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Table of Contents   
GUEST EDITORIAL  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 1-2
Revitalizing Alma-Ata: Strengthening primary oral health care for achieving universal health coverage


Public Health Foundation of India, Gurugram, Haryana, India

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Date of Web Publication20-Mar-2019
 

How to cite this article:
Mathur MR. Revitalizing Alma-Ata: Strengthening primary oral health care for achieving universal health coverage. Indian J Dent Res 2019;30:1-2

How to cite this URL:
Mathur MR. Revitalizing Alma-Ata: Strengthening primary oral health care for achieving universal health coverage. Indian J Dent Res [serial online] 2019 [cited 2019 Oct 22];30:1-2. Available from: http://www.ijdr.in/text.asp?2019/30/1/1/254534



In 1978, the Declaration of Alma-Ata articulated primary health care (PHC) as the central means to achieve development in health systems. It defined PHC as “essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms an integral part both of the country's health system of which it is the nucleus and of the overall social and economic development of the community.”[1] Values of equity, people-centeredness, community participation, and self-determination defined the ethos of PHC. Forty years after the Declaration at Alma-Ata, people are healthier, wealthier, and are living longer. However, this progress has not been equal, especially in terms of burden of oral diseases.

Oral conditions still remain highly prevalent in 2017 globally. Nearly one-third of the world population suffers from untreated caries of permanent teeth (31.2%). There has also been a negligible or insignificant change in the global prevalence of severe periodontitis and prevalence of edentulism in the past three decades.[2] The conventional oral health-care system is characterized by a disproportionate focus on specialist care, fragmentation of services, and commercialization.[3]

These drawbacks of a conventional oral health system are clearly evident in the profile of oral diseases in India today. Oral disorders are the most prevalent disease condition in India and have remained so for the past 30 years [Figure 1].[2] In terms of disability-adjusted life years, oral disorders were ranked 20th in India in 1990 and have now climbed up the table to 16th in 2017.
Figure 1: India – ranking of disease conditions (prevalence per 100,000 cases) (source: Global Burden of Disease Study)

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The past few years have seen a renewed and reinvigorated interest in strengthening PHC to deliver quality, accessible, and affordable health services for all. World Health Organization, in 2018, announced the Declaration of Astana[4] stating that “Primary Health Care is a cornerstone of sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals.” The declaration further states that it will focus on meeting people's health needs across their life span “through comprehensive preventive, promotive, curative, rehabilitative services and palliative care.” It also highlights disease prevention through health promotion.

PHC in India faces many challenges today. It is scattered and predominantly related to providing reproductive and child health services and control of infectious diseases. Noncommunicable diseases are the biggest contributor to disease burden in India and are still not effectively managed at the PHC level. This grim situation is compounded by the fact that public sector only caters to 20% of the population's health-care needs.[5] The National Sample Survey Office (71st Round)[6] states, 28% in rural areas and 21% in urban areas seek care in the public sector, of which only 11% and 3%, respectively, sought any form of care at a level below the community health center.

Recently, the Government of India announced the Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana, which aims at strengthening PHC and providing financial protection to the most vulnerable section of the society. About 1.5 lakh existing subcenters and primary health centers have been proposed to be transformed into health and wellness centers to ensure universal health access under the scheme.[7] This comprehensive PHC initiative also includes basic oral health care in its essential package of services.

In order to mainstream oral health in this vision of Ayushman Bharat, we will have to overcome the multifarious challenges that dentistry faces today, namely, serious shortages in diversity of trained personnel, irregular outreach to the poorest and underserved populations, high treatment costs, barriers such as transport and lack of appropriate technologies, isolation of oral health services from the broader health system, and limited adoption of prevention and oral health promotion strategies.

Achievement of universal coverage for oral health in India requires the following: systems of oral health-care delivery that can absorb and integrate many now-fragmented services and provide accessible treatment and prevention universally to those in need, health financing schemes that cover the costs of oral health care without putting health consumers, governments, or providers at risk of bankruptcy or severe economic hardship, and a health-care workforce that displays a deeper range of skill mix and skills and that features greater attention to health management and community-based caregivers. Resource constraints can be overcome through frugal innovations in service delivery and preventive programs. In order to be this innovation crucible, we must work toward promoting and conducting more interdisciplinary and implementation research.

Many global reports over the years have emphasized that health-care systems contribute most to improving health and health equity where the institutions and services are organized around the principle of universal coverage and where the system as a whole is organized around PHC. The time is right to revitalize the Declaration of Alma-Ata to develop an operational model of primary oral health care. Effective primary oral health care, if implemented, would advance health equity and strengthen integration of now-fragmented health services helping to achieve the goal of achieving universal oral health coverage.

 
   References Top

1.
Passmore R. The declaration of Alma-Ata and the Future of Primary Care. Lancet 1979;314(8150):1005-8.  Back to cited text no. 1
    
2.
Global Health Data. GBD Results Tool. GHDx. Institute for Health Metrics and Evaluation. 2016.  Back to cited text no. 2
    
3.
World Health Organization. Primary Health Care: Now More Than Ever the World Health Report 2008. World Health Report 2008;26:148.  Back to cited text no. 3
    
4.
Word Health Organization. Declaration on Primary Health Care- Astana 2018;2018-20.  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare, December 2014. Draft National Health Policy 2015;2015.  Back to cited text no. 5
    
6.
Government of India. National Sample Survey Office NSSO 71st Round; 2015.  Back to cited text no. 6
    
7.
Primary Health Care in Wellness Centers. Comprehensive Primary Health Care through Health and Wellness Centers Operational Guidelines; 2018.  Back to cited text no. 7
    

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Correspondence Address:
Manu Raj Mathur
Public Health Foundation of India, Gurugram, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_934_18

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