It was in this city in 1979 that public health experts from over 100 countries, international health officials from multi-lateral and bi-lateral agencies as well as non-governmental organizations met, discussed, and eventually signed on to the Alma Ata Declaration that enshrined health as a basic human right. This is what primary health care was all about – that all human beings were entitled to health as a matter of right and that governments were mandated to ensure this right as a matter of obligation.

At the time of the declaration, Kazakhstan and all the Central Asian republics near it were a part of the old Union of Soviet Socialist Republics, the monolithic old communist Russia. The health status indicators of these countries were then considered at par with most of the developed world. The communist health system was centrally planned and controlled but apparently working well. While not nearly as affluent as their western counterparts, health workers – doctors, nurses and others – were well paid, motivated, and competent and enjoyed high social status.

About a dozen years after the declaration, the old Soviet Union collapsed. Central Asian republics like Kazakhstan and Kyrgyzstan became independent. A new economy based on free enterprise was introduced and allowed to influence not just trade and commerce but also social structures such as the systems of health and education.

Early in this period of desocialization, there were already some signs of an impending deterioration in health when immunization programs faltered and outbreaks of diphtheria and other old scourges of young children began to occur. Although the immediate problems of immunization were apparently addressed, the general deterioration of the health systems was apparently ignored.

Even as the free market reigned supreme throughout these former communist countries, corruption crept into its social service infrastructures. The gravity of the situation of corruption in the health system of these unfortunate states was only recently uncovered.

Last year in Kazakhstan and early this year in Kyrgyzstan, scores of doctors and nurses were found guilty of causing the transmission of the AIDS virus to hundreds of infants and children. A former minister of health, who had resigned as a sign of protest against the pervasiveness of corruption in the new health systems, was quoted as saying that the worst infection in her country was the corruption of its health personnel.

It is now apparent that the central management and support programs of the old communist regime were not replaced by an adequate new health system. Health workers’ pay did not keep up with their individual needs, promotions and professional advancement came to depend on bribery and favoritism, and morale inevitably suffered. Thus, even as the better health professionals left the country for better jobs abroad, the most important component of the health services – its workforce -- was terribly neglected.

Countries in similar situations (including the Philippines) should note the adverse consequences of neglecting their health workforce. Even with the most modern technology and the most efficient finance and management systems, health services will not function properly without appropriately trained and well motivated health professionals.

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When the Sulpicio Lines’ Princess of the Stars capsized off Romblon last week, it revealed not just defects in our system of sea transport or weather prediction management or emergency preparedness. The obvious neglect of these areas by government is probably not solely the fault of the present government of questionable legitimacy and integrity. The elitist nature of the country’s social and political system has been in place ever since the Americans hijacked our revolution more than a hundred years ago.

One of the most disconcerting revelations of the tragedy is the fact that a toxic pesticide – 10 metric tons of it - was in the cargo hold of the vessel bound for the pineapple fields of Mindanao. It is bad enough that such a deadly load was on a passenger vessel – an illegal act in itself. If the containers on the capsized ship somehow begin to leak, the threat to human life and the fishing industry in the area would be imminent.

But the worst thing about Endosulfan (the toxic pesticide) on board the Princess of the Stars was that it was there at all. A chemical that has been banned throughout most of the developed world was about to be used in the corporate farming of one of the countries favorite fruits – the pineapple. Reports say that only the corporate farms of Dole and Del Monte have been cleared to use this chemical. Environmentally conscious public health advocates fervently hope that the other small pineapple farms in which most people believe the sweetest varieties are grown have been resisted the temptation to use any pesticides at all.