By Dr Harry Phoolchund
In 1978, at the Alma‐Ata Conference, ministers from 134 member-countries in association with WHO and UNICEF declared “Health for All by the Year 2000” selecting Primary Health Care as the best tool to achieve it. Unfortunately, that dream never came true.
The health status of third world populations has not improved. In many cases it has deteriorated further. Currently we are facing a global health crisis, characterized by growing inequalities within and between countries.New threats to health are continually emerging. This is compounded by negative forces of globalization which prevent the equitable distribution of resources with regard to the health of people and especially that of the poor.
Within the health sector, failure to implement the principles of primary health care, as originally conceived in Alma‐Ata has significantly aggravated the global health crisis. Governments and the international bodies are fully responsible for this failure. It has now become essential to build up a concerted international effort to put the goals of health for all to its rightful place on the development agenda.
Genuine, people-centred initiatives must therefore be strengthened in order to increase pressure on decision‐ makers, governments and the private sector to ensure that the vision of Alma‐ Ata becomes a reality. Several international organizations and civil society movements, NGOs and women’s groups decided to work together towards this objective. This group together with others committed to the principles of primary health care and people’s perspectives organized the first “People’s Health Assembly” (PHA) which took place form 4‐8 December 2000 in Bangladesh, at Savar, on the campus of the Gonoshasthasthaya Kendra or GK (Peoples Health Centre). 1453 participants from 92 countries came to the Assembly which was the culmination of eighteen months of preparatory action around the globe. The preparatory process elicited unprecedented enthusiasm and participation of a broad cross section of people who have been involved in thousands of village meetings, district level workshops and national gatherings.
The plenary sessions at the PHA covered five main themes: Health, Life and Well‐Being; Inequality, Poverty and Health; Health Care and Health Services; Environment and Survival; and The Ways Forward.
People from all over the world presented testimonies of deprivation and service failure as well as those of successful people’s initiatives and organization. Over a hundred concurrent sessions made it possible for participants to share and discuss in greater detail different aspects of the major themes and give voice to their specific experiences and concerns. The five days event gave participants the space to express themselves in their own idiom. They put forward the failures of their respective governments and international organizations and decided to fight together so that health and equitable development become top priorities in the policy makers agendas at the local, national and international levels. Having reviewed their problems and difficulties and shared their experiences, they have formulated and finally endorsed the People’s Charter for Health. The charter from now on will be the common tool of a worldwide citizens’ movement, the global “People’s Health Movement” (PHM) committed to make the Alma‐ Ata dream reality.
The principles of the People’s Charter for Health are:
- The attainment of the highest possible level of health and well‐being is a fundamental human right, regardless of a person’s colour, ethnic background, religion, gender, age, abilities, sexual orientation or class.
- The principles of universal, comprehensive Primary Health Care (PHC), envisioned in the 1978 Alma Ata Declaration, should be the basis for formulating policies related to health. Now more than ever an equitable, participatory and intersectoral approach to health and health care is needed.
- Governments have a fundamental responsibility to ensure universal access to quality health care, education and other social services according to people’s needs, not according to their ability to pay.
- The participation of people and people’s organisations is essential to the formulation, implementation and evaluation of all health and social policies and programmes.
- Health is primarily determined by the political, economic, social and physical environment and should, along with equity and sustainable development, be a top priority in local, national and international policy‐making.
The underlying perspective of the PHM is summarised in what one speaker said at the second PHA in Cuenca, Ecuador:
“Illness and death every day anger us. Not because there are people who get sick or because there are people who die. We are angry because many illnesses and deaths have their roots in the economic and social policies that are imposed on us.”
The vision of a ‘global people’s health movement’ is not to be seen as aiming to co-opt the huge diversity of individuals, organisations and networks into a monolithic, centrally organised and directed PHM. These individuals and organisations have their own history, commitments and identities. To call for a strengthening of the people’s health movement implies calling for stronger communication links and collaboration when appropriate. However, the diverse purposes, ways of working and identities should not be compromised; indeed this rich diversity is the strength of the movement.
PHM exists in many countries, including India, Bangladesh, South Africa, UK and many European countries. The branch in India, “Jan Swasthya Abhiyan” is one of the largest, with thousands of activists working at the grassroots. The priorities and campaigning tools differ in each country, depending on the country-specific issues.
The PHM has held 4 PHAs so far, the last (4th Global People’s Health Assembly) in Bangladesh in November 2018 which saw 1500 participants from across the world. The PHM has also published 5 Editions of Global Health Watch (GHW), GHW5 was published in 2018, as a radical analysis in health care, covering key challenges facing governments and health practitioners world-wide.
In PHM-Mauritius, we want to start by having interactive discussions with local communities across the island, hearing their experiences of health care in our country. We have free access to health care but, from the press and social media, it is apparent that too may people are dying young from diseases which can be managed better e.g. diabetes; the availability and quality of treatment for cancer is sub-standard; and the public often do not get the respect they deserve from doctors and other clinicians in hospitals.
We wish to energise and mobilise people at the grassroots to challenge the dominant ideology which creates the impression that private health care is better and to demand excellence in public hospitals and community health clinics.
After a few meetings at a local level, by the end of 2019, we aim to publish a draft alternative strategy to improve health care in our country.
The launch meeting in Sebastopol on Saturday 9 February is a small first step, only the beginning of a movement which aims to transform health care for our people, particularly those who are the poorest and in need of the best care.
Dr Harry Phoolchund
MBChB (Glasgow), MRCGP(UK),
MFOM(London), MSc (Dermatology, Wales)