Nueva declaración Astana
Oct 4, 2018 —
Gobiernos y sociedad civil propusieron cambios a la Declaración de Astaná. A continuación última versión que recoge aspectos de nuestro movimiento. Si tienes alguna sugerencia hacerla llegar inmediatamente al Ministerio de salud de su país.
Declaration of Astana
Global Conference on Primary Health Care:
From Alma-Ata towards universal health coverage
and the Sustainable Development Goals
Astana, Kazakhstan, 25-26 October 2018
The Global Conference on Primary Health Care, meeting in Astana this twenty-fifth day of October in the year Two Thousand and Eighteen, reaffirming the commitments expressed in the ambitious and visionary Declaration of Alma-Ata of 1978 and in the 2030 Agenda for Sustainable Development, to achieve Universal Health Coverage in pursuit of Health for All, hereby makes the following Declaration.
Governments and societies that prioritize, promote, and protect people's health and well-being, both at population and individual levels through strong health systems;
Primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed;
Individuals and communities empowered and engaged in maintaining and enhancing their own health and well-being in enabling and health-conducive environments;
Partners and stakeholders aligned in effective support to national health policies, strategies and plans.
The Conference strongly affirms its commitment to respect, protect and promote the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind. Convening on the 40th anniversary of the Declaration of Alma-Ata, we reaffirm our commitment to all its values and principles, as in particular to justice and solidarity, and underline the importance of health for peace, security and socio-economic development.
We assert that strengthening Primary Health Care (PHC) is the most equitable, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that PHC is the foundation of a sustainable health system that can achieve Universal Health Coverage (UHC) and health-related SDGs. We welcome the convening of the United Nations General Assembly high-level meeting in 2019 on UHC to which this Declaration will contribute. We will pursue achieving UHC so that all people have equitable access to the quality and effective health care they need, ensuring that the use of these services does not expose users to financial hardship.
We admit that in spite of remarkable progress in the last 40 years, people in all parts of the world still have unaddressed health needs. We regret that remaining healthy is challenging for many people, particularly for those who are poor or vulnerable, children, youth, persons with disabilities, people living with HIV/AIDS, older persons, indigenous peoples, refugees, internally displaced persons and migrants. We find it ethically, politically, socially and economically unacceptable that inequity in health and disparities in health outcomes persist.
Unless we act immediately, we will continue to lose lives prematurely because of wars, violence, epidemics, natural disasters, health impacts of climate and environmental factors, poverty, harmful use of alcohol, tobacco, other products and unhealthy behaviours, leading to poor health, especially non-communicable diseases. We must not lose opportunities to halt disease outbreaks and global health threats such as antimicrobial resistance that spread beyond countries’ boundaries.
Health care services must be accessible by all who need them. We must save millions of people from
poverty, particularly extreme poverty, caused by disproportionate out-of-pocket spending on health. We
can no longer underemphasize prevention, nor tolerate fragmented, unsafe or poor quality care. We must
address the shortage and uneven distribution of health workers. We must act on growing costs of health
care and medicines. We cannot afford waste in health care spending due to inefficiency.
Despite these challenges, we are more likely to succeed than ever before, because we will:
Make Bold Political Choices for Health across all Sectors. We acknowledge governments’ responsibility to
ensure the right of everyone to the enjoyment of the highest attainable standard of health through multisectoral
action and UHC, engaging relevant stakeholders and empowering local communities. We will
address complex determinants of health and aim to reduce risk factors through evidence-informed Health
in all Policies. We will involve more stakeholders in the achievement of health for all, leaving no one
behind, while addressing conflicts of interest, promoting transparency and implementing participatory
governance. We will strive to avoid or mitigate conflicts, which are powerful determinants of health that
undermine health systems and roll back health gains. We must use coherent and inclusive approaches to
expand PHC as a pillar of UHC in emergencies. Within health sector, we will support PHC through
appropriate distribution of human and other resources in order to meet health needs throughout the life
course. Exemplary support of PHC by governments has been demonstrated in many countries, and we
applaud them for such leadership, calling on all countries to follow these examples.
Build Sustainable Primary Health Care. We will strengthen health systems based on PHC. We will enhance
capacity and infrastructure for primary care – the first contact with health services, prioritizing essential
public health functions. PHC will be accessible, equitable, quality, comprehensive, people-centered,
gender responsive, efficient, acceptable, available, affordable, delivering continuous, integrated services,
across the life course. We will strive to avoid fragmentation and have a functional referral system between
primary and other levels of care. We will prioritize disease prevention and health promotion and will aim
to meet people’s health needs through comprehensive preventive, promotive, curative, rehabilitative and
palliative care. We acknowledge that PHC is key in ensuring universal access to sexual and reproductive
health-care services, including family planning and related information and education. We will benefit
from sustainable PHC that enhances health systems’ resilience to prevent, detect and respond to infectious
diseases and outbreaks.
We believe the success of primary health care will be driven by:
Knowledge and capacity building. We will apply knowledge of what works and what does not
to improve health outcomes, including scientific as well as traditional knowledge, to
strengthen health systems based on PHC, to ensure access for all people to the right care at
the right time and at the most appropriate level of care, taking into account their rights,
needs, dignity, and autonomy. We will continue research and share knowledge and
experience in order to build capacity and improve health service delivery. We will support
research, evaluation and knowledge management to implement effective strategies for multisectoral
Human resources for health. We will create decent work and adequate compensation for
health workers, such as family doctors, nurses, midwives, pharmacists, social workers and
other health workers, to respond effectively to people’s health needs in a multidisciplinary
context. We will continue to invest in the education, training, recruitment, development,
motivation and retention of PHC workers with appropriate skill mix. We will strive for the
retention and availability of PHC workers in rural, remote and economically less attractive
areas within countries. We assert that the international migration of health personnel should
not undermine countries’, particularly developing countries’, ability to meet the health needs
of their populations.
Technology. We support broadening the range of health care services through the use of
quality, safe, effective and affordable medicines (including, as appropriate, traditional
medicines), vaccines, diagnostics, and other technologies. We will promote their accessibility
and their rational and safe use. Through advances in information systems, we will be better
able to collect appropriately disaggregated, high-quality data, improve information
continuity, disease surveillance, transparency, accountability and monitoring of health system
performance. We will use a variety of technologies to improve access to health care, enrich
health service delivery, improve health care quality and patient safety, and to increase
efficiency and coordination of care. Through digital and other technologies, we will enable
individuals and communities to identify their health needs, to participate in planning and
delivery of services and to play an active role in maintaining their own health and well-being.
Financing. We call on all countries to invest in PHC, as countries who did so, have achieved
improved health outcomes. We will address the inefficiencies and inequities that expose
some people to financial hardship for using health services through better allocation of
resources for health, appropriate reimbursement systems for providers or users, and
adequate financing of primary health care to improve access and achieve better health
outcomes. We will work towards financial sustainability, efficiency and resilience of the
national health systems, appropriately allocating resources to PHC based on national context.
We will leave no one behind, including those in fragile situation and conflict affected areas,
by providing access to quality PHC services across the continuum of care.
Empower Individuals and Communities. We support the involvement of individuals, families,
communities and civil society, through participation in the governance, policies and planning that have an
impact on health. We will strive to satisfy expectations of individuals and communities for reliable
information about health and will promote health literacy. We will support people in acquiring knowledge,
skills and resources needed to maintain their health or the health of those for whom they care, guided by
health professionals. We will protect and promote solidarity, ethics and human rights. By acting so, we will
increase community ownership, contribute to accountability of public and private sectors and will allow
more people to live healthier lives in enabling and health-conducive environments.
Align Stakeholder Support to National Policies, Strategies and Plans. We call on all stakeholders – health
professionals, academia, patients, the civil society, international partners, agencies and funds, private
sector, and others – to take joint actions to build stronger and sustainable PHC in pursuit of UHC, and to
align with evidence-based, gender-responsive policies, strategies and plans across sectors. Stakeholders
should facilitate and help countries to direct sufficient human, technological, financial and information
resources to PHC. Countries and stakeholders will cooperate in a spirit of partnership, sharing knowledge
and good practices in implementing this Declaration in accordance with national sovereignty, human rights
and effective development cooperation.
We will act immediately on this Declaration in solidarity and coordination between
governments, the World Health Organization, the United Nations Children’s Fund and all
All people, countries and organizations are encouraged to support this movement.
Countries will periodically review the implementation of this Declaration in cooperation with
Together we can and will achieve health and well-being for all, leaving no one behind.
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