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    From Alma-Ata to the year 2000: reflections at the midpoint.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1988. vi, 158 p.

    This report in 1988 summarizes the progress made toward attainment of the goals set forth at the International Conference on Primary Health Care in Alma-Ata, USSR, in 1978. Policies changed immediately within the World Health Organization (WHO) and priorities slowly shifted within member nations. This report summarizes relevant papers, ideas, comments, and questions pertaining to the 1988 conference in Riga that followed-up the problems and prospects of Alma Ata. This volume is organized into four units: background to Alma Ata and the address of the Director General of WHO in 1978, background to Riga and its progress and failures, the Forty-First World Health Assembly addresses and a technical discussion on leadership development, and future agendas and recommendations. The resolutions passed in 1988 by the World Health Assembly on Health for All are included in the annexes. Over the ten year period since Alma Ata, there was evidence of the guidance provided to the health and development community worldwide by the ethical principles, political imperatives, and technical directions established at Alma Ata. The concept of Health for All was incorporated in part or fully by a variety of individuals ranging from policy makers to school children. The concept was influential in developed and developing countries and was accepted by poorer countries in formulating their national and regional strategies. The survival of Health For All (HFA) is attributed to the ethical, political, social, and technical elements of the effort. The purpose of HFA is to provide a conceptual structure for thinking about multiple and related problems and guiding decisions about priorities and actions. One outcome has been the development of monitoring and reporting procedures for gauging progress. Targets, but not principles, are expected to shift over time. The 1988 assessment of statistical indicators is that progress has been too slow and may be stagnating. Progress was made in health system development and use of new technologies, but problems persisted that were resistant to the solutions during 1978-88: high maternal and under five mortality rates and population growth and ecosystem instability. These problems affect the poor and most vulnerable people, are difficult to solve, and require new responses from WHO.
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