From Alma-Ata to Astana – and the 4,000-day countdown to the Sustainable Development Goal deadline

This blog post is written by Taskan Rahman, our Regional Campaign Manager in Asia 

Just 4,000 days – give or take – until the Sustainable Development Goal deadline. It’s clear what’s required: urgent action at a breathtaking pace – in health, protection and learning.

A critical mass of high-level policy makers, development experts, civil society organisations, campaigners, advocates, innovators and health workers met in Astana, Kazakhstan last week. It culminated on 26 October in the Astana declaration, which reminds us that health is a basic human right and that it should be available, accessible and affordable for all – at least, primary healthcare.

The Astana declaration reaffirms and develops on the landmark Alma-Ata declaration from 40 years ago. Alma-Ata was ahead of its time, urging us to look at health differently in three particular respects:

  • Good health is a right of every person, and so the state should consider it a responsibility to ensure access to it.
  • Health is the result of not just the availability of treatment, but the social and economic factors that make people vulnerable to illness, and these need to be addressed to prevent illness from occurring.
  • Since most countries with the lowest levels of health are poor, and primary health services are the most cost-effective way to improve, these services would be the priority focus of the health system.

Since Alma-Ata, few countries have been able to implement the philosophy. But those who have, like Vietnam, Thailand and the United Kingdom, have seen the benefits. These countries boast better health outcomes and lower out-of-pocket expenditure.

By contrast, a lot of countries and donors invested in disease-specific interventions, trying to curb high rates of mortality from killers like diarrhoea and malaria. However, illnesses and diseases are inherently dynamic, and specific interventions often can’t be adapted to the changing context. As a result, interventions may fail to address the differential needs of citizens.

“A primary healthcare approach is the most efficient, fair, and cost-effective way to organise a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from filling the emergency wards of hospitals. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction.” Margaret Chan, Head of the World Health Organization

At Astana last week, governments and key stakeholders signed an agreement that the health systems of the future would provide high-quality, affordable and accessible healthcare to all. Primary health care should be seen as a pillar of universal health coverage, with universal primary health care the route to catalytic progress in most middle- and low-income economies.

The Astana 2018 Declaration puts communities at the centre, with good systems, infrastructure, governance, measurements and quality in order to address health needs and investment. In particular, its approach will support countries to deliver Sustainable Development Goal 3: ‘ensure healthy lives and promote well-being for all at all ages’.

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  • Nazmul Haque

    Thanks for sharing, well written. Now it’s clear to me about Astana declaration and it’s relation with SDG3.