Information and communication technology development and health gap nexus in Africa.

Introduction: Development of information and communication technology has been identified as a tool for fast and effective information gathering and dissemination, and as a means through which almost every social and economic sector (including the health sector) could achieve economic, operational, and service delivery efficiencies that can enable the realization of targeted outcomes. ICT can serve as a tool for achieving international agreements (including the Alma Ata Declaration of 1978), thereby accelerating the achievement of various global development targets. Methods: Consequently, based on a sample of 38 countries from 2000 to 2018, this study investigates the effect of ICT development on the health gap, and whether the effect varies by gender and sub-region in Africa. The dependent variable (health gap) was measured as the difference between the achieved life expectancy at birth of 60 years and the Alma Ata Declaration of 1978 targeted life expectancy at birth of 60 years. The main independent variables are ICT indicators (ICT index, mobile cellular subscriptions, and internet access), while the gross domestic product (GDP), which is the measure of economic growth, healthcare expenditure, urbanization, and labor market outcome, is employed as control variables. The effect was examined using Driscoll-Kraay standard errors, feasible generalized least squares (FGLS), and panel-corrected standard error (PCSE). Results and discussion: The findings of the Driscoll-Kraay standard errors estimation technique supported by those of FGLS and PCSE suggest that ICT does act as an indispensable stimulator for Africa to significantly exceed the international health target of life expectancy at birth of 60 years. It can be concluded that African leaders need to take advantage and maximize the health-enhancing potential of the internet component of ICT through relevant policies that would improve internet coverage, connectivity, and access for individuals and health institutions.

Una mirada a la atención primaria desde Alma-Ata hasta Astaná / Um olhar sobre cuidados primários de Alma-Ata a Astaná / A look at primary care from Alma-Ata to Astaná

The history of Primary Care does not begin in 1978 with the Declaration of Alma-Ata, but mustbe contextualized in the history of Social Medicine, as the first is a strategy of the second. The advancesthat have been made in the area of Primary Care are undeniable, but they have not been enough toovercome inequities with regard to addressing vulnerable groups with low economic resources. Theobjective of the article is to analyze the evolution of Primary Health Care from the declaration of AlmaAta to that of Astana. To do this, a bibliographic review of articles published in the last five years wascarried out in journals indexed in Google Scholar, Lilacs and Scopus. Scientific recognition of thepractices of Traditional Chinese Medicine is evident, extending its use to various regions of the westernworld; the enactment of health promotion and disease prevention as a necessity of the first order.Strengthening the primary level of care constitutes the most inclusive, efficient and effective approach toimproving people's physical and mental health, as well as their social well-being.

La historia de la Atención Primaria no comienza en 1978 con la Declaración de Alma-Ata;aunque la primera es una estrategia derivada de la segunda, hay que contextualizarla en la historia dela Medicina Social. Son innegables los avances que se han dado en materia de Atención Primaria,sin embargo no han sido suficientes para superar las inequidades en lo que respecta al abordaje delos grupos vulnerables y de bajos recursos económicos. El objetivo del artículo es analizar el devenirde la Atención Primaria en Salud desde la declaración de Alma-Ata hasta la de Astaná. Para ello, serealizó una revisión bibliográfica, de artículos publicados en los últimos cinco años, en revistasindexadas en Google Scholar, Lilacs y Scopus. Resulta evidente el reconocimiento científico a lasprácticas de la Medicina Tradicional China, extendiéndose su uso por diversas regiones del mundooccidental; la promulgación de la promoción de la salud y la prevención de las enfermedades comouna necesidad de primer orden. El fortalecimiento del nivel primario de atención constituye elenfoque más inclusivo, eficaz y efectivo para la mejora de la salud física y mental de las personas,así como su bienestar social.

A história da Atenção Básica não se inicia em 1978 com a Declaração de Alma-Ata, mas deve sercontextualizada na história da Medicina Social, visto que a primeira é estratégia desta. Os avanços obtidosna Atenção Básica são inegáveis, mas não têm sido suficientes para superar as iniquidades na abordagemde grupos vulneráveis com poucos recursos econômicos. O objetivo do artigo é analisar a evolução daAtenção Primária à Saúde desde a declaração de Alma-Ata até a de Astana. Para tanto, foi realizada umarevisão bibliográfica de artigos publicados nos últimos cinco anos em periódicos indexados no GoogleScholar, Lilacs e Scopus. O reconhecimento científico das práticas da Medicina Tradicional Chinesa éevidente, estendendo seu uso a várias regiões do mundo ocidental; a efetivação da promoção da saúde eprevenção de doenças como uma necessidade de primeira ordem. O fortalecimento do nível primário deatenção constitui a abordagem mais inclusiva, eficiente e eficaz para melhorar a saúde física e mental daspessoas, bem como seu bem-estar social.

The Breathing Catastrophe: COVID-19 and Global Health Governance.

In the second year of the pandemic, the malaise of global health governance has come to the fore at the intersection of the trajectories of global crises that have converged in 2020: the soaring inequalities, the climate disaster and the effects of a globalization that takes our breath away. COVID-19 puts into question most of the global health assumptions and reaffirms the political intuitions of the 1978 Alma Ata Declaration on primary health care, which positioned health at the centre of a public sector-led project for economic transformation and human dignity, based on human rights. The new coronavirus imposes a new sense of purpose to health policymaking, which is not yet captured in the current failed global response to the pandemic. This is also an opportunity for the international community that believes in public health and the role of public institutions, to re-imagine itself and project new creative ways to engage beyond classical models, so as to reconquer some ground for a healthier future.

Primary care behind the former "Iron Curtain": changes and development of primary healthcare provision in the Eastern part of the European Union.

BACKGROUND: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. AIM: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. METHOD: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. RESULTS: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. CONCLUSION: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

[Declaration of Astana and preventive medicine in China].

At the time of the 40th anniversary of the Alma-Ata Declaration, the World Health Organization member states signed the Declaration of Astana. From Health For All to Universal Health Coverage, primary health care is consistantly identified as the key to achieving human health, and preventive services are critical and central component of primary health care. China has provided valuable experience for primary health care to countries around the world. However, with significant socioeconomic changes and rapid population aging, the contexts of primary health care and prevention services in China has undergone tremendous changes. Chronic diseases have become major burden of disease. System development and institution building, health service delivery system development, and the entire society of the country with large population are encountering new and serious challenges. On the basis of reviewing the development of preventive medical services in China for 40 years, Authors analyzes strengths and weaknesses of preventive services in China and looks forward to the challenges and opportunities in the coming decades, from perspective of primary, secondary and tertiary prevention strategies, and proposes suggestions for future development.

Declaration of Astana and preventive medicine in China / 中华预防医学杂志

At the time of the 40th anniversary of the Alma-Ata Declaration, the World Health Organization member states signed the Declaration of Astana. From Health For All to Universal Health Coverage, primary health care is consistantly identified as the key to achieving human health, and preventive services are critical and central component of primary health care. China has provided valuable experience for primary health care to countries around the world. However, with significant socioeconomic changes and rapid population aging, the contexts of primary health care and prevention services in China has undergone tremendous changes. Chronic diseases have become major burden of disease. System development and institution building, health service delivery system development, and the entire society of the country with large population are encountering new and serious challenges. On the basis of reviewing the development of preventive medical services in China for 40 years, Authors analyzes strengths and weaknesses of preventive services in China and looks forward to the challenges and opportunities in the coming decades, from perspective of primary, secondary and tertiary prevention strategies, and proposes suggestions for future development.

Alma Ata after 40 years: Primary Health Care and Health for All-from consensus to complexity.

Forty years ago, the 134 national government members of the WHO signed the Alma Ata Declaration. The Declaration made Primary Health Care (PHC) the official health policy of all members countries. Emerging from the conference was the consensus that health was a human right based on the principles of equity and community participation. Alma Ata broadened the perception of health beyond doctors and hospitals to social determinants and social justice. In the following years implementing this policy confronted many challenges. These included: (1) whether PHC should focus on vertical disease programmes where interventions had the most possibility of success or on comprehensive programmes that addressed social, economic and political factors that influenced health improvements; (2) whether primary care and PHC are interchangeable approaches to health improvements; (3) how equity and community participation for health improvements would be institutionalised; and (4) how financing for PHC would be possible. Experiences in implementation over the last 40 years provide evidence of how these challenges have been met and what succeeded and what had failed. Lessons from these experiences include the need to understand PHC as a process rather than a blueprint, to understand the process must consider context, culture, politics, economics and social concerns, and therefore, to recognise the process is complex. PHC needs to be examined within evaluation frameworks that address complexity. Recent developments in monitoring and evaluation have begun to respond to this need. They include realist evaluation and implementation research.