Tuesday, May 5, 2020

The Relevance of Alma-Ata Declaration Free Sample for Students

Question: Write an Essay on the Relevance of Alma-Ata Declaration. Answer: Introduction The WHO Health Assembly in 1977 made a resolution that the main goal for nations across the globe in the decades to come, would be to ensure that their citizens attained a level of health by the year 2000, that would allow them to live an economically and socially productive life. This target or aspiration was referred to as "Health For All." The question that arose at that time and still remains is whether the HFA objective was possible. Is it an operation that can be attained? What would need to be done for HFA to be a reality? The answer that was proposed was Primary Health Care. That said the following year, UNICEF and WHO sponsored a major conference in which the agenda was PHC and that was held in Alma-Ata. The reaffirmation of health as a basic human right was the main agenda of the conference and the declaration was made that PHC was the key for the attainment of this target and which was a part of social justice development. In this paper, the relevance of the declaration is analyzed in the current-day lens, close to 40 years after it was made. The relevance of the Alma-Ata is discussed and the way forward with regard in its sustainability is also highlighted. Thesis Statement: The relevance of the Alma-Ata Declaration lies in community health Current challenges in the global healthcare systems Countries in the middle and low income levels, as well as high income countries, all face the challenge of increased non-communicable illness prevalence. This change has resulted in the simultaneous existence of under nutrition, persistent infectious diseases, and problems related to reproductive health along with the emergence of non-communicable diseases with their associated risk factors (including cardiovascular disease, stroke, diabetes, obesity, hypertension, and smoking) (Fren Moon, 2013). This transition in epidemiology presents a major challenge to the global healthcare systems. A majority of these systems are focused around child and maternal health as well as the care of episodic, acute illnesses. The future needs PHCs that are appropriate and which are capable of delivering effective chronic disease management as well. Global initiatives that focus on prioritized diseases such as malaria, TB, and HIV/AIDS may be undermining the wide services in healthcare through effort duplication, national budgets and health plan distortion, and more so via the re-routing of the valuable and scarce human resource (Congressional Research Service, 2012). More often than not, disease control technicalities take precedence over holistic care. On a rather ironic note, the Alma-Ata declaration highlighted the short comings of the single issue, top-down programs. The horizontal integration and PHC of health programs is critical in the attainment of the MDGs. An example is the integration efforts of preventive chemotherapy programmes that are targeted at five of what are referred to as the neglected tropical diseases, which are estimated to result in major cost cuts of more than 47% (WHO, 2014) PHC also plays the role of linking the interface between hospital and ambulatory care; speciality services and hospitals; community health and the individual; and family planning and nutrition programs. By failing to see the connection between the various district health care system components, adverse inefficiency becomes the end result. In countries at the low income level, the first care level can resolve close to 90% of its citizens heath care services demands. There is sufficient evidence indicating that health systems that focus on PHC have a high likelihood of delivering better outcomes with regard to health for the public ,with greater satisfaction among recipients in addition to greater savings in costs (Salam, Lassi, Daset al., (2014) There is no one-system-fits-all (Henderson, 2015).A major challenge is in the establishment of a combination of interventions that are most effective and which target several risk factors and conditions that affect the main groups(for example, the elderly, children, and women) and that are adopted in an appropriate manner at the local level in socio-cultural, economic, and epidemiological contexts. Interventions' clustering results in the achievement of comprehensiveness, resource limitations notwithstanding. These kinds of clusters will include management integration of illnesses affecting children, reproductive and maternal healthcare; community and clinic based management of malaria, TB, STIs, and HIV/AIDS; management of cardiovascular risk factors including hypertension and stroke; substance abuse and mental illness (Henderson, 2015) PHC constitutes the first contact point for family and patient care in addition to being the critical foundation for the extension of care to vulnerable communities. Focus of outreach services may be on preventive measures at an individual level (such as ORT, vitamin A, or immunizations) or health promotion at the community level (such as exercise, diet, or child nutrition). The provision of these services relies heavily on the mechanisms and support for the identification, training, as well as support of the community health care workers (White, 2015) The universal challenge is affordability. Defining which services can be provided at no-charge and in a realistic manner at the first contact point and the financial mechanism mix that need to be promoted, is a question begging for an answer. User charges for provision of PHC is a major issue of contention as there has been repeated deterrence in the people that really need the services not being able to access the same. Indeed, providing financial incentives to poor populations is an effective option. There are several countries that have pilot schemes that offer financial incentives in the form of vouchers and money to increase and encourage community members' access specific services such as family planning and maternity services (Grainger, Gorter, Okal et al. 2014). Monitoring health care services and outcomes is also a viable way of improving access that is equitable. This is in addition to providing incentives to the human resource that delivers services to the community membe rs that are vulnerable. The stark reality in countries in the middle and low income levels is that most healthcare service will continue to be a job done by NGOs and private organizations (Basu, Andrews, Kishore et al., 2012) Most places across the globe and more so in Sub Sahara Africa, have human resource shortfalls that cripple the healthcare services partly because of internal and international migration which has renewed the interest in mobilising community workers to fill in the gap. The irony is that the poor countries that used industrialised countries' training standards are the same that are most vulnerable to poaching by their mentors. A major challenge is overcoming the sense of resignation and motivation loss of majority of PHC workers who work in minimally staffed settings. These staffs lack managerial support that is consistent and have adjusted to inadequate services (Bonenberger, Marc, Moses et al., 2014). PHC jobs in most developing countries are viewed as being menial and are not valued by policy makers or the public. To reverse this perception, adequate governance and prioritized political commitment, as well as adequate funding, will change the status and make primary care an attract ive option for workers (Boneneberger, et al., 2014) The Relevance of the Alma-Ata declaration is synched to community health care Global efforts toward convergence of grand health are propelled by the Sustainable Development Goals where children and women form poor communities are able to access the same quality levels of health services as those from wealthier countries. When recognition is given to communities as being change factors that are key for the transformation of health care systems for adolescents, children, women, and other vulnerable groups, and when such communities are empowered and valued for the assets they possess, then it becomes possible for progress to be driven and sustained toward health outcomes that are equitable and accelerate the progress toward maternal and child mortality (UNICEF, 2013). It is a known fact that mortality rate of 2.4 million children and mothers can be averted every year(Black, Levin, Walker et al., 2016) through the scaling up and strengthening of evidence-based packaged interventions that focus on volunteers at the community level, salaried healthcare community workers, and communities that are involved and committed to the course. However, there has been lagging in health systems with regard to strengthening the community and existing initiatives have gained traction at a very slow pace at the community level, often resulting with communities as recipients of services rather than empowering the key actors who are capable of strengthening the systems and making them more equitable. In decentralized environments, the challenge of implementing national policies on community health remains a major issue (Black et al., 2016). While there is continued accumulation on evidence that supports community empowerment and engagement effectiveness in saving lives of children, newborns, and mothers, more is needed in acquisition of knowledge on building, sustaining, and scaling vibrant partnerships in communities that are integrated effectively within the healthcare systems. This is a critical step in the development of supportive programs and policies for community health and for the documentation, replication, and scaling up of approaches that are successful with regard to other vulnerable groups as well. Health efforts at the community level are complex requiring a variety of methods for the documentation of what works and comprehending why, within different countries is necessary. Countries should focus on building community health systems that are stronger and which are capable of driving progress toward the achievement of the SDGs. Developing countries should be ready to emulate the few countries that have built successful community platforms and are on the path to ensuring the universal access of primary care for mothers , children, and other vulnerable groups. To do so, a meaningful focus and attention should be given to community healthcare development. Although this is not a novel idea, focusing on community health development should aim at supporting the roles of members as empowered and valued actors for services delivery; provision of oversight for health services delivery at all levels; improving and advancing health literacy and social norms that encourage good health; enhancement of health systems' accountability to the recipients; and giving a voice to those who have been denied one. This vision encapsulates strengthening of community systems through empowerment, agency, cohesion, trust, participation, and inclusion. Facilitation of community empowerment and participation Active participation of the community is necessary for interventions to be effective including those for children, newborn, and maternal health and diseases that are environment related. Community participation goes beyond mobilization of persons in accepting interventions. The need for a move from focusing on health education (information provision) to promotion of health (transformation of behaviour and attitudes) is necessary for the empowerment of communities to have roles that are more active with regard to their health (Foot, Gilbert, Dunn et al., 2014). Messages that promote health are dynamic- the transition and epidemiological rise in non-communicable, chronic diseases among the elderly populations, tobacco use, changing diets, and lives that are more sedentary, will call for messages that are appropriate and dissemination of the same in an effective way. Through health promotion and education in schools, communities will be empowered to take control with reference to their individual health. The main challenge for mobilization of communities lies in replicating it at scale in an effective manner (Campbell Cornish, 2012; Marston, Renedo, Mcgowan et al., 2013). The earlier emphasis on participation by communities was focusing on poor populations living in rural areas. However, most of the global populace resides in the cities and the need for urban population community engagement requires models of care that are functional. Conclusion Every level- global, national, provincial, district, facility, community, family, and individual- has a responsibility and role to fulfill if HFA is to be achieved. Delivery of results with an approach based on PHC will require links, partnerships, and an environment that is enabling including support from the bottom-up from communities that are empowered, support form the top-down from governments that are responsible, and across state and municipal levels, and support from external financial and technical resources, when appropriate and needed. There is a need to strengthen PHC facilities and services and link them to the communities in which they are located and whom they serve. However, PHC is much broader than the health system and hence greater action is needed. The Alma-Ata declaration emphasized on intersectoral and community collaboration and that is needed now more than ever in light of the increasing development architecture complexity. There is a need for measurable and p ragmatic approaches that construct evidence on the manner in which these strategies can be implemented ,in the best way possible, and within various settings. References Basu,S; Andrews, J; Kishore,S; Panjabi, R, Stuckler, D (2012). Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review. https://dx.doi.org/10.1371/journal.pmed.1001244 Black, R.E., Levin, C., Walker, N., Chou, D., Liu, L., Temmerman, M. (2016). Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition. The Lancet, 388 (10061), 2811-2824. doi: 10.1016/s0140-6736(16)00738-8 Bonenberger, Marc, Moses Aikins, Patricia Akweongo, and Kaspar Wyss. (2014). "The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study". Hum Resour Health 12, no. 43;10-1186.Campbell C, Cornish F (2012) How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa. AIDS Behav 16: 847857. Congressional Research Service (2012). The Globbal Challenge of HIV/AIDS, Tuberculosis, and Malaria. https://www.everycrsreport.com/files/20120529_R41802_3707b8ef1bad19b1cf56bfda27a712b074f40856.pdf Foot, C; Gilbert, H; Dunn, P; Jabbal J; Seale, B; et al., (2014). People in control of their own health and care: the state of involvement. https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/people-in-control-of-their-own-health-and-care-the-state-of-involvement-november-2014.pdf Frenk, J Moon, S. (2013). Governance Challenges in Global Health. N Engl J Med; 368:936-942. DOI: 10.1056/NEJMra1109339 Grainger C, Gorter A, Okal J, Bellows B.(2014). Lessons from sexual and reproductive health voucher program design and function: a comprehensive review.Int J Equity Health. 13(1):33. 10.1186/1475-9276-13-33J, Henderson J.W. (2015). Health economics and policy. Singapore: Cengage Learning Asia Pte Ltd. Marston, C., Renedo, A., Mcgowan, C.R., Portela, A. (2013). Effects of Community Participation on Improving Uptake of Skilled Care for Maternal and Newborn Health: A Systematic Review. PlosONE, 8(2). doi: 10.1371/journal.pone.0055012. Salam, R. A., Lassi, Z. S., Das, J. K., Bhutta, Z. A. (2014). Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.Reproductive Health,11(Suppl 2), S3. https://doi.org/10.1186/1742-4755-11-S2-S3 UNICEF (2013) Strategic Plan 2014-2017. https://www.unicef.org/about/execboard/files/2013-16-Strategic_Plan_2014-2017-ODS-English.pdf White, F (2015). Primary Health Care and Public Health: Foundations of Universal Health Systems. Med Princ Pract. 24:103-116 https://doi.org/10.1159/000370197 World Health Organization (2014)Preventive chemotherapy: planning, requesting medicines, and reporting.Wkly Epidemiol Rec89: 6171

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