Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Co-Action Publishing
Abstract
BACKGROUND: The 4-year (2007 2011) Revitalizing Health for All international research program (http://www.
globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 lowand
middle-income countries to explore the strengths and weaknesses of comprehensive primary health
care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior
researcher, a new researcher, and a 'research user' from government, health services, or other organizations
with the authority or capacity to apply the research findings. Multiple regional and global team capacityenhancement
meetings were organized to refine methods and to discuss and assess cross-case findings.
OBJECTIVE: Most research projects used mixed methods, incorporating analyses of qualitative data (interviews
and focus groups), secondary data, and key policy and program documents. Some incorporated historical
case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived
through qualitative analysis of final project reports undertaken by three different reviewers.
RESULTS: Evidence of comprehensiveness (defined in this research program as efforts to improve equity in
access, community empowerment and participation, social and environmental health determinants, and
intersectoral action) was found in many of the cases.
CONCLUSION: Despite the important contextual differences amongst the different country studies, the
similarity of many of their findings, often generated using mixed methods, attests to certain transferable
health systems characteristics to create and sustain CPHC practices. These include:
1. Well-trained and supported community health workers (CHWs) able to work effectively with
marginalized communities
2. Effective mechanisms for community participation, both informal (through participation in projects
and programs, and meaningful consultation) and formal (though program management structures)
3. Co-partnership models in program and policy development (in which financial and knowledge supports
from governments or institutions are provided to communities, which retain decision-making
powers in program design and implementation)
4. Support for community advocacy and engagement in health and social systems decision making
These characteristics, in turn, require a political context that supports state responsibilities for redistributive
health and social protection measures.
Description
Keywords
Primary healthcare, Community health workers, Alma Ata Declaration, World Health Organization (WHO), World Health Report
Citation
Labonte, R. et al. (2016). Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project. Global Health Action, 7: 24997