Alma-Ata: Rebirth and revision 8 - Primary health care: making Alma-Ata a reality
Alma-Ata: Rebirth and revision 8 - Primary health care: making Alma-Ata a reality
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DOI：
10.1016/s0140-6736(08)61409-9
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发表时间：
2008-09-13
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Walley, John;Lawn, Joy E.;Black, Robert E.
30年前在阿拉木图达成的原则现在和当时一样适用。到2000年，“人人享有健康”的目标没有实现，如果不大幅加快初级卫生保健，大多数低收入国家将无法实现2015年的千年发展目标。这些因素包括对卫生的政治优先考虑不足、结构调整政策、治理不善、人口增长、卫生系统不足以及对初级卫生保健的研究和评估不足。我们建议重振初级卫生保健的优先事项如下。需要加强包括人力资源和基本药物在内的卫生服务基础设施，并应取消初级保健服务的使用费，以改善使用情况。需要对包括计划生育在内的孕产妇、新生儿和儿童保健服务进行持续的护理。应根据国情调整、评估和扩大以循证为基础的综合社区和初级治疗和预防一揽子服务。需要社区参与和社区卫生工作者与加强的初级保健设施和第一转诊服务相联系。此外，必须采取跨部门行动，将卫生与发展联系起来，包括改善水、卫生设施、营养、粮食安全和艾滋病毒控制。应解决慢性病、心理健康和儿童发展问题。应该衡量进展并确保问责。我们优先考虑研究问题，并为当地和全球的利益攸关方建议行动和措施，这是重振初级卫生保健所必需的。
The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.