THE CONTEXT

The global commitment by governments on the achievement of MDGs, especially in the context of working towards universal coverage of maternal, newborn and child health interventions1 and on sustainable health financing, universal coverage and social health insurance, universal access to HIV prevention treatment and care by 2010, requires a well-functioning Primary Health Care (PHC) to deliver effective services to target populations.

Investment in primary healthcare infrastructure, adequate financing and social protection for the poor would ensure better access to services and achievement of health-related MDGs. Strong health systems promote international health security, and that governments, WHO, international organizations, private industry and civil society are all stakeholders in and have responsibilities on strengthening health systems (WHO

2007, Issues Paper: invest in health, build a safe future).

A well-organized and sustainable health system is essential to achieve Health, Nutrition and Population (HNP) results on the ground, and form a guiding principle for the World Bank loan and technical supports in the next decade (World Bank 2007, Healthy Development: the World Bank Strategy for Health, Nutrition, and Population Results). In addition, health system strengthening means improving capacity in critical components of health systems in order to get more equitable and sustained improvement across health services and outcomes. The six components are: policy; financing; human resources; supply systems; service management; and information and monitoring systems (WHO 2006, Opportunities for Global Health Initiatives in the health systems, action agenda, WHO/EIP/healthsystems/2006.1). In particular human resources requires adequate production, ensure proper skill-mix that address health needs of the population, equitable distribution and better retention, especially at primary care level.

In developing countries, the private sector including clinics, pharmacies and traditional providers play a significant role, despite lack of adequate regulatory framework. Free movement of population across borders and trade in health services often channel well-trained human resources away from primary care in favor of the urban affluence population. International migration of human resource from poor to rich countries warrants global concerted efforts and ethical recruitment, not to undermine the health systems of sending countries.

The functioning of PHC closely relates to financing, human resources, relationship of PHC in a broader health system context, the role of the private sector, and the impact of trade in health services.

It is noted that 2008 marks the 60th year of WHO (1948) and the 30th year of the Alma Ata Declaration (1978) on PHC as main strategies to achieve HFA2000 and a mid-point to the 2015 commitment towards the MDGs. There is a need to revisit PHC after three decades of implementation to learn the lessons and plan for the future. The conclusion of PMAC 2007 highlights the utmost importance of a functioning primary health care in effective delivery of essential health products. Therefore, Three Decades of Primary Health Care: Reviewing the Past and Defining the Future was chosen as the theme for the Prince Mahidol Award Conference in 2008.

Referred to the Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, paragraph VI,

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.