Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries

John J Hall and Richard Taylor
Med J Aust 2003; 178 (1): 17-20.


  • Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978.

  • The model formally adopted for providing healthcare services was "primary health care" (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement.

  • PHC did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own heathcare services.

  • Changes in economic philosophy led to the replacement of PHC by "Health Sector Reform", based on market forces and the economic benefits of better health.

  • It is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.

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  • John J Hall1
  • Richard Taylor2

  • School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.


Competing interests:

None identified.

  • 1. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. Available at <>.
  • 2. Braveman P, Tarimo E. Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med 2002; 54: 1621-1635.
  • 3. Bennett F. Primary health care and developing countries. Soc Sci Med 1979; 13A: 505-514.
  • 4. Benyoussef A, Christian B. Health care in developing countries. Soc Sci Med 1977; 11: 399-408.
  • 5. Oral glucose/electrolyte therapy for acute diarrhoea [editorial]. Lancet 1975; 1: 79.
  • 6. Pierce N, Hirschhorn N. Oral fluid — a simple weapon against dehydration in diarrhoea: how it works and how to use it. WHO Chron 1977; 31: 87-93.
  • 7. The Mahler revolution [editorial]. BMJ 1977; 1: 1117-1118.
  • 8. Spencer M. Public health in Papua New Guinea. 1870–1939. ACITHN Monograph No. 2. Brisbane: University of Queensland, 1999.
  • 9. Dennon D. Public health in Papua New Guinea: medical possibility and social constraint 1884–1984. Cambridge: Cambridge University Press, 1989.
  • 10. World Health Organization global strategy for health for all by the year 2000. Geneva: WHO, 1981.
  • 11. Warren K. The evolution of selective primary health care. Soc Sci Med 1988; 26: 891-898.
  • 12. Unger J, Killingsworth J. Selective primary health care: a critical review of methods and results. Soc Sci Med 1986; 22: 1001-1013.
  • 13. Werner D. Health hazard: user fees. New Internationalist 2001; 31(Jan): 22-23.
  • 14. Tarimo E, Webster EG. Primary health care concepts and challenges in a changing world. Alma-Ata revisited. ARA Paper Number 7 (WHO/ARA/CC/97.1). Geneva: WHO, 1997.
  • 15. World Bank. World development report 1993: investing in health. New York: Oxford University Press, 1993.
  • 16. Primary Health Care 21: "Everybodys Business". An international meeting celebrating 20 years after Alma-Ata. Almaty, Kazakhstan, 27–28 November 1998. Geneva: WHO, 1998.
  • 17. World Health Organization. The World Health Report 2000. Health systems: improving performance. Geneva: WHO, 2000. Available at <>.
  • 18. Hill A, MacLeod W, Joof D, et al. Decline of mortality in children in rural Gambia: the influence of village-level primary health care. Trop Med Int Health 2000; 5: 107-118.
  • 19. World Health Organization. Global measles vaccine coverage and reported cases, 1980–1999. May 2000. Available at (accessed 15 Oct 2002).
  • 20. Rutstein S. Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bull World Health Organ 2000; 78: 1256-1270.
  • 21. Whitehead M, Dahlgen G, Evans T. Equity and health sector reforms: can low- income countries escape the medical poverty trap? Lancet 2001; 358: 833-836.
  • 22. Chowdhury Z, Rowson M. The people's health assembly. BMJ 2000; 321: 1361-1362.
  • 23. Zwi A, Yach D. International health in the 21st century: trends and challenges. Soc Sci Med 2002; 54: 1615-1620.
  • 24. Mehrotra A, Jarrett S. Improving basic health service delivery in low-income countries: "voice" to the poor. Soc Sci Med 2002; 54: 1685-1690.
  • 25. Sachs J. Weapons of mass salvation. The Economist 2002; Oct 20: 73-74.
  • 26. Kleinert S. What are the world's priorities? Lancet 2002; 360: 1118.


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