General Assembly high-level meeting on UHC in 2019.
The new declaration is also a chance to commemorate the 1978 Alma-Ata Declaration on Primary Health Care, and reflect on how far we have come and the work that still lies ahead.
“We are convinced that strengthening primary health care (PHC) is the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals.”
The Declaration of Astana makes pledges in four key areas:
- make bold political choices for health across all sectors;
- build sustainable primary health care;
- empower individuals and communities; and
- align stakeholder support to national policies, strategies and plans.
1. Make bold political choices for health across all sectors
- promote multisectoral action and UHC
- involve more stakeholders in the achievement of Health for All
- strive to avoid/ mitigate conflicts that undermine health systems and roll back health gains
- use coherent and inclusive approaches to expand PHC as a pillar of UHC in emergencies
- allocate and provide resources to strengthen PHC
2. Build sustainable primary health care
- strengthen health systems by investing in PHC
- enhance capacity and infrastructure for primary care
- prioritize disease prevention and health promotion
- provide comprehensive preventive, promotive, curative, rehabilitative services and palliative care
- PHC will provide a comprehensive range of services and care
The success of Primary Health Care will be driven by:
Knowledge and capacity-building
- apply knowledge, including scientific as well as traditional knowledge, to strengthen PHC, improve health outcomes and ensure access for all people to the right care at the right time and at the most appropriate level of care.
- research and share knowledge and experience, build capacity and improve
the delivery of health services and care.
Human resources for health.
- create decent work and appropriate compensation for health professionals and other health personnel working at the primary health care level to respond effectively to people’s health needs in a multidisciplinary context
- strive for the retention and availability of the PHC workforce in rural, remote and less developed areas.
- support broadening and extending access to a range of health care services through the use of high quality, safe, effective and affordable medicines, including, as appropriate, traditional medicines, vaccines, diagnostics and other technologies.
- use a variety of technologies to improve access to health care, enrich health service delivery, improve the quality of service and patient safety, and increase the efficiency and coordination of care.
- Through digital and other technologies, enable individuals and communities to identify their health needs, participate in the planning and delivery of services and play an active role in maintaining their own health and well-being.
- continue to invest in PHC to improve health outcomes.
- ensure better allocation of resources for health, adequate financing of primary health care and appropriate reimbursement systems in order to improve access and achieve better health outcomes.
- leave no one behind, including those in fragile situations and conflictaffected areas, by providing access to quality PHC services across the continuum of care.
3. Empower individuals and communities
- support the involvement of individuals, families, communities and civil society through their participation in the development and implementation of policies and plans that have an impact on health
- support people in acquiring the knowledge, skills and resources needed to maintain their health or the health of those for whom they care, guided by health professionals.
- increase community ownership and contribute to the accountability of the public and private sectors for more people to live healthier lives in enabling and health-conducive environments.
4. Align stakeholder support to national policies, strategies and plans.
- take joint actions to build stronger and sustainable PHC towards achieving UHC.
- Stakeholders and countries will work together in a spirit of partnership and effective development cooperation, sharing knowledge and good practices while fully respecting national sovereignty and human rights.
Link to the WHO news release:
Link to the Declaration of Astana, 2018:
Link to WHO fact sheet on Primary Health Care (updated October 2018):
Link to the Declaration of Alma-Ata, 1978: