Abstract

Since the Alma-Ata (WHO) declaration of primary health in 1978 and the Ottawa Charter for Health Promotion in 1986, the concept of primary health care has become central to the definition of health care. Public health professionals have generally embraced the WHO's broadened definition of primary health care and have encouraged governments to reformulate national health policies to reflect this new orientation. However, although the rhetoric of primary health care has expanded beyond the traditional focus on general practitioners and hospitals to include a focus on community-based health care, intersectoral collaboration and community participation, a review of experiences in America and Europe suggests that national health systems are still struggling to implement this broader notion of health care.