As we commemorate the 40th anniversary of the Alma Ata Declaration, it is necessary to enrich the fundamental tenets of the Declaration in the light of new challenges in health and healthcare that confront us. In 1978 the major preoccupation for health systems related to control and elimination of threats posed by communicable diseases. 40 years on, while communicable diseases continue to pose challenges in many parts of the world, non-communicable diseases (NCDs) are responsible for a major proportion of burden of disease in most countries, including many low and middle income countries.
There is a tendency to reason that control of NCDs require ‘high-tech’ solutions, best provided at secondary and tertiary levels of care. However, experience shows that, as in the case of communicable diseases, the burden of NCDs can be minimized by effective primary health care. To address NCDs at the primary level of care it is necessary to incorporate specific strategies, trained human resources (including community health workers), and equipment and infrastructure, keeping in mind the necessity to promote early detection of NCDs and disease prevention and health promotion interventions.
Moreover the broader determinants of NCDs need attention within the framework of the overall concept of PHC. A new economic order, as envisaged in the Alma Ata declaration, needs to address the role played by the global trade regime and that of TNCs in the food and beverages sector. The broader concept of PHC also requires consideration of the role of governments in regulating to create environments that substantially reduce the risk of developing NCD’s.