Tipping the balance towards Primary Health care Network (TTB) (Future Strategic Directions for Primary Health Care The story so far;. Or holding on to Alma Ata essentials)Tipping the balance towards Primary Health care Network (TTB) (Future Strategic Di

Keith Barnard


A presentation to the 
TTB Conference, Espoo September 2006

The purpose of this presentation is to give TTB members the opportunity to view our experience in the context of key global developments and possible directions; and to consider how to prepare for an uncertain future.

In January2000 the WHO Director General Brundtland proposed that WHO should conduct a global review of the challenges to PHC. Some of us in TTB were involved in the European  regional review that formed part of the exercise. Later the World Health Assembly passed the resolution WHA. 56.6  that inter alia requested the Director General to convene a meeting to “examine the lessons of the past 25 years” and “identify future strategic directions for PHC”

The meeting was held Madrid October 2003.  A Report  with the working title Future Strategic
Directions for PHC
 was subsequently drafted. It set out to integrate  the outcomes of the Global 
Review with those of the high level expert meeting in Madrid. That report remains unpublished. However enough has become known of the essence of its findings.

DG’s message to the Madrid meeting

Brundtland had retired by the time of the Madrid  meeting. Her successor Lee, who had spoken in very positive terms about PHC in the period immediately after his election, did not attend the Madrid meeting, but  did send it a strong message . The following paragraphs touch on some of the points he made.

He started by recalling that twenty-five years ago the Declaration of Alma-Ata challenged the world to embrace the principles of primary health care to overcome the stark health inequalities between and within countries. The goal of health for all could be achieved by strengthening PHC systems. 

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