Consensus during the Cold War: back to Alma-Ata

Headnote

This month Kazakhstan is hosting a conference to mark the historic International Conference on Primary Health Care held 30 years ago in Alma-Ata, now called Almaty. Fiona Fleck reports on the origins of the 1978 conference and of primary health care - the strategy and approach devised 30 years ago to achieve the goal of 'health for all' the people.

On a cold January day in 1976, Dr? Dimitri Venediktov, the Soviet deputy health minister, turned up unannounced at his colleague's home in Geneva.

It was the eve of the World Health Organization's (WHO's) Executive Board. Member States had decided the previous May, at the 28th World Health Assembly, that an international conference on primary health care, proposed by the Soviet Union, was "desirable". But funds were needed and a venue had yet to be named, and Moscow was lobbying hard to host it in the Soviet Union.

"I'll give you US$ 2 million for an international conference on primary health care," Venediktov told assistant director-general Dr? David A Tejada de Rivero, according to the Peruvian physician, who recalls how the Soviet offer took him by surprise.

The following day, Venediktov repeated his offer to the Executive Board which accepted it on one condition: the conference would not be held in Moscow - as Venediktov proposed - but in a developing country.

In the midst of the Cold War, in a world divided between communist and capitalist spheres of influence, primary health care - a new concept at the time - became the unlikely vehicle for a political and ideological battle, especially in the socialist camp.

The concept of primary health care did not appear overnight. Some trace it back to an intergovernmental conference in Bandoeng, Indonesia, in 1937. That conference was held by the health organization of the League of Nations - a predecessor to WHO - that recommended that "the greatest benefit to the health of the rural populations, at the smallest cost, can be obtained through some process of decentralization".

This recommendation was in line with the vision of missionaries working in community health care in developing countries. Notably, the Christian Medical Commission (CMC), which was part of the World Council of Churches, encouraged...