Reassessing the Alma-Ata Declaration: A Scoping Review of Its Impact on Global Surgery

BACKGROUND: The 1978 Alma-Ata Declaration is a landmark document that has profoundly shaped the evolution of the global health agenda. The declaration defined and emphasized low-cost primary healthcare, a hazy definition that, for many, implied a focus on primary care, thereby inadvertently excluding surgical care. With 5 billion people lacking access to quality surgery, determining the potential contributors to this monumental catastrophe is a first step to resolving it. This review explored the impact of the 1978 Alma-Ata Declaration on global surgery (GS).

METHODS: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent scoping review of publications, from which data characterizing the effects of the declaration on surgery were extracted and synthesized into a comprehensive overview.

RESULTS: Eleven studies were included in the final analysis. Four studies focused on essential surgery; 1 additionally included anesthesia delivery and surgical access. Two pre-2000 publications identified the steep challenges toward achieving "health for all," whereas all 9 of the post-2000 articles acknowledged the failure to meet this goal.

CONCLUSIONS: The noble intentions of the 1978 Alma-Ata Declaration have yet to be met. "Health for all" remains an elusive, distant goal. By not explicitly promoting surgery, the declaration inadvertently deprioritized GS. The current state of the GS ecosystem calls for a reenergized, focused agenda that will realign health policies with increased GS funding for surgical scale-up in low- and middle-income countries.