HEALTH FOR ALL: Definition and Strategy for Health for All

As you know, there is a vast contrast in the health status of people in developed and developing countries despite of many scientific and technological advances in health care. You are also aware that most people in developed countries and elites of the developing countries including Nigeria enjoy good health, nutrition, sanitation, safe drinking water, education, income etc.

In Nigeria 80% of the population lives in rural area and urban slums in contrast to 10-20% who live in urban areas. It is only this small fraction of urban people who enjoy ready access to health services and facilities whereas the rest of the 80-85% are living in rural and urban slum areas do not have access to health services and/or facilities.

The disparities in health and socio-economic conditions between rich and poor, within countries and between countries, and the concern of members of WHO regarding status of health and deterioration of existing health status lead to new thinking in provision of health care in order to narrow this gap and finally eliminate it. It was also realized that the underprivileged population constituting 80% of the total population have an equal claim to their rights and privileges of health services such as: health care, protection from vaccine prevented communicable diseases (VPD) of childhood e.g. Diphtheria, Tetanus, T.B., Whooping cough, Polio etc., maternal and child health care, and treatment/control of non-communicable diseases.

So there was felt a need among health planners/administrators for evolving a health care approach that would answer the problems and needs of under- privileged. Ultimately the 30th World Health Assembly resolved in May 1977 that the main social target of Governments and WHO in the coming decades should be the attainment of health for all by year 2000 AD.

In 1972-73 WHO study on the development of health services concluded that there was a widespread dissatisfaction among people with their health care systems which were failing to cope with primary health care problems in countries at all stages of development.

In developed countries, health care system despite the cost and impressive infrastructure and highly specialized technologies, the emerging health problems of people are not being solved. The principal reason for this discrepancy is that new health problems require completely new approaches, which emphasize individual self-reliance and commitment to good health.

Similarly most of the developing countries including Nigeria face major problems with control of infectious disease, provision of safe water and basic sanitation services, the provision of care during pregnancy and delivery and elevating the standard of living to a ‘minimum acceptable level’. In the rural areas and rapidly expanding urban areas, millions of people still remain without access to essential health care and life saving measures.

All the above concepts led to a continuing discussion of how health care system should evolve and how WHO could best support countries struggling to improve their health systems. Expressing the ideas that were dominating the International discussion during 1960s and early 1970s, the World Health Assembly (WHA) decided in a ground breaking resolution in 1977 that “main social targets of governments and WHO in the coming decades should be the attainment of all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” with the adoption of this resolution the HFA movement was born and the slogan was created.

Definition and meaning for “Health for All” (HFA)

HFA has been defined as “the attainment of a level of health that will enable every individual to lead a socially and economically productive life”. From this definition you will realize that the goal of HFA implies realization of goal by all people of the highest possible level of health which includes, physical, mental and social wellbeing; secondly it also implies that as a minimum, all people in all countries should at least have such a level of health that they are capable of being economically productive, removal of unemployment and poverty) and participating actively in the social life’ of the community in which they live i.e., have education, housing, water supply and sanitation.

Health For All means that health care/services are to be made accessible/within the reach of every individual in a given community. It implies the removal of obstacles to health, that is, elimination of ignorance, malnutrition, disease, contaminated water supply, unhygienic housing etc.

“Health For All” is a holistic concept. It calls for efforts in education, agriculture, industry, housing or communication first, as much as in public health and medicine. It symbolizes the determination of countries of the world to provide an acceptable level of healthful living to all people.

It is an expression of the feeling for social justice from all those who suffer inequity in health care services. It is intended to draw attention to the importance of health, to a serious search for new ways of solving the problems of health and to help mobilize all available resources for health.

To have a correct perception of the meaning of “Health For All” you should be convinced that HFA does not mean that as of the year 2000, we shall all be free of diseases and disability.

Health For All means that health is to be brought within the reach of every one in a given country including the remotest part of a country and the poorest members of the society. By health, is meant not just the availability of health services but a personal well-being and a state of health that enables a person to lead a socially and economically productive life.

“Health for all”, means that health should be regarded as an objective of economic development and not merely as one of the means of attaining it. Health begins at home, in school and in the work places. .People will use better approaches for preventing diseases and alleviating unavoidable illness and disability. There will be an even distribution among the population of whatever health resources are available.

That essential health care will be accessible to all individuals and families in an acceptable and affordable way and with their full involvement.

The achievement of the Health For All goal, calls for dramatic changes, and a social revolution in health development. It aims at bringing about the change in the mentality of people, restructuring of health system, and reorientation and training of health workers/professionals. So, to bring about these changes the practical shape to the slogan of HFA could be given only through development as a strategy.

Strategy for health for all

Alma-Ata conference called on all governments to formulate national policies, strategies and plans of action and set down the principles of Primary Health Care, which is the basis of “Health For All” strategy.

In 1981, global strategy of HFA was evolved by WHO through consultations with countries, regions and at the global level. That strategy defines the broad lines of action to be undertaken at policy and operational levels, nationally and internationally, both in the health sector and in other social and economic sectors.

This was followed by individual countries developing their own strategies for achieving HFA and synthesis of national strategies for developing regional strategies. Let us discuss the global and national strategies in the following subsections.

Global strategy

The global strategy for Health For All is based on the following fundamental principles.

·        Health is a fundamental human right and a worldwide social goal.

·        The existing gross inequality in the health strategies is of common concern to all countries and must be drastically reduced.

·        People have the right and the duty to participate individually and collectively in the planning and implementation of their health care.

·        Governments have a responsibility for the health of their people

·        Countries must become self-reliant in health matters.

·         Health is an integral part of the overall development of the countries.

·        Energy generated by improved health should be channeled into sustaining development of a country.

·        Better use must be made of the world’s resources to promote health and development and this will help to promote world peace and prevent conflict among nations.

National strategy for health for all by 2000 AD

By the Alma-Ata declaration and Nigeria commitment to HFA by 2000 AD resulted in the formulation of National Health Policy.

 The Federal Government of Nigeria convened a national conference in February 1988 to discuss the national strategies and action plan to achieve Health For All.

 In July 1988 a working group on Health For All to evolve national strategies for implementation of health care programmes to move towards the goal for Health For All by 2000 AD and to suggest suitable indicators to monitor the progress achieved from time to time.

 The working group submitted its report in 1989 which was accepted by the Federal Government.

 Thus a National Health Policy was evolved by Government of Nigeria in 1989 which commits the government and people of Nigeria to achieve the goal of Health For All by 2000 AD.

The Health Policy in Nigeria has the following Key Elements:

i. Creation of a greater awareness of health problems in the community and means to solve these by the communities,

ii. Supply of safe drinking water and basic sanitation using technologies that the people can afford,

iii. Reduction of existing imbalance in health services by concentrating more on the rural health infrastructure,

iv. Establishment of a dynamic health management information system to support health planning and health programme implementation.

v. Provision of legislative support to health protection and promotion, concerted actions to combat widespread malnutrition,

vi. Research into alternative methods of health care delivery and low-cost health technologies, and

vii. Greater coordination of different systems of medicine.

The health strategies include restructuring the health infrastructure developing health manpower and research development. WHO has established some global indicators as the basic point of reference to assess the progress towards Health For All.

These indicators to achieve HFA are:

·           Reduction of Infant Mortality Rate from the present level of 87 to below 60 by 2000 AD.

·           To raise the life expectancy at birth from present level of 58 years to 64 by 2000 AD.

·           To reduce the crude death rate from the present level of 10.4 to 9 by 2000 AD.

·           To reduce the crude birth rate from present level of 27 to 21 by 2000 AD.

·           To achieve a net reproduction rate of 1 by 2000 AD.

·           To provide potable water to the entire rural population by 2000.

Nigeria took some steps to implement the strategies outlined in National Health Policy. Some of these are:

i. To establish one health centre for every 5,000 rural population (3,000 in tribal and hilly areas) with one male and female health worker.

ii. To establish one primary health center for every 30,000 rural population (20,000 in hilly and tribal areas).

iii. To establish Community Health Centres (CHC).

iv. To train Village Health Guides (NHG) selected by the community for every village or 1,000 rural population.

v. To train traditional birth attendants (TBA) in each village.

vi. Training of various categories of health personnel, e.g., multipurpose workers (MPW).

These schemes are expected to ensure the availability of adequate infrastructure and medical and paramedical manpower to take us nearer the goal of universal provision of primary health care as envisaged in the national health policy.