Source:
People's Health Movement
Global Health Watch 2 is a civil society alternative to the WHO's World Health Report. It was coordinated by the People's Health Movement, the Global Equity Gauge Alliance and Medact with input from 80 organisations and more than 130 individuals. November 2008.
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BACKGROUND
Civil society is expressing concern over the privatization process that is affecting essential services such as education, health and basic infrastructure.
The widespread problems in health systems in developing countries have their roots in the economic crisis of the 1980s and the economic reforms which attempted to deal with that crisis.
The political and economic trends of those years had effects on health that broke all the promises made at the International Conference on Primary Health Care that took place in Alma Ata in 1998. There, 134 countries agreed that health “is a fundamental human right” and that “the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector”. This should have be attained through a revolutionary approach called “Primary Health Care”.
Over the following years the burden of making large interest payments on debt squeezed out spending on health, education and other public services. Reforms demanded by the World Bank and the International Monetary Fund, in return for loans which could be used to deal with the crisis, included reining in government expenditure even further, a measure which only reinforced the negative impact of the economic crisis.
This model, which has been promoted under the label of modernization, has transferred to individuals the responsibility historically assumed by governments. This has been done mainly through the introduction of user charges, decentralization and the development of health insurance. This is part of a broader approach that was made public under the name of Structural Adjustment Programmes.
Although the World Bank claims that "in most developing countries, the private sector exerts a significant and critical influence on health and nutrition outcomes", there are alarming signs of deterioration in health system effectiveness in those countries. Poor people cannot afford the cost of health and are increasingly dropping out of the system.
Basic services are considered a part of human rights. The United Nations has its own Committee on Economic, Cultural and Social Rights. It has promoted a declaration in the framework of the General Agreement on Trade in Services (GATS), a WTO initiative that focuses on free trade in services in the professions, health and education. The UN declaration "seeks trade law and policy that take into account the rights of all individuals, in particular vulnerable individuals and groups". However, it does not specifically refer to the policy of privatization, perhaps out of the desire to avoid open conflict with powerful member governments that support it.
The World Health Assembly closed 27 May after adopting several decisions on a range of health issues. The most important of these was a resolution establishing a working group to produce a global strategy and action plan on intellectual property, health research and public health. The WHA also passed a resolution urging giving the WHO secretariat the mandate to assist governments to take on board health concerns in trade policies and trade agreements. May 2006.
The World Health Assembly debated a wide range of health problems ranging from malaria and bird-flu to how to deal with public health emergencies, and disasters like the tsunami. Decisions were taken on some of these major global health problems. June 2005.
Twenty-five years ago WHO promised 'Health for All' through the Alma Ata declaration. However, the UN body abandoned the primary health care agenda in the later years. ‘Health systems, including primary health care’, a new WHO document, endorses the primary health care agenda. Grassroots movements offer a cautious welcome, but say this is not enough. Among other things, they say that the document is silent on the disastrous effects of the policies dictated by the World Bank, IMF and other financial institutions. May 2004.
This link provides the full text of the Declaration from the International Conference on Primary Health Care, held in Alma-Ata on 12 September 1998. It states that health “is a fundamental human right” and that “the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector”.
In order to ensure that the vision of Alma-Ata becomes a reality, several international organisations and civil society movements, NGOs and women's groups organised the People's Health Assembly, which took place form 4-8 December 2000 in Bangladesh. This charter is the outcome of the Assembly, and is still open to endorsement.
This document provides comprehensive resources on the 25th anniversary of the Alma Ata Declaration, the final document of an international conference organized by the WHO and UNICEF in 1978. There, 134 countries subscribed to the goal of “Health for All by the Year 2000”, to be attained through a revolutionary approach called “Primary Health Care” (pdf format).
WTO negotiations on General Agreement on Trade in Services (GATS) are threatening essential public services throughout the world. In the current negotiations, governments are pressuring each other to open up services to private sector, even in socially sensitive areas such as water, health and education.
High up on the agenda of the WTO is the privatization of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services (pdf format).
According to this article, global trade in health and social services, and the privatization of healthcare that GATS promotes, will lead to costlier and inequitable health systems which will adversely affect the health and well-being of the majority of peoples everywhere.
Experience in the United States and several Latin American countries, where health services have been run for profit over the past decade or so, suggests that the result will be a decline in accessibility to health care worldwide.
Structural reforms in return for loans, demanded of African Countries by the WB and de IMF, forced governments to reduce health expenditure. They also demanded user fees, which notably reduce poor people access to health services (pdf format).
The poor are completely priced out of the private health market. The poor instead use the public sector that, due to fiscal constraints, has seen public health spending per person fall, resulting in deteriorating healthcare for the poor.
According to this report, the health crisis that these countries face is the result of the combined impact of economic decline, the HIV/AIDS epidemic and the conflict and violence that affect them.
Compared to 20 years ago in Kenya, people live for ten years less on average, more children die in infancy and a greater proportion of those who survive face stunting. Why? Soren Ambrose makes a case for holding the International Monetary Fund (IMF) responsible, arguing that the institution's obsession with low inflation rates - one of the foundations of trade liberalization - starves economies and hurts the poor.
One million people excluded from even the most basic health-care and two-thirds of the population having to resort to extreme measures such as forced labour or selling their meagre belongings for treatment. This is the situation of access to healthcare in Burundi. Yet according to a new report from Médecins Sans Frontières (MSF), this reality is not linked to war, it is a direct consequence of a new health-care financing system. May 2004.
Patients are increasingly being asked to purchase their own medical supplies before being treated. The proposed corporatization of government hospitals will lead to sharply increased health care costs, particularly for the poor, elderly and chronically ill, as well as compromising the quality of publicly-funded medical care for all Malaysians.
According to this paper, privatization as a panacea for the alleged ills of the public system, in fact threatens a system that is relatively inexpensive and that has on balance performed well in delivering primary health care to the vast majority of the population.
According to this article, public health experts suggest that current trends in health care, and the policies demanded by the structural adjustment programmes, have sharpened inequities in health.
In this country people directly finance, through user fees and purchase of health goods, nearly 80% of the total health care expenditure. This is the first cause of indebtedness and asset alienation among poor households.
Experienced and highly specialised doctors, competent to do the most complicated surgeries, well trained nurses and medical technicians, advanced technologies, luxury specialised hospitals. India has set the stage for the show. These fabulous arrangements are not meant for the country's poor but for the affluent Indian elites and foreign patients. For the latter, even the visa processes have been eased. August 2007.
A thorough report written from a Third World perspective. It includes chapters on the role of the World Bank and the Structural Adjustment Programmes, the WTO, the GATS and examines in depth the socio-economic causes of the health crisis (pdf format).
Global Health Watch 2 is a civil society alternative to the WHO's World Health Report. It was coordinated by the People's Health Movement, the Global Equity Gauge Alliance and Medact with input from 80 organisations and more than 130 individuals. See the whole report by chapters. November 2008.
Developing country governments will struggle to invest in decent public health facilities when valuable resources are needed to service debt. (PDF). April 2008.
There is a huge gap between the countries in the better and worse relative situations as regards health care. Conditions in some poorer countries amount to a public emergency, but in the more developed countries lethal diseases have been brought under control. Health care provision is a question of human rights, and this means there must be universal access and efficient public services says the new Social Watch report 2006.
Coming from 82 countries around the world, 1492 people met at the Second People's Health Assembly in Cuenca, Ecuador from 17th to 22nd July 2005, to analyse global health problems and to develop strategies to promote Health for all. July 2005.
Public health experts from the developing and developed world have called on governments to pursue remedies for global health problems with a new vision rather than going by a 'disease-based' approach at the 6th Global Conference on Health Promotion held August 7-11 in Bangkok, Thailand. August 2005.
Despite lessons from history about its failures, the rise of private provision and financing in health care and in other health-sustaining services has become one of the most important issues of our time. International organizations such as the World Bank and IMF have facilitated commercialization by cutting or imposing limits on public expenditure and actively promoting privatization. July 20, 2005.
Privatization is being pushed by international governance institutions, the governments that control them, and the corporations that lobby both groups, even though the dangers that privatization entails can seriously -and permanently- harm the livelihoods of the world's poorest people.
Civil society organisations all over the world are worried about privatisation processes that are taking place in the health sector, intended or as a result of failing and under-resourced public systems.
This report outlines the process whereby SAPs are likely to affect health, summarizes the empirical evidence for such effects, draws conclusions about the impact of SAPs on health and makes recommendations regarding their future application.
Under the free market model that the bank promotes, health is no longer considered an absolute human need: it is a private good, rather than an inalienable right. Health is subjected to the forces of the free market where free choice and competition is the golden rule. This means the dismantling of the state welfare system.
The World bank states that "engaging the private sector has the potential to improve the quality of services, expand the supply of key health goods and services, remove unnecessary burdens from the government, and increase utilization of health services".
Reforms promoted by the World Bank and the International Monetary Fund have helped commercial interests to cater to wealthier people in developing countries through private health care insurance and private hospitals. Most people are left dependent on a poorly-equipped, shrinking public sector; it is the affluent who call upon rapidly-expanding and increasingly high-cost private services.
The World Bank failed to protect social spending during its structural adjustment operations in the 1980s and 1990s, and this led to the deterioration of basic services - including those needed for the prevention and control of HIV/AIDS. The World Bank sought improvements in the way goods and services were provided and financed through health sector reforms, such as user fees, privatisation, decentralisation and integration of services. These reforms frequently reduced access to effective health care, including services aimed at the prevention and control of HIV/AIDS.
According to this document, states have the obligation to ensure that privatization of the health sector does not constitute a threat to the availability, accessibility, acceptability and quality of health facilities, goods and services.
This document sets the promotion and protection of human rights among the objectives of trade liberalization and examines the effects of trade liberalization on individuals and seeks trade law and policy that take into account the rights of all individuals, in particular vulnerable individuals and groups.
After five years of negotiations, countries meeting at UN Headquarters in New York have agreed on a new treaty to protect the rights of persons with disabilities. Article 25 refers to health recognizing that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. September 2006.
A new Bangkok Charter for Health Promotion was adopted at the 6th Global Conference on Health Promotion, co-hosted by the World Health Organization (WHO) and the Ministry of Public Health of Thailand. It identifies major challenges, actions and commitments needed to address the determinants of health in a globalized world by engaging the many actors and stakeholders critical to achieving health for all. August 2005.
Gender relations of power constitute the root causes of gender inequality and are among the most influential of the social determinants of health. This report shows that addressing the problem of gender inequality in health requires actions both outside and within the health sector. (PDF). October 2007.
The World Health Organization launched a report on the occasion of the World Health Day 2005 that states that 11 million children under five years of age will die from causes that are largely preventable while more than half a million women will die in pregnancy, childbirth or soon after. An appalling number of which live in developing countries and have no access to basic healthcare and sanitation. Reducing this toll in line with the Millenium Development Goals is therefore an urgent point in the international agenda. April 2005.
Health sector reforms have increasingly introduced market mechanisms into health-care provision, giving the private sector a greater role as the provider of public services. They may seem gender-neutral, but they have significant impact specifically on women due to their reproductive capacity and their socio-cultural and economical responsibilities and status. June 2004.
The reform carried out at the end of the seventies essentially consisted in decentralizing the official system and in privatizing an important part of the services. This system has proved to be particularly discriminatory against women.
Free market reforms have led to a deterioration in the general health of the population. Private companies took over a major part of healthcare services through the marketing of insurance contracts. A subsidized regime was created to cover the poorest sector of the population, with the assurance that by the year 2000 the whole population would be covered. Full coverage was not achieved, but has rather decreased.
