In 1978, leaders from around the world gathered in Alma-Ata, Kazakhstan, for what would prove to be a seminal moment in global health. The Declaration of Alma-Ata was the first to call for urgent and effective national and international action to develop and implement primary health care throughout the world.”

The Sustainable Development Goals urge countries to achieve Universal Health Coverage (UHC), including financial risk protection and access to quality essential health care services. However, the reality in many settings is that providing quality care remains a significant challenge, and inadequate quality results in avoidable mortality, human suffering and significant economic losses.

How can governments, health organizations, health care professionals and communities transform the bold vision of the Declaration of Astana into action?

The Operational framework for primary health care: transforming vision into action provides stakeholders with a series of levers to help countries and communities adopt a PHC approach and work to strengthen health systems as a way to achieve universal health coverage

Core strategic levers

A person is said to have hearing loss if they are not able to hear as well as someone with normal hearing, meaning hearing thresholds of 20 dB or better in both ears. It can be mild, moderate, moderately severe, severe or profound, and can affect one or both ears. Major causes of hearing loss include congenital or early onset childhood hearing loss, chronic middle ear infections, noise-induced hearing loss, age-related hearing loss, and ototoxic drugs that damage the inner ear.

WHO’s work is aligned with SDG target 3.8, which focuses on achieving universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Approximately half the world’s population lacks access to such essential health services. Therefore, to achieve SDG target 3.8 of Universal Health Coverage for all by 2030, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030.

Immunization is a global health and development success story, saving millions of lives every year. Vaccines reduce risks of getting a disease by working with your body’s natural defences to build protection. When you get a vaccine, your immune system responds.

We now have vaccines to prevent more than 20 life-threatening diseases, helping people of all ages live longer, healthier lives. Immunization currently prevents 2-3 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles.

HIV is fully preventable. Effective antiretroviral treatment (ART) prevents HIV transmission from mother to child during pregnancy, delivery and breastfeeding. Someone who is on antiretroviral therapy and virally suppressed will not pass HIV to their sexual partners.

Hospitals should reflect the needs and values of the communities in and around them, while also being resilient and able to maintain and scale up services in emergency situations. Effective hospitals are designed for their users, with attention to the needs of special populations, such as children and the elderly. A well-designed hospital environment maximizes the effectiveness of clinical care delivery and enhances the well-being of patients and hospital staff. 

Hospitals complement and amplify the effectiveness of many other parts of the health system, providing continuous availability of services for acute and complex conditions. They concentrate scarce resources within well-planned referral networks to respond efficiently to population health needs. They are an essential element of Universal Health Coverage (UHC) and will be critical to meeting the Sustainable Development Goals (SDG).

Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart has to pump. 

Reducing modifiable risk factors is the best way to prevent hypertension and associated diseases of the heart, brain, kidney and other organs. These factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.  

Malnutrition affects over 2 billion people worldwide, and the burden is felt disproportionately by people in low- and middle-income countries. Infants and children are particularly vulnerable, with most deaths due to malnutrition occurring in children under 5 years of age. 

Infection prevention and control (IPC) is a practical, evidence-based approach preventing patients and health workers from being harmed by avoidable infections. Effective IPC requires constant action at all levels of the health system, including policymakers, facility managers, health workers and those who access health services. IPC is unique in the field of patient safety and quality of care, as it is universally relevant to every health worker and patient, at every health care interaction. Defective IPC causes harm and can kill.

Much of the work done on infection prevention and control (IPC) is hidden, as by its nature it prevents issues rather than treating them after the fact. However, health care-associated infections (HAIs) are an ongoing problem that no health authority can afford to ignore. To help in this fight, WHO has created a number of programmes and campaigns that set standards for evidence-based recommendations and operating procedures and promote behaviours to limit avoidable infections.

Infertility is a global health issue affecting millions of people of reproductive age worldwide. Available data suggests that between 48 million couples and 186 million individuals have infertility globally. Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previously successful conception.