On 30 December 1991, a provisional agreement was reached among the members of the Commonwealth of Independent States on the composition and conduct of the Councils of Heads of State and Government. The protocols consisted of one declaration, three agreements and separate annexes. In addition, Field Marshal Yevgeny Shaposhnikov was confirmed as the incumbent commander of the armed forces of the Commonwealth of Independent States. A separate treaty on reciprocal measures concerning nuclear weapons has been signed between Belarus, Kazakhstan, Russia and Ukraine. [2] Forty years ago, the World Health Organization (WHO) and UNICEF convened the International Conference on Primary Health Care on September 6, 1978, in Alma-Ata, USSR (now Almaty, Kazakhstan). Together with representatives from 134 countries, the conference adopted the Declaration on Primary Health Care (known as the Alma-Ata Declaration), in which delegates reiterated their agreement that primary health care is essential to achieving human well-being through the underlying determinants of health. The resulting Alma-Ata Declaration establishes a framework that will guide States in the multisectoral policies necessary for the realization of a wide range of health-related human rights, adopt a holistic view of health and embody the idea that human rights and public health are intimately linked and mutually reinforcing. The Alma Ata Protocols were the founding declarations and principles of the Commonwealth of Independent States (CIS). On 8 December 1991, the leaders of Russia, Ukraine and Belarus approved the Belovezha Agreement, which dissolved the Soviet Union and formed the CIS. On 21 December 1991, Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan approved the Alma Ata Protocols and acceded to the CIS. The latter agreement included the three original signatories of Belavezha as well as eight other former Soviet republics.

Georgia was the only former republic not to participate, while Lithuania, Latvia and Estonia refused to do so after restoring their independence status before 1940. [1] In recent years, evaluation frameworks have been put in place to address this need. The Medical Research Council in the United Kingdom has developed a framework for the evaluation of complex interventions, which it defines as such with many interacting components, the implementation of which requires flexibility and which allows for a wide range of possible outcomes in relation to a variable target population45. 46 the realistic assessment is more promising. Based on the work of Pawson and Tilley.47 This approach uses theoretically transmitted models that study the context and mechanisms underlying the intervention and produce processes and outcomes that can be observed. Recently, research on implementation in the field of health has gained credibility to study complexity. It is defined as the study of “all aspects of implementation, including factors that influence implementation, implementation processes and implementation outcomes, including how to introduce potential solutions into a health system or how to promote their wide-scale use and sustainability”. .

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