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The 1978 Alma Ata Declaration of Health located community participation as integral to redefining health as a human right for all and as a fundamental principle for achieving it through the pathway of comprehensive primary health care. The discussion on the universality of accessible and affordable care has continued through policy approaches such as Universal Health Coverage, Millennium Development Goals (MDGs) and SDGs. Despite these advances alienation of communities has continued in several ways. On the one hand, the commercialisation of health care is undermining the gains of the Alma Ata. On the other hand, States have continuously failed to ensure citizen participation in planning, budgeting, implementation and oversight of the health services resulting in real needs and priorities of citizens - especially poor and vulnerable communities - being left out. Quite often, accountability deficits experienced in the community, are created in the global alignments of private and non-state actors who wield undue influence on global and national health governance. The dominant accountability discourses have not taken into account such local – global linkages in accountability deficits.
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