Declaration of Astana: A Landmark Commitment to Universal Health Coverage


All member states of the World Health Organization (WHO) made a renewed commitment to primary health care (PHC) as the way to achieve universal health coverage when they unanimously endorsed the Astana Declaration. This was during the Global Conference on Primary Health Care held in Astana, Kazakhstan, on October 25-26, with the theme “From Alma-Ata towards universal health coverage and sustainable development goals.”  The voice of nurses was brought the conference by the International Council of Nurses (ICN) and Nursing Now, emphasizing that nurses were at the heart of delivering effective PHC.


The Conference was co-hosted by the World Health Organisation, UNICEF and the government of Kazakhstan. It served as a reaffirmation, after 40 years, of the historic 1978 Declaration of Alma-Ata, when world leaders first committed to PHC as the means to achieve health for all.

Dr. Tedros Ghebreyesus, Director-General of the World Health Organization (WHO) said that progress in delivering health care over the past four decades had been uneven – at least half of the world’s population still did not have access to basic health services. “Today, instead of health for all, we have health for some,” said Ghebreyesus. “We all have a solemn responsibility to ensure that today’s declaration on primary health care enables every person, everywhere to exercise their fundamental right to health.”


“Today, instead of health for all, we have health for some,”

The Declaration of Astana contains pledges in four main areas, namely:

  • To make bold political choices for health across all sectors, with prioritization of people’s health and well-being;
  • To build sustainable primary health care with quality, comprehensive services for everyone, everywhere, and provided by skilled and committed health professionals;
  • Empowering individuals and communities to take responsibility for their own health and well-being; and
  • Aligning all stakeholders in supporting national policies, strategies, and plans.

The ICN and Nursing Now made a joint statement during the conference, calling on governments to ensure that nurses were able to work to their full scope of practice to achieve the vision of the Astana Declaration. They strongly supported the recommitment to PHC and pointed out that, as nurses made up about half of the healthcare workforce, they were central to achieving universal health coverage.

Nursing models supported the holistic people-centered approach to care and contributed to each of the components of PHC. They are the main group of health care workers providing PHC across different settings and coordinating care between clients – including communities – and the health care system.  “Nurses and midwives are vital in dealing with the problems of access within PHC, reducing health inequalities, applying a people-centered approach and managing the holistic needs of individuals, families, and communities. Nurses should be able to prevent, detect and manage common conditions encountered in PHC settings and be supported to do so through policy and legislation.”

Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

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