There are a number of factors that made the 1978 Alma-Ata Declaration to focus on Primary health care as a way to address the healthcare challenges in the global society. Notably, Primary health care promotes equitable distribution of different variables that have an influence on the health of people in society (Hiremath, 2006). This means that by promoting the integration of Primary health care in comprehensive national health system and in coordination with other sectors, the 1978 Alma-Ata Declaration sought to promote equality in the access to healthcare. Similarly, Primary health care promotes community participation in health care issues in society, and particularly focuses on prevention of illness through empowerment of the community (Hiremath, 2006). Furthermore, apart from encouraging multi-sectorial approach to health care, Primary Health Care encourages the use of appropriate technologies to promote health.
有许多因素促使1978年《阿拉木图宣言》将重点放在初级卫生保健上，以此应对全球社会的卫生保健挑战。值得注意的是，初级卫生保健促进了对社会人群健康产生影响的不同变量的公平分配（Hiremath，2006年）。这意味着，1978年的《阿拉木图宣言》通过促进初级卫生保健纳入全面的卫生系统，并与其他部门协调，力求促进获得卫生保健的平等。同样，初级卫生保健促进社区参与社会卫生保健问题，特别注重通过赋予社区权力预防疾病（Hiremath，2006年）。此外，除了鼓励多部门的医疗保健方法外，初级卫生保健还鼓励使用适当的技术促进健康。
Integrating primary health care in comprehensive national health system: challenges
将初级卫生保健纳入全面的卫生系统：挑战
There are different factors in society that have made it difficult for some governments across the globe to integrate primary health care into their comprehensive national health systems in collaboration with other sectors in society. To begin with, one of the greatest impediments to the achievement of this goal of the 1978 Alma-Ata Declaration is the lack of leadership and political commitment. According to Hussein, McCaw-Binns and Webber (2012), leadership and political will plays a critical role in influencing the establishment of different plans and policies that enable the implementation and development of the health care systems. Furthermore, Hussein, McCaw-Binns and Webber (2012) affirm that commitment from the political leadership determines whether a nation would be able to develop robust policies that are able to withstand a change in political regime. In the case of sustaining primary health care as a critical element of a comprehensive national health system, most countries around the globe have been unable to marshal support from different political quarters, thus undermining its overall adoption and implementation. Even in in cases where there has been political support towards integrating this goal in the national healthcare system, such support has been short-lived, and mostly lasts only a few years.
社会上有各种不同的因素，使得全球一些政府难以与社会其他部门合作，将初级保健纳入其全面的卫生系统。首先，实现1978年《阿拉木图宣言》这一目标的更大障碍之一是缺乏领导和政治承诺。根据Hussein、McCaw Binns和Webber（2012年）的说法，领导力和政治意愿在影响制定不同的计划和政策以实现医疗体系的实施和发展方面起着关键作用。此外，Hussein、McCaw Binns和Webber（2012）确认，政治领导层的承诺决定了一个是否能够制定能够承受政治体制变革的稳健政策。在维持初级卫生保健作为全面卫生系统的一个关键要素的情况下，全球大多数都无法从不同的政治方面获得支持，从而破坏了该系统的整体采用和实施。即使在政治上支持将这一目标纳入医疗体系的情况下，这种支持也是短暂的，而且大多只持续几年。
Apart from leadership and political will, another factor that has made it difficult for most countries to meet the eighth goal of the 1978 Alma-Ata Declaration is the lack of sufficient resources to support its implementation. Research and studies reveal that limited financial resources particularly in developing countries have been the major hindrance to the adoption and implementation of Primary Health Care (Mullings and Paul, 2007). In this case, Mullings and Paul (2007) observe that poor countries often face the challenge of meeting their debt obligations while at the same time meeting the healthcare needs of their citizens. For instance, a country such as Haiti, which has huge domestic and foreign debts, has been forced to meet its debt obligations at the expense of meeting the health needs of its people. For instance, such a country is unable to invest in the training of community health workers to help create a link between the public and health professionals. With this in mind, it is almost impossible for this country to implement the concepts of Primary Health Care in its national health system because of lack of funds. On the other hand, whereas other sectors in the economy such the private sector could contribute immensely towards the integration of primary health care in the national health systems of most countries across the globe through providing financial support, corruption, mismanagement and lack of accountability has made such sectors to refrain from supporting such healthcare initiatives (Puras, 2016). This has undermined the availability of funds to support the adoption of primary health care initiatives.
除了领导能力和政治意愿外，另一个使大多数难以实现1978年《阿拉木图宣言》第八项目标的因素是缺乏足够的资源来支持其执行。研究表明，财政资源有限，特别是发展中的财政资源有限，是初级卫生保健采用和实施的主要障碍（Mullings和Paul，2007年）。在这种情况下，Mullings和Paul（2007）观察到，穷国经常面临着在满足其公民医疗需求的同时满足其债务义务的挑战。例如，像海地这样一个拥有巨额国内外债务的，被迫以满足其人民的健康需求为代价来履行其债务义务。例如，这样一个无法投资培训社区卫生工作者，以帮助在公众和卫生专业人员之间建立联系。考虑到这一点，由于缺乏资金，该国几乎不可能在其卫生系统中实施初级卫生保健的概念。另一方面，鉴于经济中的其他部门，如私营部门，可以通过提供财政支持，为将初级保健纳入全球大多数的卫生系统作出巨大贡献，管理不善和缺乏问责制使得这些部门不愿支持这些医疗保健计划（Puras，2016）。这削弱了支持采用初级保健倡议的资金的可用性。