The Alma Ata Declaration launched at the Who/Unicef conference on primary health care in 1978 was influential in rural communities in rural areas in low-income countries all around the world. Its aim was Health for All by the Year 2000. Community participation was seen as crucial for successful implementation. According to the Declaration access to health care was a human right, and it should engage with maternal and child health, family planning, water and sanitation, essential drugs, food and nutrition, immunization, simple treatment, health education and control of endemic diseases. In addition, importance of management, health information, human resources, logistics, physical infrastructure and research was underlined, as well as multi-sectoral collaboration. Following the Alma Ata Declaration, the priorities for the implementation were extensively debated. Selective primary health care, i.e., concentration on some but not all of the key components of primary health care, was increasingly supported by donors. Vertical approach was adopted. Community participation became restricted to cost sharing, which in fact meant imposition of user fees. The goal Health for All in the year 2000 was far from being achieved, and the Millennium Development Goals replaced the Alma Ata Declaration. In this paper the implementation of Alma Ata in Guinea-Bissau, a small and fragile will be analyzed in a historic perspective with particular focus on the post-conflict period following the military uprising in 1998. The paper is based on fieldwork carried out in the country since July 2009. It is argued that the trendy character of global policy and international aid comes at the cost of a long-term engagement and persistence.
