It has been 45 years since the landmark 1978 Alma-Ata Declaration, which defined Primary Health Care (PHC) as “essential healthcare based on practical, scientifically sound and socially acceptable methods and technology 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.”
The goal of PHC is to provide better health services for all, making it an integral part of a country’s health system and the central function for the community’s overall social and economic development. The aim is to achieve the highest possible level of health and well-being, ensuring equitable distribution and a sustainable healthy life without financial burden on patients.
Despite the promulgation of the PHC agenda after the Alma-Ata Declaration, its actualization has remained elusive. The declaration outlined eight key elements and four pillars necessary to support the actualization of the vision of improved health outcomes for the population. The eight elements include:
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Aligning practice to evidence in strengthening PHC for lasting health change in Africa
This sub-theme focuses on evidence-based approaches and models that improve access to PHC services. The elements of this sub-theme include evidence based:
1.1 Community Participation and Engagement of community health workforce
1.2 Models for Universal Health Coverage
1.3 Quality Service Delivery
1.4 Digital information for PHC
Social Determinants of Health (SDH) are crucial in addressing the increasing burden of disease. This sub-theme focuses on evidence-based interventions that focus on modifying social determinants of health thereby improving uptake of PHC. The subtheme focuses on the following.
2.1 Resilience: dimensions of resilience and its impact on health outcomes within the context of social determinants
2.2 Livelihoods: Interplay between livelihoods and health, exploring factors such as employment opportunities, income inequality, social support, and access to essential resources influence health outcomes and contribute to health disparities
2.3 Education: innovative strategies and interventions that leverage education as a tool for promoting health equity and improving population health
This sub-theme focuses on facility-based services at PHC level. It interrogates the best evidence for improving services in the following areas:
3.1 Adolescents & sexual reproductive health
3.2 Maternal, child health & Nutrition
3.3 Mental Health & gender-based violence
3.4 Non-communicable diseases, including hypertension, diabetes, cancers, etc.
3.5 Water Sanitation and Hygiene, Neglected tropical diseases and Communicable diseases
This sub-theme explores evidence in areas that have emerged and that affect PHC after the Alma-Ata Declaration. It focuses on evidence on the following areas:
4.1 Improving PHC in the face of climate change; maintaining health system resilience
4.2 Zoonoses and evidence on the one Health approach
4.3 Use of technology to improve communities’ access to Primary healthcare.
4.4 New evidence on management of infectious diseases including environmental drivers of antimicrobial resistance
This sub-them will allow participants to share evidence for improving PHC on the following areas:
5.1 Role of citizens’ voices in improving access to PHC services
5.2 Effective health leadership and governance approaches and Practices
5.3 Financing and entrepreneurship models, including public-private partnerships and cost-effective healthcare financing for PHC
The four pillars emphasized Community Participation, Inter-sectoral Coordination, Appropriate Technology, and the availability of Support Mechanism. Additional declarations such as the Abuja Declaration, Maputo Declaration, Ouagadougou Declaration and Bamako Declaration have also been made.
These notwithstanding, the PHC agenda is yet to be fully realized, and the scientific foundation of PHC requires further examination. The implementation of PHC in Africa could be more impactful if it is based on evidence that is contextualized. Much of the researches that inform PHC is not Africa-led, and even when evidence is generated within Africa, its translation to programs and policy remains dismal. In light of these challenges, Amref International University together with its research partners from Africa and beyond have convened to deliberate on the extent to which PHC practices in Africa are evidence-based and to share recent evidence that can enhance PHC practice.
