Send to

Choose Destination
Lancet. 2018 Oct 20;392(10156):1461-1472. doi: 10.1016/S0140-6736(18)31829-4.

Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals?

Author information

Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK. Electronic address:
Department of Community Health Sciences and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.


The Sustainable Development Goals (SDGs) are now steering the global health and development agendas. Notably, the SDGs contain no mention of primary health care, reflecting the disappointing implementation of the Alma-Ata declaration of 1978 over the past four decades. The draft Astana declaration (Alma-Ata 2·0), released in June, 2018, restates the key principles of primary health care and renews these as driving forces for achieving the SDGs, emphasising universal health coverage. We use accumulating evidence to show that countries that reoriente their health systems towards primary care are better placed to achieve the SDGs than those with hospital-focused systems or low investment in health. We then argue that an even bolder approach, which fully embraces the Alma-Ata vision of primary health care, could deliver substantially greater SDG progress, by addressing the wider determinants of health, promoting equity and social justice throughout society, empowering communities, and being a catalyst for advancing and amplifying universal health coverage and synergies among SDGs.

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science Icon for Spiral, Imperial College Digital Repository
Loading ...
Support Center