Alma Ata and health for all by the year 2000. The roles of academic institutions.

The title of this article raises a complex set of questions. To begin, what happened at Alma Ata and the goal that emanated from it-Health for All by the Year 2000--are themselves controversial matters. At least there are some who are strongly critical of those events and ideas. Even without linking academic institutions with Alma Ata and HFA/2000, a controversy is spawned when one asks about the roles of such institutions in dealing with societal problems--which problems should a university address, and how deeply does a university become engaged in them, particularly if it carries the university out of the cloister into the trenches of societal conflict? Linking academic institutions with Alma Ata and HFA/2000 deepens the controversy but also provides a framework for examining the basic principles on which each is based, and for testing those principles against the realities of real world problems of health development. This article draws on recent critical assessments of both sides of the equation: a recent Consultative Committee to the Director General of WHO that analyzes the successes and failures of PHC development to date, and lays out conditions for greater effectiveness in the future; and the Technical Discussions of WHO on the Roles of Universities in the Strategy for Health for All that review traditional and progressive arguments about the roles of universities in their societies, and how HFA can be seen as fitting into that debate. The thinking contained in these documents provides ample opportunity to examine whether or not academic institutions should have a role that relates to Alma Ata and Health for All, and, in the end, takes the position that, indeed, this is an appropriate role for those universities prepared to make the commitment. The point is also made that such involvement cannot be effective if the scale of the institutional commitment is marginal--it must be substantial and institution-wide. An example is given of the Aga Khan University in Karachi, Pakistan, an institution avowedly committed to a community orientation and to health services development. The Network of Community-Oriented Educational Institutions for Health Sciences can be considered a movement of educational institutions in this direction. It is functioning with considerable creative initiative in addressing issues having to do with problem-based teaching methods, community orientation, and partnerships with governmental health services.(ABSTRACT TRUNCATED AT 400 WORDS)