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| Declaration of Astana | |
|---|---|
| Name | Declaration of Astana |
| Date signed | 25 October 2018 |
| Location signed | Astana, Kazakhstan |
| Parties | World Health Organization, member states |
| Language | English, Russian |
Declaration of Astana The Declaration of Astana is a global political declaration reaffirming commitment to primary health care, signed during the Global Conference on Primary Health Care in Astana, Kazakhstan, in 2018. The Declaration builds on historical milestones such as the Alma-Ata Declaration and interfaces with actors including the World Health Organization, United Nations, World Bank, Gavi, the Vaccine Alliance, and regional bodies like the European Union and African Union. It frames commitments alongside agendas such as the Sustainable Development Goals, the Universal Health Coverage Partnership, and instruments like the International Health Regulations.
The Declaration emerged from evolving multilateral dialogues following the 1978 Alma-Ata Declaration and linked to conferences convened by the World Health Organization and the United Nations General Assembly. Preparatory processes involved stakeholders including the Global Financing Facility, Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Assembly, Pan American Health Organization, UNICEF, World Food Programme, and civil society networks such as People's Health Movement and Doctors Without Borders. Policy frameworks that informed the Declaration included the Sustainable Development Goals, Millennium Development Goals, Primary Health Care Performance Initiative, Declaration of Astana Summit processes, and national strategies from states like Kazakhstan, Ethiopia, United Kingdom, Canada, India, Brazil, South Africa, China, and Australia. Technical inputs came from institutions such as the Harvard T.H. Chan School of Public Health, London School of Hygiene & Tropical Medicine, Johns Hopkins Bloomberg School of Public Health, and think tanks like Chatham House, Brookings Institution, and the Overseas Development Institute.
The Declaration was adopted at the Global Conference on Primary Health Care attended by heads of state, ministers, and representatives of organizations including the World Health Organization, United Nations Children's Fund, World Bank Group, International Monetary Fund, Gavi, the Vaccine Alliance, Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation. Signatories included member states from regions represented by the African Union, European Union, Association of Southeast Asian Nations, Organization of American States, and the Arab League. High-profile attendees included delegations from Kazakhstan, Sweden, Norway, Finland, Germany, France, Italy, Spain, Japan, Republic of Korea, United States, Mexico, Argentina, Colombia, Nigeria, Kenya, Pakistan, Bangladesh, Indonesia, Philippines, Malaysia, Thailand, Vietnam, Egypt, Turkey, Russia, Saudi Arabia, and United Arab Emirates. The declaration received endorsements from global health partnerships including Roll Back Malaria Partnership, Stop TB Partnership, UNFPA, UNHCR, and professional associations such as the World Medical Association.
The Declaration articulated core principles aligned with prior accords like the Alma-Ata Declaration and frameworks such as the Universal Health Coverage Partnership. Commitments addressed primary health care pillars referenced by institutions including the World Health Organization, World Bank, and United Nations Development Programme: access, quality, equity, people-centered care, and multisectoral action. It emphasized synergy with the Sustainable Development Goals, the Global Vaccine Action Plan, and national health strategies from Bangladesh, Brazil, Cuba, Ethiopia, and Rwanda. The Declaration called for strengthening health workforce policies informed by bodies like the International Labour Organization, World Health Organization Global Code of Practice, and educational partners such as WHO Academy, Harvard Medical School, University of Oxford, and University of Cape Town. It referenced financing mechanisms advocated by the World Bank Group, Global Financing Facility, International Monetary Fund, and philanthropic actors including the Bill & Melinda Gates Foundation.
Implementation efforts invoked technical and programmatic support from agencies such as the World Health Organization, UNICEF, WHO Regional Office for Europe, WHO Regional Office for Africa, Pan American Health Organization, United Nations Development Programme, World Bank', and bilateral partners including United Kingdom Department for International Development, United States Agency for International Development, Norwegian Agency for Development Cooperation, and Swedish International Development Cooperation Agency. National case studies cited policy reforms in Rwanda, Ethiopia, Thailand, Cuba, Mexico, Chile, China, India, and Brazil. Programmatic links involved initiatives like the Primary Health Care Performance Initiative, Integrated Management of Childhood Illness, Community Health Worker programs supported by Partners In Health and Clinton Health Access Initiative, and immunization drives with Gavi, the Vaccine Alliance and WHO coordination. Outcomes reported by agencies such as the World Health Organization and World Bank included shifts toward Universal Health Coverage Partnership metrics, adjustments to national health expenditure reported to the International Monetary Fund, and alignment with Sustainable Development Goals indicators.
Critiques from civil society groups like the People's Health Movement, Health Poverty Action, and academic commentators at London School of Economics and Johns Hopkins focused on perceived gaps in binding financing commitments, parallels with neoliberal policy trends debated at forums such as the World Economic Forum and G20, and concerns raised in analyses by The Lancet and BMJ. Debates involved tensions between advocacy groups including Médecins Sans Frontières and institutional actors like the World Bank over user fees, privatization trends noted in reports from Oxfam and Transparency International, and disputes over metrics defended by the World Health Organization and Global Fund to Fight AIDS, Tuberculosis and Malaria. Controversies also touched on geopolitical dynamics among United States, China, Russia, and European Union actors influencing global health financing and agenda-setting at venues like the United Nations General Assembly and World Health Assembly.
The Declaration is linked to ongoing global efforts by World Health Organization, United Nations, World Bank Group, Gavi, the Vaccine Alliance, Global Fund, and regional bodies including the African Union and European Union to advance primary health care within the Sustainable Development Goals framework. It informed subsequent policy dialogues at the World Health Assembly, United Nations High-level Meetings, G20 Health Ministers Meeting, and academic symposia at institutions such as Harvard, Johns Hopkins, LSHTM, and University of Oxford. Legacy elements appear in national strategies across Rwanda, Ethiopia, Thailand, Cuba, and Chile, and in programmatic initiatives supported by WHO, UNICEF, World Bank, and philanthropic partners including the Bill & Melinda Gates Foundation and Rockefeller Foundation.
Category:Public health treaties