Equity was a core value in the Alma Ata declaration on PHC. However, the interpretation of equity varied and its application became difficult. Equity goals and objectives have often been rhetoric rather than practical. Policy reforms since Alma Ata have been dominated by the neo-liberal economic ideology, which does not include equity as its core value. After 25 years, reforms such as the essential health package, sector-wide approach, user-fees and decentralization have not achieved the key goals of PHC such as equity, and of health sector reforms such as cost recovery, efficiency and sustainability.