It is thirty years since the Alma Ata Declaration which outlined an international consensus on the need to provide universal access to primary health care (PHC). During the ensuing years some countries established and consolidated well-organised government health services in which PHC played an important role. Many others were less successful. Some countries have experienced major reversals in life expectancy after a long period of steady improvement and their health systems have deteriorated. There is a growing concern by national governments and the international community to expand access to PHC and they have committed a lot of money for this purpose. But there have been many major changes in these last three decades that pose big challenges for the future configurations of PHC.
This key issues guide unpacks some of the challenges for the future of PHC and highlights promising models of health system arrangement and service delivery that are improving access for the poorest and most marginalised. It focuses on 4 main areas: the increasing marketisation of health and how governments respond; the challenge of responding to progressive and chronic illnesses; the emergence of new epidemics and the globalisation of public health responses and the pressure to keep up with new treatments and technologies.

In this guide

1. The Alma Ata Declaration – what does it mean?
This section provides more information on the content of Alma Ata, the process that led to its development and opinion on its implementation.

2. Responding to the marketisation of health
This section explores how the delivery of health services has shifted since the Alma Ata Declaration was signed. It looks at how private and informal providers are playing an increasing role in health systems and how governments are responding.

3. From prevention to progressive and chronic illness
This section explores how pressure has been brought to bear on health systems by chronic illnesses such as HIV and ‘lifestyle’ conditions. These have affected the way that health systems are financed and arranged and the type of service that is offered.

4. New and altering epidemics
This section looks at the impact of new and emerging epidemics and the corresponding global health responses. It interrogates how these changes to disease patterns and the actions put into play to tackle them impact upon the provision of PHC.

5. The role of new technologies
From innovations in medical practice to the upsurge in the use of mobile phone technologies in developing countries health systems actors are learning to navigate their way with new technologies. This section provides examples of ways in which they are shaping the way that PHC is delivered.

6. Moving forward – innovations for equity
This section provides examples of innovative research, policies and programmes that have attempted to improve access to PHC by rethinking the ways in which health system strengthening has been traditionally viewed.

7. Recommended readings