Primary health care comes full circle. An interview with Dr Halfdan Mahler.

Dr Halfdan Mahler served three terms as director-general of the World Health Organization (WHO) from 1973 to 1988. He joined WHO in 1951 as a senior officer attached to the National Tuberculosis Programme in India. He came to WHO headquarters in 1962 as chief of the tuberculosis programme, a post he held until 1969. From 1969 until 1970, he served as director of project systems analysis. From 1970 until 1973, he served as assistant-director general of several divisions. After retiring from WHO in 1988, he directed the International Planned Parenthood Federation until 1995. He obtained his medical degree at the University of Copenhagen in 1948 and holds a post-graduate degree in public health.

Thirty years ago last month 134 Member States of the World Health Organization gathered in the former Kazakh capital, Alma-Ata, against a backdrop of the Cold War, at an international conference to reach a landmark agreement: to adopt primary health care as the key strategy for achieving ‘health for all’ by the year 2000. Dr Halfdan Mahler, who was director-general at the time, talks to the Bulletin about why primary health care lost its way and his hopes for its renewal today.

Q: Initially, you didn’t think it was a good idea to hold an international conference on primary health care, why was that?

A: My colleagues and I in the Conference Secretariat were convinced we needed more time to prepare background documents, but that was rejected by the Executive Board when it agreed the conference should take place in 1978. In retrospect, it was a good thing that they shot us down in flames.

Q: Where did the initiative for more of a health systems-oriented approach come from?

A: From many countries. A lot of documentation came from nongovernmental organizations (NGOs). A WHO publication Health by the people based on feedback from individual countries, NGOs and institutions was also important. After its creation, the World Health Organization (WHO) had for many years a strong communicable-diseases focus. That was during the Cold War, when there was always competition among the superpowers to be first. Malaria eradication was supported by the United States of America, and the Soviet Union took on smallpox eradication. Many in the WHO Secretariat were big communicable-disease characters. Then, in the 1960s, Member States started telling WHO that it had failed to support them with their health services. In the 1970s, WHO’s Secretariat at last began to search for a balance between the vertical (single disease) programmes and the horizontal (health systems) approach.