A lot of big commitments were made at a UN conference on world health at Alma Ata in 1978. Twenty years later, there were many lessons to be learned about big commitments and tiny progress ... and the biggest lesson of the lot is that conference commitments and talk do not get much accomplished.
Twenty years later ... 1998 ... instead of addressing this lesson of history the high command of the UN and the international official relief and development assistance (ORDA) industry did something even bigger in terms of conference and commitment, they came up with the idea of the Millennium Development Goals (MDGs) with a whole range of things that were going to get done, on a timetable that was then, way into the future!
Surprise surprise ... the commitments associated with the MDGs have not proved much more solid than the old Alma Ata commitments. The ORDA community loves long term goals that are really easy to talk about, and need nothing done right now ... it is very easy to "kick the can down the road" rather than getting to real grips with the problem.
This was the e-mail message that reminded me of the Alma Ata commitments of 1978 and the tiny amount of accomplishment that was achieved compared to what was promised.
The declaration of Alma Ata still relevant to primary health care!Perhaps the MDGs are even worse than the Alma Ata commitments ... they have been used to mobilize a lot of development money. But, since the metrics about performance and effective use of money are missing, this has been a bonanza for the ORDA industry participants without moving much towards satisfying the needs of beneficiaries!
Gillam S: British Medical Journal 336:536-538, 8 March 2008
After years of relative neglect, the World Health Organization has recently given strategic prominence to the development of primary health care. This year sees the 30th anniversary of the declaration of Alma Ata. Primary health care 'based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people's full participation and at a cost that the community and country can afford' was to be the key to delivering health for all by the year 2000.
Primary health care in this context includes both primary medical care and activities tackling the social determinants of ill health.
PHM hopes this WHO prominence will result in recommendations that will respect the views of civil society.
Why do we not learn? Perhaps the answer is that there is no need ... we have little memory ... and the necessary metrics are missing.