Primary health care: a review of its implementation in sub-Saharan Africa

Abstract

Health for all was identified by the World Health Assembly in 1977 as the desirable main social target for governments, international agencies and the global community. Primary health care was defined at Alma Ata in 1978 and was then seen as the vehicle to achieving health for all. Governments in sub-Saharan Africa embarked on processes to align their health policies and indeed implement them within the PHC framework. PHC in Africa was seen as an overall strategy for achieving health for all, rather than just as the first level of care. Thus countries restructured their entire health systems in the framework of PHC rather than focus on the first level of care only. The mid to late 1980s saw worsening economic performance which was followed by the enforcement of structural adjustment programmes, sociopolitical instability, man-made and natural disasters and the beginning of the HIV/AIDS pandemic. All these wrecked havoc on plans countries had for implementation of PHC. Within this context, the elaborate policies and plans were not fully implemented. Furthermore, there appears to have been a general underestimation of the resources required. Though there was some initial progress in improving health status as shown by some health parameters, health for all was not achieved by any of the countries.