As nations seek to strengthen their health systems, they are
increasingly looking to primary health care (PHC) to provide
a clear and comprehensive sense of direction. The World Health
Report 2008 analyses how primary health care reforms, that embody
the principles of universal access, equity and social justice, are an
essential response to the health challenges of a rapidly changing world
and the growing expectations of countries and their citizens for health
and health care.
The Report identifies four interlocking sets of PHC reforms that aim
to: achieve universal access and social protection, so as to improve
health equity; re-organize service delivery around people's needs and
expectations; secure healthier communities through better public policies;
and remodel leadership for health around more effective government and
the active participation of key stakeholders.
This Report comes 30 years after the Alma-Ata Conference of 1978 on
primary health care, which agreed to tackle the "politically, socially and
economically unacceptable" health inequalities in all countries. Much has
been accomplished in this regard: if children were still dying at 1978 rates,
there would have been 16.2 million child deaths globally in 2006 instead
of the actual 9.5 million. Yet, progress in health has been deeply and
unacceptably unequal, with many disadvantaged populations increasingly
lagging behind or even losing ground.
Meanwhile, the nature of health problems is changing dramatically.
Urbanization, globalization and other factors speed the worldwide
transmission of communicable diseases, and increase the burden of
chronic disorders. Climate change and food insecurity will have major
implications for health in the years ahead thereby creating enormous
challenges for an effective and equitable response.
In the face of all this, business as usual for health systems is not a
viable option. Many systems seem to be drifting from one short-term
priority to another, increasingly fragmented and without a strong sense
of preparedness for what lies ahead.
Fortunately, the current international environment is favourable to a
renewal of PHC. Global health is receiving unprecedented attention. There
is growing interest in united action, with greater calls for comprehensive,
universal care and health in all policies. Expectations have never been
By capitalizing on this momentum, investment in primary health
care reforms can transform health systems and improve the health of
individuals, families and communities everywhere. For everyone interested
in how progress in health can be made in the 21st century, the World
Health Report 2008 is indispensable reading.