• health policy
• health systems
• public health

On 25 October 2018, the world’s governments convene again at Astana on the 40 anniversary of the Declaration of Alma-Ata. The draft Declaration for this Second International Conference on Primary Care reaffirms the principles of the original Declaration. Behind the slogan of ‘Health for All by the year 2000’ was the commitment to provide universal access to basic comprehensive primary care services built on a moral case—the human right to health, the right and duty of people to participate in planning and implementing their healthcare, and the unacceptable injustice of inequities between and within countries. Concerns regarding the breadth of the vision, lack of operationalised plan or indicators of progress led, in 1979, to what has been described as a counter-revolution; Selective Primary Health Care.1 2 With scarcity, the argument went, choices were inevitable. When these came, they were radical—a focus on just four interventions linked to maternal, newborn and child health.

Four decades on, and we are ‘back to the future’. Drafts of the Astana Declaration have asserted that a strengthened primary healthcare approach is essential to achieving universal health coverage, forming the core of integrated service delivery, and providing care that is ‘continuous, comprehensive, coordinated, community-oriented and people-centred’. It is another bold vision, requiring political will, planning and persistence for full realisation. Half the world’s population still lacks access to comprehensive basic healthcare …