By Dylan Goh
The Astana declaration, from Alma-Ata towards universal health coverage and the sustainable development goals, was adopted on the 25th of October, following from the original declaration of Alma Ata 40 years ago (1978). This declaration reaffirmed the international community’s goal of providing Universal Healthcare Coverage (UHC) for all, with primary healthcare (PHC) serving a fundamental role in achieving UHC. Health and well-being of the population should be achieved through a combination of primary care and essential public health as core health services, addressing broader determinants of health through better policy across all sectors and the empowerment of communities. (1)
Drawing up on the experiences from the Alma Ata declaration, the new declaration describes PHC composed of three different components. First by meeting people’s health needs through a healthcare system with primary care and public health at its core to deliver comprehensive healthcare that is promotive, protective, preventative, curative, rehabilitative and palliative provided over the lifetime of individuals and family within populations. Secondly, the declaration calls for multisectoral collaboration and evidence-based policy to systemically address the broader determinants of health (social, economic, environmental, including individual characteristics and behaviour). Lastly, the final component includes the empowerment of individuals, families and communities to optimize their health, being advocates for factors that contribute to better health and well-being, to co-develop health and social services and finally as self-carers and caregivers. (2) Ted Chaiban summed this up perfectly during the Astana declaration calling for a healthcare system that is “people-centered, population-focused, integrated, coordinated, continuous, accountable, participative, evidence based, and technology enabled.”
WHO describes its reasons behind the push for PHC at the core of health systems. PHC allows for health systems to adapt and respond to the health challenges of the world. Placing the population at its center allows greater efficiency and better division of resources and creates a robust health system that is able to face future threats to the health of the system. It is also essential to keep in mind that even though primary care is central to PHC, that PHC should also include other stakeholders that may contribute to or take away from health. Studies have also shown the impact that non-health interventions have on the general population, signifying the importance of a focus outside of healthcare as well. (2)
Throughout the conference, many leaders of their countries describe the steps that they have taken towards UHC, including the various examples on the empowerment of the populations such as in Argentina, and Indonesia where policies have allowed for the responsibilities of the care of populations to be decentralized and placed on the populations themselves. Similarly, in Brazil and Namibia, community health teams have been assigned the role of taking care of the health of a defined community.
Although PHC is essential in achieving UHC, there are limitations in what it can do; the role of surgery is irreplaceable and essential to achieve well-rounded and complete healthcare. It is important make the case for surgery within UHC. Essential surgeries, defined as surgical intervention for neoplasms, injury, neonatal and obstetric care and gastric surgery, also contribute to the provision of UHC. The Lancet Commission on Global Surgery 2030 has illustrated the lack of surgical access- 5 billion people in the world lack access to safe surgical care, with 143 million additional surgical procedures required to save lives and prevent disability. Financially, more than 33 million individuals face catastrophic financial spending due to surgical costs. Surgery is an irreplaceable component of healthcare and similar to healthcare, investment in healthcare can yield potential financial gains from reduced financial losses. (3)
InciSioN supports the Astana declaration and the need for quality and affordable healthcare for all. However, we also call for the integration of essential surgical services within PHC through both the better access to surgical care and task sharing and task shifting of aspects of surgery. (4,5) Going back to the definition of UHC, surgery often acts in preventative, curative and sometimes palliative health services. Surgery an indivisible part of healthcare, and to achieve the vision of UHC by 2030, the inclusion of surgery is required.
- WHO, UNICEF (2018). Declaration of Astana- from Alma-Ata towards universal health coverage and the sustainable development goals. Kazakhstan.
- A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2018 (WHO/HIS/SDS/2018.X). Licence: CC BY-NC-SA 3.0 IGO
- Meara, J., Leather, A., Hagander, L., Alkire, B., Alonso, N., Ameh, E., Bickler, S., Conteh, L., Dare, A., Davies, J., Mérisier, E., El-Halabi, S., Farmer, P., Gawande, A., Gillies, R., Greenberg, S., Grimes, C., Gruen, R., Ismail, E., Kamara, T., Lavy, C., Lundeg, G., Mkandawire, N., Raykar, N., Riesel, J., Rodas, E., Rose, J., Roy, N., Shrime, M., Sullivan, R., Verguet, S., Watters, D., Weiser, T., Wilson, I., Yamey, G. and Yip, W. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), pp.569-624.
- Pongsakul, A., Valle, Y., Chia, Y., Ndajiwo, A. and Chen, J. (2018). Surgery, rural health and primary healthcare. InciSioN- International Surgical Students Network.
- World Health Organisation. World Health Report 2008: Primary Health Care (Now more than ever). Available at: http://www.who.int/whr/2008/en/