Primary health care. Alma Ata revisited and the Chilean experience

Abstract

The fundamental concept of Primary Care (PHC) included in the Alma Ata Declaration already indicated its central place in the Health Care System and is still fully valid. We acknowledge today that its specific characteristics can be different in different countries; but that it is an essential human right everywhere. This very variability requires that, both at the national and international levels, the PHC experiences and innovations be evaluated and exchanged. We describe succinctly the advances of PHC in Chile, and also its shortcomings. In particular, there is a shortage of physicians at this level and, accordingly, the PHC doctors are not performing properly the role they should have in the comprehensive health care model that is officially accepted.. Also, there is a gap between PHC and the hospitals. This brings about serious consequences regarding the effectiveness, efficiency, equity and integrality of the public health care system. The lessons learnt lead to an awareness of the need to improve PHC in Chile in a way that fits fully with the aforementioned model. The concept of PHC “renewal”, which is being proposed by PAHO/WHO, requires, in this country, the strengthening of the medical staffing of the PHC clinics, through feasible and effective policy measures, which are here described and which are being initiated in practice by the Ministry of Health, in collaboration with some of the main medical Faculties and some Municipalities, with the approval of the young physicians involved.