Milestone on the road to Universal Health Coverage: Palliative care is now included in the Declaration of Astana on Primary Health Care

The International Association for Hospice and Palliative Care (IAHPC), as a non-state actor in official relations with the World Health Organization (WHO), was invited to attend the Global Conference on Primary Health Care in Astana, Kazakhstan on 25-26 October.  

The IAHPC delegation comprised Dr Katherine Pettus, IAHPC Advocacy Officer, Dr Sébastien Moine, European Association for Palliative Care (EAPC) Primary Care Reference Group, and Ms Gulnara Kunirova, Kazakhstan Palliative Care Association. They explain here why the Declaration of Astana’s decisive inclusion of palliative care as an essential service supports integration of our discipline into universal health coverage.  

Top right clockwise: Sébastien Moine, Katherine Pettus and Gulnara Kunirova.

We recently had the privilege to attend the Global Conference on Primary Health Care, sponsored by WHO, UNICEF, and the Government of Kazakhstan in Astana (25-26 October 2018).

The aim of this conference was to celebrate the 40th anniversary of the Declaration of Alma-Ata, and to adopt a new Declaration on Primary Health Care (PHC). PHC is a broad and comprehensive concept that places national health development within overall social and economic development. PHC refers to core functions of a nation’s health system. Encompassing front-line health service delivery (primary care) as well as health system structure; governance and financing; the intersectoral policy environment; and social determinants of health, primary health care provides essential health interventions according to a community’s needs and expectations [1][2][3].

Ministerial Parallel Session on Palliative Care. Left to right: Dr Katherine Pettus (IAHPC); Hon. Minister of Health of Russia, Dr. Veronika Skortsova; Dr Eric Krakauer (Harvard University); Hon. Minister of Health of Uzbekistan, Dr Alisher Shadmanov; Deputy Secretary of Health of Singapore Dr. Benjamin Koh and Dr Sébastien Moine (EAPC).

Prior to the meeting, WHO had carried out a public online consultation in order to update the Declaration of Alma-Ata. The EAPC Primary Care Reference Group, IAHPC, and other partners had the opportunity to contribute to the draft Declaration, which at first made no mention of palliative care as an essential service of PHC. One of the main expectations of our delegation in Astana was to read the words “palliative care” in the final Declaration, and hear the words mentioned by speakers during plenaries, and at side events. We were delighted that the new Declaration of Astana stipulates: “Promotive, preventive, curative, rehabilitative services and palliative care must be accessible to all,” and that many high-level speakers mentioned palliative care in their interventions. We also had the privilege of participating in a Ministerial Level side event on palliative care and primary health care.

An analogy to pregnancy is in order here: maternal, neonatal and child health is not limited to specialist interventions during labour and around delivery. It is now well known that primary health care settings/ services/ professionals are instrumental in improving the health of populations of women throughout their pregnancy [4]. This can be directly attributed to the legacy of the Declaration of Alma-Ata. Similarly, the scope of palliative and end-of-life care cannot be reduced to symptoms and associated distress during the final days of the dying process. Here too, PHC has a crucial role to play in promoting and improving health for persons experiencing serious illness at each point of their illness trajectory and in any place of care, in collaboration with specialist palliative care services where they exist [5][6]. 

The unequivocal statements regarding integration of palliative care in the Astana Declaration reaffirm our discipline as one of the core components of universal health coverage (UHC), paving the way for the High-Level Meeting on UHC to be held during the next United Nations General Assembly in 2019. From now on, we are collectively responsible for Astana’s legacy.

1. World Health Organization. Primary Health Care. Now More Than Ever. Geneva: WHO, 2008.

2. World Health Organization. Closing the gap in a generation. Health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva: WHO, 2008.

3. Primary Health Care Performance Initiative (PHPCI). Primary Health Care — Technical Definition ( — accessed 20 November 2018).

4. Khan AM, Lassi ZS, Bhutta ZA. Community-Oriented Primary Health Care for Improving Maternal, Newborn, and Child Health. New York, NY: Oxford University Press, 2018.

5. Moine S, Murray SA, Boyd K, et al. Palliative care and the endless cycle of serious health-related suffering. Lancet 2018; 392: 471–472.

6. World Health Organization. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers. Geneva : WHO, 2018.






This entry was posted in ADVOCACY & POLICY, EAPC Task Forces/Reference Groups and tagged , , . Bookmark the permalink.

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