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Health: Alma-Ata Declaration

Volume 788: debated on Monday 22 January 2018


Tabled by

To ask Her Majesty’s Government whether they have plans to celebrate the 40th anniversary of the Alma-Ata Declaration on primary health care.

My Lords, on behalf of the noble Lord, Lord Crisp, and at his request I beg leave to ask the Question standing in his name on the Order Paper.

My Lords, achieving universal health coverage, including access to primary healthcare, is a priority for the Government. Our work to deliver the global goal of universal health coverage continues and we welcome the increased international attention on primary healthcare that the Alma-Ata Declaration’s 40th anniversary will bring.

My Lords, I thank the Minister for his Answer but to what extent do the Government believe that, in our own four countries, sections IV and VI of the declaration are being achieved—namely, that communities have the right to be involved in planning their services and that primary care should be a central function of the overall social and economic development of the community?

The assessment of the level to which that is the case is a reflection of the priority which we give to primary care, as 90% of healthcare interventions are through primary care. It is absolutely right that we should have community-based solutions. I recently attended an event for the one-billionth treatment of neglected tropical diseases by Sight Savers. It was interesting to learn there that it had community dispensing people who went round in each community with a small measuring stick, which measured the dosage based on the height of the recipient. Two things were found: first, that it was very quick and efficient but, secondly, that there was greater acceptance and take-up because the people were from within the community and there was therefore greater trust. That is a model of how things ought to continue.

My Lords, following on from the question about the role of general practice, and mindful of the fact that we recently combined the Department of Health with social care, is it perhaps not time to redefine the role of general practice to ensure continuity of care between the two sectors and avoid some of the problems we saw in our A&E departments over the Christmas and new year period?

That coming together of health services is obviously important. We share that knowledge and expertise through international health partnerships with some of the poorest countries in the world so that they can learn from it as well. But my noble friend is absolutely right to say that those first points of contact are essential in a good, functioning primary healthcare system, which was the Alma-Ata aspiration.

My Lords, building sustainable health systems is clearly critical to address health inequalities. Ebola in Sierra Leone has taught us many lessons. Just how are the Government responding to building sustainable health systems to ensure that the global community can withstand the next round of diseases that will hit it?

That resilience work is important. We work closely with the World Health Organization and, importantly, with health organisations in the countries concerned. We are certainly putting more money into this than ever before and have made some big commitments: to the Gavi vaccine programme, with £1.4 billion; to the Global Fund, with £1.1 billion; and to the Ross Fund, which will do some pioneering work in researching this area of diseases, with about £1 billion as well. Significant amounts are going in but we need to do more.

Since the Alma-Ata Declaration is based on the foundations of the National Health Service, albeit some years later than the foundation of the NHS, does the Minister think that our Government could promote the declaration within the concept of the National Health Service principles a great deal more than we do? It is, after all, the key rulebook of the World Health Organization and something that we helped to create.

It is the key rulebook of the World Health Organization, but we should also remember that in the intervening 40 years we have had the sustainable development goals. Sustainable development goal 3 on health contains many of the provisions in the declaration. The sustainable development goals, unlike the millennium development goals, apply to all countries that sign them, not just least-developed countries.

Primary healthcare is critical in reducing child and maternal mortality through family planning initiatives, yet DfID has failed to provide funding this year to both the International Planned Parenthood Federation and Marie Stopes International. Should DfID not have safeguarded these essential programmes for women when remodelling the programme partnership arrangements, particularly in the light of the Trump Administration’s global gag rule?

The noble Baroness particularly mentioned the programme partnership arrangements but we have changed that and distribute the money through a different mechanism to many similar organisations. I must put on record the fact that the UK Government and the people of the United Kingdom can be proud as they have done more in the area of family planning and providing access than any other Government. We initiated the first family planning summit in 2012, and we held the last one in 2017. We have made huge commitments in this area and are the second-largest donor, in overall terms, in this very important area of giving women control over their own lives and futures, which is important not only for the economy but for education.

The Alma-Ata conference and declaration changed the attitudes of Governments and health planners by demonstrating the cost-effectiveness and humanity of universal primary care as compared with possibly more prestigious but very expensive secondary care hospitals. Is that not relevant to the situation we have in this country today, with hospitals full of patients with chronic diseases which could have been prevented and could certainly be cared for in the community if we had properly funded primary and social care?

We need to remember that, in Alma-Ata in particular, we are referring to some of the poorest countries in the world. We have the best health service in the world. That is not just my word; that was recognised by the Commonwealth Fund, which produced that statistic saying that we have the best healthcare. It is a tremendous service. In many of the countries that we are dealing with, people have to travel for days or weeks to get any sort of health intervention. We need a priority to ensure that those people are brought into the ambit of the sustainable development goals so that they get the healthcare they need and we save lives as well as being mindful of the important responsibility we have in this country.

Given the excellent public health record that now 91% of the global population has improved water—up from only 76% in 1990—does DfID still recognise that 2.3 billion people do not have access to a decent toilet and that it is important for our own health that the 9 million new cases of tuberculosis worldwide are diagnosed early and managed appropriately? Will DfID undertake to work with those of us in end-of-life care and pain relief to make sure that the 150 countries where there is virtually no access to any pain relief are encouraged to come into line with modern science in pain relief?

I am very happy to do that. Of course, with these waterborne diseases, clean water and sanitation are important. They come under sustainable development goal 6, which we are committed to as well. We are dealing now with the Rohingya situation in Cox’s Bazar—the diphtheria outbreak there is waterborne. There is a massive outbreak of cholera in Yemen. These are important issues, which is why we are drawing on the resources of British taxpayers and ensuring that they are distributed to the people in need.