Selected Press Coverage
Globalization Hits Public Health: NGOs
Globalization Hits Public Health: NGOs
6 December 2000, Nepal
Source: The Rising Nepal
Participants representing (NGOs) Non-Governmental Organizations from 92
countries at the People's Health Assembly (PHA), which kicked off here
today, voiced their determination to initiate concerted efforts to fight the
negative impacts of globalization on health systems around the world.
Representatives of the PHA Secretariat said though nearly three decades
had elapsed after the World Health Organization (WHO) had endorsed the “Health
for All” motto, the noble objective had not materialized.
"The WHO has come under the influence of the World Bank and the
International Monetary Fund, thereby deviating from the objective to render
health services to the poorest of the poor", Qasem Chowdhury,
coordinator of the PHA Secretariat said. He further pointed out that the
need to strengthen WHO.
"The PHA aims at strengthening the global network of NGOs and forge
solidarity for the health rights of the people," Chowdhury said. He
said that a health charter would be circulated all over the world to
generate widespread awareness amongst the deprived sections of the society
at the end of the five-day Assembly.
"Our aim is to tell the poorest of the poor that health services are
their rights and not something given as a mercy," Chowdhury said.
Jihad Mashal, Vice-President of Palestinian Medical Relief Committees
said the aim of the movement is to forge solidarity to mobilize communities
in safeguarding their health rights.
Goran Sterty of the Dag Hammarskfold Foundation, Sweden, said the issue
of health for all had been sidelined as the decision-making process of the
UN was taking place outside the UN.
Speaking at the inaugural session, Prasad Misra, Health Minister of the
Indian state of Orissa, suggested that countries like India, which have a
long indigenous medicine tradition like Ayurved, must give emphasis to
developing these systems.
There are 70 participants representing different NGOs from Nepal and they
will be elaborating the health problems prevalent in Nepal. The NGOs were
engaged in a year-long preparation to join the PHA. The PHA Secretariat in
Nepal was opened at the Primary Health Services Resource Centre (RECPHEC),
an NGO involved in addressing the emerging health problems in Nepal.
Dr. Mathura Prasad Shrestha is the coordinator of the PHA Secretariat in
Nepal. Dr. Shrestha, who is also the former health minister, will present an
issue paper entitled " New Paradigm of Globalization, Replacing
Existing Unequal Relations Among People and Nations with Humane Form"
at the Assembly. The paper was jointly prepared by Dr. Shrestha, Indira
Shrestha and Mahesh Maskey.
WB Contribution May Come Under PHA Scrutiny
10 November 2000, Bangladesh
Source: The Independent Bangladesh
The World Bank will face a trial before the global assembly of the world
community to be organized in Bangladesh next month.
The World Bank will have to reply as to what extent it contributed to the
primary health care, poverty alleviation, human rights protection and the
overall development of the global community, according to the organizers of
the first ever People's Health Assembly (PHA) to be held at Savar
Gonosasthaya Kendra on December 4-8.
While formulating a People's Charter for Health, the global community
would also scrutinize the development activities carried out by the
international agencies over the decade, Dr Zafrullah Chowdhury, a member of
the global co-ordinating group of the PHA told The Independent yesterday.
The four-day PHA would provide an opportunity for the global community to
share and discuss the people's experiences as well as the socio-economic
perspectives of health issues to translate it into a democratic and
affordable policy guidelines for health development as a basic human right
in all societies, said Dr Qasem Chowdhury, the coordinator of the Assembly.
Jointly hosted by about 300 NGOs (Non-Governmental Organizations) of Bangladesh including Grameen Bank, BRAC, ASA, PROSHIKA, CCDB, Caritas,
Naripakkha and ARCHES, the PHA 2000 will bring together about 1500
participants from over one hundred countries in five continents. The
participants will include policy planners, experts, practitioners,
researchers, grassroots level workers and the community representatives.
According to the coordinating secretariat at Savar Gonosasthaya Kendra,
86 countries have already confirmed their participation. The World Bank,
WHO, UNEP, UNICEF have also confirmed their participation in the Assembly.
The International Organizations like Dag Hamarskjold Foundation of
Sweden,
The Government of Netherlands, Government of Finland, DFID of UK,
Rockfeller Foundation of the USA, Swedish International Development
Agency are funding the biggest ever global health assembly.
According to the organizers, there will be a plenary session beginning
with the presentation of life experience of one grassroots level participant
from each of the five continents.
Discussions will be held in 20 to 25 workshops to be held simultaneously
each day. Deliveries will be made in English, French, Spanish, Arabic,
Chinese, Hindi and Bangla. To accommodate the guests, the host organizations
have made arrangement at the dormitories and rest-houses of the Gonosasthaya
Kendra, Proshika, BRAC and PATC in Savar and Manikganj.
Arrangement would be made for 50 foreign participants to stay a night at
a poor man's house in a neighboring village for having practical experience
about the extent of poverty and the miserable life of a poor man in
Bangladesh, said Dr Zafrullah Chowdhury.
There will be 50 women groups from 50 different villages of Bangladesh to
prepare food in 50 makeshift kitchens at the assembly venue, he said adding
that the guests would have the option to choose food of different varieties
from different shops run by the women groups.
During the grand assembly of global communities, an exhibition would be
held to display traditional items including apparel and handicrafts from
different corners of the globe, the organizers said.
Meanwhile, different countries have completed their country-level
preparations to join the grand Assembly in Bangladesh.
There will be a national gathering at Salt Lake in Calcutta where nearly
20 thousand participants from different Indian cities and villages would
join with a slogan 'Health for all now'.
They will make their journey by "Health Trains" two days ahead
of the scheduled gathering at Calcutta from four Major cities including
Mumbai, Tripura and Punjab. On their way, they would make brief stoppages at
different stations, distribute leaflets, sing the songs campaigning for the
causes of people's health.
As spadework for the grand assembly, the host country Bangladesh has
completed health assembly program at five divisional headquarters of Dhaka,
Chittagong, Sylhet, Barisal and Khulna.
Organized by five different NGOs the divisional level assemblies were
attended by government ministers. Environment and Forest Minister Begum Sajeda Chowdhury and State Minister for Health Professor Amanullah
inaugurated the Dhaka assembly on September 17 while Food Minister Ameer
Hossain Amu inaugurated the Barisal assembly on October 5.
The Chittagong assembly was attended by Labour and Manpower Minister MA
Mannan on October 7 with 40 NGOs attending the program. Health and family
Welfare Minister Sheikh Fazlul Karim Selim is going to inaugurate the
Rajshahi divisional assembly soon, according to the organizers.
PHA 2000 will focus on fundamental health care
The Daily Star, Wed. 2 August 2000
By Staff Correspondent
People's Health Assembly 2000 (PHA), an international conference of
experts working on health will be held in Dhaka in the first week of
December, organisers said at a press conference yesterday.
The five daylong international assembly on health will begin on December
4 at Ganoshasthaya Kendro at Savar.
"The aim of the assembly is to focus on health and equity-based
development and priority setting of primary health care and implementation
of techniques at local and international level," Zafrullah Chowdhury,
Projects Co-ordinator of Ganoshasthaya Kendro and member of core of PHA told
reporters.
Chowdhury said that the assembly will create a common platform to resolve
different prevailing problems in the sector and build a peoples network to
implement fundamental human health service.
The conference will focus on five fundamental sectors including
socio-economic factors, infrastructure and social health environment, role
of related health sectors and initiative from the grass root level to
overcome prevailing situation in health sectors.
A number of workshops, round table discussions and cultural shows will be
organised during the five-day long assembly.
Some 1,200 participants from about 100 countries will participate in the
conference to adopt a "Peoples Health Recommendation," organisers
said.
The PHA is a forum to change the prevailing health system, which has been
a failure to provide health service to poor and of neglected community.
Ganoshasthaya Kendro will host the conference in collaboration with Asian
Community Health Action Network (ACHAN), Consumers International (CI), Dag
Hammarskjold Foundation (DHF), Health Action International - Asia Pacific (HAIAP),
International People's Health Council (IPHC), Third World Network (TWN), and
Women's Global Network for Reproductive Rights (WGNRR).
The PHA will also hold a three-day follow up meeting from December 9 for
implementation of plan and advocacy.
Dr Morshed Chowdhury, Co-ordinator of the PHA, Pamela Zinkin of England,
Ken Harvey of Australia, Evelyn Hong of Malaysia, Olle Nordberg of Sweden,
Mohan Rao of India, Nadine Gasman of Mexico, Sumati Nair of Holland and
Claudio Schuftan of Vietnam were among the others spoke at the press
conference.
Foreign Health Specialists have already arrived in the capital to attend
in a pre-assembly session. The specialists called upon people to participate
in the pre-assembly procedures to raise points on peoples health concern to
improve the worldwide health system.
Global economic system is bad medicine
by Ranjit Devraj
Savar (Bangladesh), 11 Dec 2000 (IPS) -- Diagnosing what ails public
health delivery was the easy part for the international People’s Health
Assembly (PHA), which ended Friday in this remote area of one of the world’s
poorest countries.
“The question now is how to tackle the virus of the global trading
system which thrives on human greed,” said Gauripada Dutta, a doctor and
veteran legislator from India’s West Bengal state, which borders
Bangladesh.
Not one of the 900-odd delegates from 92 countries here had an iota of
doubt on what was responsible for the deterioration in health service
delivery around the world or for creating socio-economic conditions that
deprive the vast majority of people a healthy existence.
They adopted with unanimity the People’s Health Charter - 2000, the
main product of the five-day assembly, which demanded the cancellation of
Third World debts and the transformation of the World Bank and the
International Monetary Fund (IMF) in favour of public health.
“The consensus is the thing - we have to learn to help each other,”
said Huma Rashid, coordinator for the Punjab Lok Sujag, a non-government
group that works for consumer protection and community awareness in
Pakistan.
Part of the credit for that consensus goes to the battery of savvy
experts who were brought in by the PHA and explained to the delegates the
dangers lurking in the thousands of pages of documents like the World Trade
Organisation (WTO) trade rules.
“These documents are drafted by the best business and legal brains that
money can hire and the fact that they are all written in English adds to the
handicap of negotiators from the Third World,” said Mira Shiva from the
Voluntary Health Association of India (VHAI), an NGO campaigning for the
rational use of drugs.
Moreover, the developing world has to contend with corrupt
administrations at home which are only too happy to do business with
transnational corporations (TNCs) and the global financial institutions that
back them such as the Bank, IMF and WTO.
“Influential sectors in many Third World countries have given up ideas
of national self-sufficiency and now intend to reap benefits as junior
partners to foreign capital in search of quick profits or purchasing public
assets at a low price through privatisation,” said Mohan Rao, a PHA
coordinator who helped draft the charter.
The result has been quick capitulation by developing countries, whose
bargaining power has been weakened by mounting debts to the interests of
TNCs articulated through the Bretton Woods institutions, set up after World
War II and which jealously guard the economic dominance of the North.
Halfdan Mahler, who was director-general of the World Health Organisation
(WHO) for 15 years, blamed the situation on the “unipolar” world, which
emerged at the end of the Cold War.
“One terror for the people was replaced by another,” said Mahler, who
as WHO chief oversaw the Alma Ata Declaration of 1978 which envisaged health
for all by 2000 through the now-abandoned primary health care approach.
Mahler said that by 1993, the World Bank had decided to give itself a ‘human
mask’ by getting itself into the health sector. Before long, he added,
through sheer financial clout, it had a budget for health larger than that
of the WHO.
Under the new world trading order which emerged with the completion of
the Uruguay Round of talks in Marrakesh, the role of the Bretton Woods
institutions and governments was redefined in a way that hurt those which
state-managed economies.
At another level, patent regimes brought in under the WTO’s
Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement
caused the prices of essential drugs to soar out of the reach of the poor,
already grappling with the commercialisation of health services.
The structural adjustment programmes (SAPs) prescribed by the World Bank
to help countries repay debts only led to retrenchment and steady withdrawal
of funds from social sectors and sounded the death knell for primary health
care.
The articles of the new, post-Cold War WTO even envisaged that many
aspects of SAPs would become legally enforceable, but the idea floundered
through stiff resistance it met at Seattle last year.
Making sense of the legalese for ordinary people was one of the tasks of
the PHA, said Kattrin Lempp of the Brussels-based Medecins Sans Frontieres.
“This is the first time we have had an opportunity to meet and share
perspectives.”
“People from vastly different countries have similar problems arising
out of globalisation,” she said, referring to the personal testimonies
that were a daily feature of the PHA.
“Don’t let them close down the garment factory,” pleaded Farida
Akhtar in one such testimony, referring to the sweatshop she labours in for
a pittance. She says she worries all the time for her small children who
have to be left at home.
From the other side of the globe, Kevin Lafferty, a tough-looking
Scotsman sporting a tartan kilt, broke down when he spoke of chronic
unemployment, which has “driven the once-proud working man of Glasgow to
poke about in the ashes of his dreams.”
Richard Lee Skolnik, a World Bank representative who attended one of the
assembly’s sessions, was treated to a giant montage on which destitute
women had embroidered headlines dealing with the consequences of structural
adjustment in Zimbabwe.
Skolnik denied that the World Bank ever asked for a stoppage of funds for
the social sector in Zimbabwe or anywhere else. He said the Bank only asked
for better governance in countries where “governments have no concern for
their people.”
But Antonio Tujan from the Philippines explained how in his country only
3% of a $1.8 billion programme actually goes into health, and most of that
into projects on women’s reproduction. “I believe that the World Bank
must be dismantled. It must be replaced with an international development
financing agency that truly recognises the objective of equity and genuine
development for our peoples and countries,” Tujan said.
Indeed, some found the people’s charter too weak to make a difference.
“The charter should have nailed the Bank and the WTO down to a
timeframe of, say, two years, in which the Bank demonstrates that it is
moving in the desired direction at least,” said Robin Storr, who chairs
the UK-based MEDACT. But the World Bank, with its 55% domination by larger
shareholders in the North, “will not disappear,” said Skolnik.
Little wonder, then, that suggestions for the “way forward” that came
from hundreds of delegates after the health charter was adopted Friday were
in favour of increased Seattle-style agitation.
Health Care Needs Shot in the Arm, Activists Say
By Ranjit Devraj
SAVAR, Bangladesh, Dec 8 (IPS) - Primary health care must be put back up on
the global agenda, immunising it from damage caused by economic
liberalisation and the privatisation of health services, activists said at
the end of the People's Health Assembly (PHA) here Friday.
Meeting in this remote setting 40 km outside Bangladesh's capital Dhaka, the
activists demanded the restoration of the primary health care approach
adopted at a 1978 international health conference in Alma Ata, Kazakhstan.
The demand is the cornerstone of a ''People's Charter for Health-2000,''
endorsed at the end of four days of deliberations and testimonies by more
than 900 delegates gathered here from 92 countries.
Although the charter reflected the Alma Ata Declaration in many ways, it
sought to remedy setbacks suffered by the global health sector caused by the
more recent processes of liberalisation, globalisation and privatisation
pushed by the World Bank and the International Monetary Fund (IMF).
''Unlike the World Health Organisation (WHO), the World Bank and the IMF are
Bretton Woods institutions and not true U.N. bodies,'' said Halfdan Mahler,
who served as WHO director-general for 15 years and played a key role in
discussions here this week.
Mahler blamed the ''hijacking'' of the global health agenda from WHO by the
World Bank after 1993 and its emphasis on market-driven policies for
deteriorating health services around the world, the main concern of the PHA.
''Governments have a fundamental responsibility to ensure universal access
to quality health care, education and other social services according to the
people's needs, not according to their ability to pay,'' the charter laid
down as a basic principle.
''You can't reverse globalisation, but you can stop people from suffering
its consequences - if large numbers come forward and protest,'' said Prem
John, Asia coordinator of PHA and director of the Asian Community Health
Action Network.
Indeed, activists said public pressure had a role to play in changing the
priorities of global institutions like the World Bank.
Asked how the just-finished PHA can change the Bank, Zafrullah Chowdhury,
programme coordinator of Gonashasthaya Kendra, the assembly's host
organisation, said the mood created by people's movements encourages their
politicians to put pressure on the World Bank and the ‘‘mafia’’,
which now runs it behind closed doors. ''Our aim is to make it (the Bank)
democratic so that every country has one vote,'' he added.
Olle Nordberg of the Dag Hammarskjold Foundation, major donor and supporter
of PHA, said: ''The PHA has wider implcations than health. It helps people
build up their own strategies and provide an important balance.''
The World Bank and the World Trade Organisation (WTO) took a beating from
experts and activists at the PHA 2000 for ''arrogating unto themselves'' the
right to set the world health agenda on hard- nosed business principles
rather than as a people-oriented service.
The charter pointedly said health was ''primarily determined by the
political, economic, social and physical environment and should, along with
equity and sustainable development be a top priority in local, national and
international policy-making.''
''Health should find a prime place. No one has the right to commodify it,''
Abdul Matim Khasru, Bangladesh's minister for law, justice and parliamentary
affairs declared at one of the sessions this week.
Heeding demands set out by the charter was one asking for ''transformation
of the global trading system so that it ceases to violate social,
environmental, economic and health rights of people and begins to
discriminate positively in favour of countries of the South.''
Reforms, the charter demanded, should include intellectual property regimes
such as patents and the Trade Related Aspects of the Intellectual Property
Rights (TRIPS) agreement.
It also asked for firm commitment in the WTO framework to support measures
to protect public health, which Mike Rowson, an economist with the United
Kingdom-based activist group Medact, explained to the delegates are missing.
''While WTO gives individual governments rights to adopt or enforce measures
to protect human, animal or plant life or health, these are not defined,
leaving it open to the danger of prioritising the interests of trade and
restrict definitions considered necessary for public health measures,''
Rowson said.
Rowson said TRIPS particularly affected the rational use of drugs, and
threatened to put essential drugs out of the reach of ordinary people.
''Disputes have already risen over the leeway given through compulsory
licensing and parallel imports,'' he added.
Activists from South Asia, such as Zafar Mirza from Pakistan and Mira Shiva
from India, said the 20-year window given for pharmaceutical companies to
determine global prices for new drugs threatened to affect the control of
diseases such as malaria and hepatitis.
The charter called for radical transformation of the World Bank and the
International Monetary Fund (IMF) so that these institutions reflect and
actively promote the rights and interests of developing countries, and
demanded a reining in of transnational corporations (TNCs).
On social and political challenges, the charter commented that economic
globalisation and privatisation have ''profoundly disrupted communities,
families and cultures.''
''Public institutions have been undermined and weakened. Many of their
responsibilities have been transferred to the private sector, particularly
corporations or to other national and international institutions which are
rarely accountable to people,'' it said.
A special committee of experts communicating with one other over the
Internet for at least two years honed the charter itself, but each section
was put before the delegates to the PHA over the week. At a special session
Thursday, members of the committee heard and accommodated demands by
delegates asking, for example, for a ban on the use of sanctions for
military purposes since it affects the health and social development of
civilian populations.
The charter came down hard on militarist tendencies. ''Increased arms
procurement and an aggressive and corrupt international arms trade undermine
social, political and economic stability and the allocation of resources to
the social sector,'' it said.
The charter also took note of environmental challenges such as water and air
pollution, rapid climate change, ozone layer depletion, nuclear energy and
waste toxic chemicals and pesticides, loss of biodiversity, deforestation,
and soil erosion, all of which affect the health of people.
But most of all, it called for a people-centred health sector and the
provision of universal and comprehensive primary health care, irrespective
of people's ability to pay. ''Health services must be democratic and
accountable with sufficient resources to achieve this,'' it stated.
Finally, activists closed the health assembly with a view to persisting with
their campaign after the meeting and said the PHA plans to function over the
Internet and plans to meet again in two or three years.
Said John: ''It took fifteen years to collect funds (1.7 million U.S.
dollars) for this one but there is momentum now.'' (END/IPS/ap-wd-he/rdr/js/00).
Sent: Tuesday, December 19, 2000 12:12 AM
The People's Health
By Russell Mokhiber and Robert Weissman
Savar, Bangladesh -- More than two decades ago, the nations of the world
issued a call for "Health for all the people of the world by the year
2000," in the Alma Alta Declaration, the product of a World Health
Organization-UNICEF conference.
In 1978, at the time of the Declaration, that goal seemed achievable.
There was serious talk of a New International Economic Order, to begin to
remedy the wealth and technology gap between the global North and South.
Primary healthcare was held "the key to attaining [the] target" of
Health for all.
Now, with 2000 upon us, it is evident that the world failed to turn the
vision into reality.
Earlier this month, approximately 1,500 public health activists from 93
countries gathered at the spirited and historic People's Health Assembly
(PHA) in Bangladesh to assess this state of affairs, and to map the way
forward so that health for all is in fact achieved.
The emerging PHA diagnosis, which focused primarily on healthcare
failures in developing countries, was multifaceted: Governments have failed
to invest sufficient resources and empower localities to assure adequate
nutrition, clean water, maternal and child health care and other components
of primary health care. This governmental failure is rooted in many internal
problems, but especially reflects the budgetary and policy squeeze imposed
by the International Monetary Fund and the World Bank and foreign debt
repayments, as well as the World Trade Organization. Meanwhile,
multinational corporations are pushing a privatization agenda for healthcare
which removes control of crucial health decisions and delivery systems from
the public sphere, where it is subject to popular influence, and often
removes access to healthcare altogether from poor people.
The delegates had an opportunity to passionately denounce the
institutions of corporate globalization when a World Bank representative
attended a session labelled "The World Bank Faces the People." Led
by the Indian delegation, PHA attendees hooted and booed the Bank, chanting
"Down, Down, World Bank, Down Down." They spoke with raw emotion
of Bank projects, which have displaced people from longstanding communities,
destabilizing both societies and public health, and of Bank lending programs
that pushed national healthcare systems in the direction of a
corporate-dominated model.
Primary healthcare remains a top priority, the PHA concluded, but it was
unlikely to be achieved broadly in the absence of fundamental
transformations in the global political economy.
A ‘People's Charter for Health’ issued by the PHA see http://www.phmovement.org/charter/pch-english.html
asserted that health is a human right and that "health and human rights
should prevail over economic and political concerns," and it called for
the provision of "universal and comprehensive primary health care,
irrespective of people's ability to pay."
But the Charter also called for the cancellation of the Third World debt,
major changes at the IMF, World Bank and WTO, effective regulation to
control the activities of multinational corporations and controls on
speculative international capital flows. It also includes provisions on the
environment, war and violence.
The imperative of achieving macro-level transformations did not depress
the delegates. There were more community health workers than professional
policy advocates at the conference, and delegates from developing countries
vastly outnumbered those from industrialized nations.
These delegates were able to relate their own successes to illustrate
what can be achieved, despite enormous obstacles, with determination and
organization.
A. Chintamani, a health worker from a low caste in India, explained how
she learned to wear shoes to prevent hookworm -- despite an expectation that
people in her caste would go barefooted -- and then became empowered to
deliver care even to upper caste persons, who were forced to turn to her,
because she offered the best available care.
Delegates from Cuba related the island's stunning public health
achievements -- with many national health indicators, such as infant
mortality levels, comparable to those in the United States -- in the face of
the U.S. trade embargo. The international audience cheered long and loud for
the Cuban delegates -- in appreciation of Cuba's accomplishments and in
solidarity for its resistance to U.S. aggression.
Most heartening, perhaps, was the example provided by the PHA hosts. The
meeting was held on the campus of Gonoshasthaya Kendra (GK), a Bangladesh
NGO that has constructed a hospital, university and generic drug factory.
Putting the concept of primary healthcare into effect, GK has trained
countless health workers -- mostly women -- to raise health standards in
surrounding villages. It leads the way in supplying care in the wake of
floods and other national emergencies in Bangladesh. GK pharmaceuticals, and
its support for Bangladesh's progressive national drug program -- which has
weathered relentless attacks from multinational drug firms -- have made
essential medicines available to consumers throughout the country.
What GK and other success stories conveyed at the PHA reveal is that it
Is not for lack of resources or knowledge that the world has failed to
deliver on the promise of the Alma Alta declaration. What is lacking is
political will, from the village to international level.
"While governments have the primary responsibility for promoting a
more equitable approach to health and human rights," the People's
Health Charter concludes, it will require people's organizations to force
them to meet this responsibility.
Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime
Reporter. Robert Weissman is editor of the Washington, D.C.-based
Multinational Monitor. They are co-authors of Corporate Predators: The Hunt
for Mega Profits and the Attack on Democracy (Monroe, Maine: Common Courage
Press, 1999).
(c) Russell Mokhiber and Robert Weissman
Volume 356, Number 9247, 16 December 2000
The Lancet
Khabir Ahmad
Policy and people
People's Health Assembly debates effect of globalisation on health care
The inaugural meeting of the People's Health Assembly (PHA; Savar,
Bangladesh; Dec 4-8), endorsed a People's Charter for Health, which calls
for "health for all" based on the abolition of all forms of
political, social, and economic barriers to equitable health.
The Charter demands that primary health care be put back on the global
health-care agenda. Patients should be protected from the damage caused by
World Bank-initiated economic liberalisation and the privatisation of health
services, it adds. "Governments have a fundamental responsibility to
ensure universal access to good quality health care, education, and social
services according to people's needs, and not according to their ability to
pay", says the Charter.
PHA represents community-based health groups, non-governmental
organisations, and civilians, and gathered 900 participants from 92
countries. The meeting is considered to be an alternative forum for
discussion of global health needs and a counterbalance to the WHO's World
Health Assembly. "Health for all", says the Charter, means that
"powerful interests have to be challenged, globalisation has to be
opposed, and that political economic priorities have to be drastically
changed".
Halfdan Mahler, WHO's former director-general accused the World Bank of
hijacking the global health agenda from WHO and of pushing market-driven
policies, which he said, are the main reason for the deterioration of health
services around the world.
"If WHO is to survive effectively, it has to take the leadership
role in health. It can't leave it to the World Bank or to transnational
corporations", says Zafrullah Chowdhury, programme coordinator of
Gonashasthaya Kendra, the organisation hosting the PHA.
In an address to the PHA, Richard Skolnik, a World Bank representative
admitted that the Bank's structural adjustment policies had not paid
attention to the impact on the poor. But he denied that the Bank recommended
wholesale privatisation of health-care services. He argued that the Bank was
the largest lender for programmes to control diseases like HIV/AIDS,
tuberculosis, malaria, and polio
The Charter urges the need for popular public movements that could
pressure governments to recognise health as a fundamental human right and
for transformation of the global trading system so that it stops violating
social, environmental, economic, and health rights of people and begins to
discriminate positively for southern hemisphere countries. The Charter also
calls for cancellation of third world debt, radical transformation of the
World Bank, IMF, and WTO, and the effective regulation of transnational
corporations.
The assembly also demands reforms of patent laws and the Trade Related
Aspects of the Intellectual Property Rights (TRIPS), which according to Mike
Rowson, an economist from UK, has particularly affected the rational
distribution of drugs, and threatened to put essential drugs out of the
reach of ordinary people.
James Orbinski, President of Médecins Sans Frontières's International
Council, also noted that one of the reasons why more than more than 90% of
all deaths and infections by malaria, tuberculosis, sleeping sickness, and
HIV/AIDS, occurred in developing world was that life-saving essential
medicines were too expensive because of patent protection.
HEALTH FOCUS/AFRICA: Continent's Health Systems Collapsing
By Lewis Machipisa
HARARE, Dec 1 (IPS) - The gospel, according to the clergy at the Bretton
Woods institutions preaching the message of economic reform, is that it is
easier for a slim government to find salvation than a fat one.
And as many countries try to adhere to this orthodoxy, governments are
transforming from centrally planned to market-oriented economies. This shift
has seen a collapse in most of the social services provided by the
governments.
Hardest hit is the health sector. There are clear indications of growing
inequities in health and health care in Africa. These indicators often seem
to be ignored and are persistently downplayed as African governments
implement policy changes that affect public health.
When Professor Norman Nyazema attends the People's Health Assembly 2000, to
be held in Bangladesh next week, his message will be: ''involve the poor if
health programmes are to succeed''.
One of the criticisms of primary health care as a route to achieving
affordable universal coverage - the goal of health for all - is that it
provides little attention to people's demands for health care, says Nyazema
who is the co-ordinator for Consumers International Regional Office for
Africa (CI ROAF), one of the conference's organisers.
Nyazema notes that as a result of this neglect, health programmes in Africa
have concentrated almost exclusively on the perceived needs of grassroots
people.
''Systems in Africa have failed because these two concepts did not match and
the supply of services offered could not possibly align with both,''
explains Nyazema, who is also with the Institute of Continuing Health
Education in Zimbabwe.
''What we now see happening is that only the simplest and most basic care
for the poor, rather than all possible care for everyone, which means
delivery to all of high-quality essential care, defined mostly by criteria
of effectiveness, cost and social acceptability.''
Nyazema calls for the promotion of equal utilisation for equal need, a
demand which would involve devising a system whereby use of health services
would be allocated ''pro rata'' with need and demand.
''A health system will have to adopt either a demand or a need stance in
order to ensure equity in health, at least at a primary health care level,''
says Nyazema.
''The intensifying struggle around scarce health resources in many African
countries requires the recognition that equity needs to define and build a
more active role for important stakeholders in health, including
communities, health providers and funders,'' he adds.
Genuine, people-centred initiatives must be strengthened to find innovative
solutions and to put pressure on decision makers, governments and private
sector.
''Grassroots organisations in Africa need to form coalitions dedicated to
changing the prevailing ailing health care delivery systems,'' suggests
Nyazema.
This is one of the themes of the Bangladesh People's Health Assembly. More
than 1,000 NGO and health activists from 90 countries in Asia, Latin
America, Africa will be participating. The meeting is organised by activists
and health workers and will explore preventive health approaches;
investigate the effects of globalisation on health funding and policies; on
the privatisation of health, and the links between poverty and health, and
war and health.
Other areas will be the issue of access to drugs, patent rights, bio-piracy,
and the politics of research funding.
While globalisation has brought with it huge benefits, some obligations and
commitments for implementation of the agreements under the World Trade
Organisation (WTO) have a negative impact on the health sector in Africa.
The cost of health services, in general, has increased beyond the capacity
of most African countries and the gap between the developing and developed
countries is widening.
A case in point is the WTO Treaty on the Right to Intellectual Property
(TRIPS) which provides that companies that register patents for products or
manufacturing processes have a 20 year protection period.
In the field of medicines, for example, this means that for drugs that fall
under TRIPS, governments may not import them from another, possibly cheaper
source or license them as necessary for public health and thus buy them from
another supplier.
For example, Zimbabwe has an essential drugs list for its major diseases.
These ''essential drugs'' are exempt from TRIPS provisions. However, many
new drugs not yet on the essential drugs list would be covered by TRIPS.
Amongst these are drugs for the treatment of AIDS related diseases, such as
AZT.
''While some argue that protecting patents will encourage drug companies to
invest in developing countries, patents raise a serious problem for
developing countries: whether the drug is covered by patent or not makes a
big difference to its price,'' says Rene Loewenson of Zimbabwe's Community
Working Group on Health.
Fluconazole is a drug used to treat AIDS related diseases, such as
styptococcal meningitis. It costs 70 US cents a day in Thailand and 20 US
dollars a day in Kenya. In Thailand it is not patent protected. In Kenya, it
is. In Zimbabwe, the drug costs the same as in Kenya.
''Trade liberalisation is increasing the marketing of harmful products at
the same time as it is limiting government rights to control it,'' says
Loewenson.
''Public sector cutbacks and privatisation of health services are leaving
many poor people without access to quality health services, while the
wealthy get costly private care.''
Says Nyazema: ''today and everyday, the lives of the African people, to a
large extent, lie in the hands of health systems inherited from their
colonial masters.''
''At the time of their evolution the health care was implemented primarily
to cater for colonial administrators and expatriates, with separate or
second-class provision made, if at all, for Africans,'' says Nyazema.
''The systems so evolved, however, now have a vital and continuing
responsibility to the people throughout their life span and are crucial to
the healthy development of individuals, families and societies in Africa,''
says Nyazema. ''This inevitably makes health care a practical as well as a
political issue.''(END/IPS/lm/sm/00)
World Bank's Cures Hurting Nations - Critics
By Ranjit Devraj
SAVAR, Bangladesh, Dec 7 (IPS) - The World Bank and its market- driven
health policies are getting the ire of health activists and experts here,
who say the Bank's cures are harming the developing- country patients they
seek to help.
Criticism of the bank and health priorities driven by the market peaked has
been a key theme of the ongoing People's Health Assembly (PHA) here, but
peaked during a stormy face-off Wednesday.
At that session between the World Bank and health activists, Bank
representative Richard Lee Skolnik was treated to the display of a giant
cloth montage with brightly embroidered newspaper headlines, which told
stories of the harmful effects of the Bank's structural adjustment programme
(SAP) in Zimbabwe.
The headlines spoke of rising food prices, increasing crime, and labour
retrenchment.
These, presenter Mary Sandari said, are the direct result of the country's
acceding to SAP to pay back its debts as directed by the bank.
Skolnik responded by saying the Bank only asked Zimbabwe to manage its
economy soundly and did not tell it to cut funding to the social sectors.
Another by Hugo Icu, a doctor from Guatemala who outlined the collapse of
primary health care in his country as a direct consequence of his government’s
following the Bank’s prescriptions, followed Sandasi’s presentation.
Skolnik said the World Bank's health policies were helping poor countries
like India fight leprosy, polio, tuberculosis and HIV/AIDS.
But at this remark, angry delegates to the health assembly shouted ''get
out'' and chanted ''no, no,'' until PHA project coordinator Zafrullah
Choudhury threatened to call off the week- long PHA which ends Friday.
Skolnik was not allowed to finish his presentation, but instead heard
activists telling the Bank about the need to restore the primary health care
approach promoted since the 1978 ''Health for all Declaration'' at an global
meeting at Alma Ata, Kazakhstan.
Critics say the global pledge set at that meeting -- which included primary
health care for all by 2000 -- have now all but been scuttled by the Bank's
approach which deprives developing- country budgets of funds for social
sectors.
''We don't want charity but justice,'' said Charles Mutasa, a panellist from
Zimbabwe, adding that the Bank's approach has driven many African countries
into a debt trap as a result of the new global economic system.
Mutasa spoke of ''exogenous'' factors that made debt repayment difficult,
such as floods, corruption and civil strife, the last of which ''the west
was so good at pioneering.''
To this, Skolnik explained that ''there was no substitute for good
governance'' and that the Bank should indeed be ''hit hard'' for lending
money to bad regimes.
But Antonio Tujan, an activist from the Philippines, disputed the assertion
that Bank funds went into social sectors. In his country, he said, less than
three percent of its loans actually went into public health.
''Most of the money goes into projects like the Subic freeport,'' he said,
referring to a vast infrastructure project for business at a former U.S.
military bases, north of the capital Manila.
Looking at the effects of economic 'reforms' on health, Tujan said there has
been ''progressive destruction of the people's health agenda'' by the
private corporatisation of health services, which has a curative rather than
a preventive approach.
As things stand, Tujan said, he wonders if ''no medicine is better than bad
medicine.''
A panellist from Australia, David Leggae, said that although the Bank's
'Wealth through growth which would trickle down' approach provided the
rationale for neoliberalism and structural adjustment, it was also
responsible for economic polarisation and increased mortality.
There are too many fundamental flaws in the Bank's approach, he said, since
it is based on the idea that ''consumption could be maintained by increasing
debt'' and that an economic crisis could thus be deferred.
Basically, Leggae adds, the game is one of maintaining the stability and
wealth of the North at the cost of the well-being and health of the South.
He said the Bank, the International Monetary Fund, the World Trade
Organisation (WTO), news corporations, money markets and rating agencies,
among others, backs this game.
Leggae adds that the only counteraction available to the ''unfair'' global
trade regime, which transfers wealth to the North at the cost of social
sectors in the South, is popular mobilisation like the recent ones seen at
trade and economic meetings in Seattle, Geneva, Melbourne and Paris.
He says also that people's understanding of regulatory regimes and
governance structures in the global system is ''essential to demand a global
trading system which discriminates positively in favour of poor countries.''
Leggae advised the Bank to ''apologise for deaths and suffering caused by
structural adjustment and stop claiming privileged access to divine truth,
and acknowledge that embedded in its recommendations were its core
constituency -- the privileged West.''
Interventions from the floor were even more biting. ''There is an easy way
out of all this -- the World Bank and IMF have enough resources to cancel
debts,'' said Robert Weissman, co-director of the U.S.-based group Essential
Action.
''The World Bank's own case studies showed that in the last 20 years it had
made no effect even on a single district in India,'' pointed out Ravi
Narayan from India, the Bank's biggest borrower.
Narayan said while the World Bank may not directly ask for cuts in social
sectors, its adjustment programmes inevitably led to governments to take on
adverse fiscal policies, including inadequate financial allocations for
capital and recurrent costs for the social sectors.
These same policies led to shortages in health equipment, drugs and
facilities, which happened in India, Narayan says. In turn, deteriorating
conditions bring down the performance of health personnel, said South
African David Sanders.
Commenting on the discussion, Halfdan Mahler, the architect of the primary
health care approach as director general of the World Health Organisation
(WHO) from 1973-1988, told IPS that the Bank was again ''postponing the
coming explosion'' through its untenable positions.
Mahler blamed the World Bank's ''hijacking of health'' from the WHO in 1993
and the abandonment of the primary health approach for the crisis in public
health management, especially in developing countries. (END/IPS/ap-he-wd/rdr/js/00)
Time to Put U.N. Back on Track, Activists Say
By Ranjit Devraj
SAVAR, Bangladesh, Dec 5 (IPS) - The United Nations system has stumbled off
the track of equitable development and now needs to be put back on that
path, activists at an international health meeting here said Tuesday.
Indeed, this was the uppermost concern of some 600 delegates at the second
day of the People's Health Assembly (PHA) held in this remote town 40 km
outside Bangladesh's capital, Dhaka.
Economic policies around the world are now being shaped not by the United
Nations, but by international financial institutions like the International
Monetary Fund (IMF) and the World Bank (WB), said professor Mohan Rao from
India's Jawaharlal Nehru University.
These, in turn, are having adverse effects on health and health services, he
adds.
Rao said the situation was created by countries like the United States
staving off falling profit rates and unemployment at home by using its clout
with the IMF and the Bank to open up markets in developing countries.
These pressures prod countries to liberalise economic policies to a more
''efficient'' one. In the process, they change a system of state control
designed to ensure equitable distribution of income -- with disastrous
consequences for poor people.
However, Rao says, this same situation is leading to movements for change at
many levels, local, national and international, including the present
People's Health Assembly from Dec. 4-8.
''Powerlessness is being addressed through a range of movements that
organise in a representative and accountable manner giving a voice to the
voiceless,'' he added.
Goran Sterky, who successfully led the international campaign to promote
breast-feeding against the interests of baby food manufacturers, says that
the U.N. system is often in cahoots with power elites in many developing
countries.
Thus, he says, activists could act by ''blowing the whistle'' on deals that
were inimical to the people.
Sterky said Sweden's Dag Hammarskjold Foundation, for which he now works, is
already using its access as well as the academic freedom it enjoys in its
home country to draw attention to profit-hungry policies detrimental to the
interests of the people.
''We are not against the U.N. system but it happens that decisions on
serious issues, including those that concern the health of the people, are
not taking place within a world body that is now operating under a unipolar
system,'' he said.
Sterky says he and his foundation were not against free trade and
liberalisation, but ''we only want to minimise its side-effects.''
He suggested as a remedy a restructured ''tricameral'' United Nations -- one
in which government and business, which now dominate the present system,
become answerable to a third house, that of the people.
According to Nadine Gasman, one of the organisers of the PHA, the world is
now struggling with a gross miscalculation on the part of the advocates of
liberalisation who believe that long-term economic gain would offset
short-term social cost.
''What they did not foresee was that the social impact could itself
frustrate the desired economic effect,'' she added.
''Globalisation expands the opportunities for unprecedented human advance
for some, but shrinks those opportunities for others and erodes human
security,'' Gasman said.
David Werner, founder of the International People's Health Council (IPHC),
said the World Bank's takeover of health planning and its recommendation of
privatisation and cost-recovery schemes had clearly pushed health out of the
reach of the poor.
Oral testimonies given at the PHA conference here show how the
liberalisation of economic policies at the international and national level
hurt health at the local level.
For instance, Mwajuma Saiddy of Tanzania told of a case where the pressure
on health care centres to show profit meant the denial of services to the
needy, and where awareness of health rights could have made a difference.
When a pregnant woman in Naikesi village in Sonega district went to a
primary health care centre, she was turned away by the health worker who
said he was ''not allowed to treat her for free.''
The woman went home, where she and her unborn child later died. There was in
fact a provision for payment to be waived for pregnant woman and children,
but neither the health centre nor the woman knew of it.
The case of India also shows how, despite the praises it earns for
''economic reforms'', it has actually been cutting down its health budget
since embarking on liberalisation and structural adjustment in 1991.
This has had disastrous consequences for health delivery in the country and
crippled the work of primary health centres, which are left without
medicines or doctors, says Isher Judge Ahluwalia, an economist and
commentator on economic policy.
American economist Jeffrey Sachs previously said that the two percent of GDP
India now spends on health is grossly inadequate and should be at least five
percent.
Werner's prescription is to get people to understand how the Bank and IMF
put the squeeze on poor countries to keep paying huge interest on foreign
debts and how structural adjustment have forced cutbacks on public services
-- making poor families pay for health care and schooling.
''People need to understand who is responsible for the decisions that
allocate vast amounts of money for weapons, pet food, tobacco, golf courses
and trips to the moon, when millions of children do not get enough to eat,''
argued Werner.
He says the present situation is the direct result of the World Bank taking
over the World Health Organisation's role as the world leader in health
policy planning. ''The takeover was powered by money and the World Bank's
health budget is now triple that of WHO's total budget,'' he added.
The result, Werner says, is that health care is no longer a human right.
''You pay for what you get. If you are too poor, sick and hungry to pay,
forget it.'' (END/IPS/ap-wd-he/rdr/js/00)
Globalisation Hazardous to Public Health
By Gustavo González
SANTIAGO, Dec 1 (IPS) - The globalisation process has a negative impact on
public health in Latin America, according to the diagnoses and proposals
regional delegates are taking to the international People's Health Assembly
(PHA 2000) next week in Bangladesh.
In response, the region has seen initiatives arise from the civil society
rooted in the belief that Latin Americans, in the realm of health, can no
longer allow themselves to be victims, but must instead take action to
improve their circumstances.
The PHA 2000, to be held Dec 4 to Dec 8 in Gonoshasthaya Kendra, Savar, 37
km north of Dhaka, will unite 600 delegates from non-governmental
organisations (NGOs) from around the world, including representatives from
Latin America and the Caribbean.
The central proposal of the conference is popular participation in health
policies and systems, based on the idea that ''health is a fundamental human
right that cannot be exercised without a commitment for equality and social
justice.''
According to the People's Health Assembly working group, globalisation
entails social inequalities worldwide.
At the same time, the process consecrates the power of a few entities, such
as the World Trade Organisation, World Bank, International Monetary Fund and
transnational corporations.
While some people live amid excessive consumption, which damages their
health and the world's ecosystems, millions suffer hunger and deprivation.
This global socio-economic system is as unsustainable as it is inequitable,
according to a discussion document for the Bangladesh meeting.
The critics of globalisation in Latin America also question of the impacts
of this process on health, often occurring as a result of the indiscriminate
liberalisation of trade and of the movements of the workforce, driven by the
deterioration of labour and environmental situations.
The Latin American consumer rights movement, which held its fourth
conference in October 1999 in Panama, indicated that privatisation within
the health sector, imposed by new economic policies, ''tends to exclude the
low-income sectors from quality medical attention.''
In a report published in May, the Economic Commission for Latin America and
the Caribbean (ECLAC) said, based on a 1999 study, 83.6 million residents of
the region lacked access to health services.
ECLAC, a United Nations regional agency, reports that out of the
approximately 500 million Latin Americans, 217.8 million are outside of any
social security system, meaning that medical attention depends exclusively
on the now-reduced government sector.
The same study establishes that 17 percent of all births in Latin America
occur without a health professional present, which reinforces, by extending
that figure to the broader picture, the fact that more than 80 million
people do not have access to health services.
The deterioration of health conditions in the region and the negative impact
of globalisation are evidenced by the resurgence of diseases once thought to
have been eradicated, such as malaria and smallpox, and of epidemics, such
as dengue in Central America, which reappears with renewed virulence.
The consumer rights conference in Panama issued a warning about the lack of
education and information programmes on the functioning of public health
services and on users' rights, as well as the lack of participatory
mechanisms in the design of health policy and projects.
Citizen monitoring of public and private health services is one of the
fundamental demands made by consumers in the region, and will be shared with
the delegates from the rest of the world at the PHA in Bangladesh next week.
Concerns about health attention also cover the lack of access to
medications, due as much to costs as to geographical and cultural factors.
One of the most often cited worries, which links health with globalisation,
is related to the growing presence of transnational corporations in the
pharmaceutical business, with widespread imports of medicines whose quality
has not been duly certified.
Health and the environment are also intertwined in the NGOs' actions against
genetically modified organisms and in the campaigns launched against the use
of pesticides and other toxic chemicals for agricultural or industrial
purposes.
One of the policies promoted in Latin America over recent years to confront
the health sector crisis has been to decentralise services, says Mexican
physician René Leyva, a professor of social medicine.
But its results so far have been mixed and even contradictory, as in many
cases the implementation of such measures is accompanied by profound
financial crisis in public health systems.
''Under these condition, we turn to participation as one strategy to
directly or indirectly finance health services,'' said Leyva.
''Another frequent occurrence is that decentralisation turns into an end in
itself... However, though scant, there is also evidence that (decentralisation)
has contributed to legitimising local demands and occasionally providing
people with greater control over health services,'' he added.
For the organisers of the People's Health Assembly, the priorities are
initiatives and actions led by the communities themselves, in terms not only
of pressuring the authorities, but also of creating their own responses in
the areas of education and health.
The Piaxtla project in Mexico is considered one of Latin America's standout
experiences in this area. Begun in the 1960s, it operates through health
workers who provide education in the poorest regions in practical approaches
to resolving the community's problems.
The Child-to-Child programme is another successful initiative underway in
Central America and Asia, taking place through the schools, where children
learn to share knowledge and efforts in taking care of their own health.
(END/IPS/tra-so/ggr/mj/ld/00)
Reviewing Another Broken Promise
By Marwaan Macan-Marka
MEXICO CITY, Dec 1 (IPS World Desk) - By this year, another global pledge
was to have been achieved: primary health care for all.
Such care was deemed essential to enable all citizens of the world ''to lead
socially and economically productive lives'', states a document from the
landmark international health conference in Alma Ata, Kazakhstan in 1978,
where the pledge was made.
But as 2000 draws to a close, it has become clear that both the governments
and the international community that backed the Alma Ata Declaration have
fallen far short of meeting their obligations. And an international health
conference to be held in Bangladesh from Dec. 4-8 - the People's Health
Assembly (PHA) - provides an opportunity for health experts, researchers and
activists from over 90 countries to ask why another set of promises were
broken.
But where should such a review begin?
Access to safe water and basic sanitation serve as a useful point of
departure, given what was stated in the Alma Ata Declaration. It identified
the ''provision of an adequate supply of water and basic sanitation'' among
the essential features to secure the promise of 'Health for All by 2000'.
Yet, according to the findings in a report, released by the World Health
Organisation (WHO) and the United Nations Children's Fund (UNICEF) last
month, close to 1.1 billion people in developing countries do not have
access to ''an improved water supply''.
In addition, around 2.4 billion people still do not have ''any acceptable
means of sanitation''.
Such deprivation results in 4 billion cases of diarrhoea in the world every
year, ''with 2.2 million deaths, mostly among children under five'', note
the authors of the report, 'The Global Water Supply and Sanitation
Assessment 2000'.
For Gro Harlem Brundtland, the director-general of the WHO, and Carol
Bellamy, the executive director of UNICEF, this situation is tantamount to
being denied ''basic human rights''.
''Access to safe water and to sanitary means of excreta disposal are
universal needs and, indeed, basic human rights,'' they state in the
introduction they jointly wrote for the report. ''They are essential
elements of human development and poverty alleviation and constitute an
indispensable component of primary health care,'' they added.
Yet, as the Global Assessment reveals, such essential features remain a
luxury for a large slice of the world's rural and urban poor.
In Africa, for instance, close to 30 percent of the rural water supply
systems do not function, while in Asia, it is 17 percent, and in Latin
America and the Caribbean, four percent.
Regards sanitation, only 35 percent of the wastewater is treated in Asia,
while in Latin America, it is 14 percent. And in Africa, ''only a negligible
percentage''.
For Dr. Richard Jolly, who heads the Water Supply and Sanitation
Collaborative Council (WSSCC), a Geneva-based international organisation,
such widespread lack of sanitation is inexcusable.
''It is shameful, a scandal that almost half of the world's population does
not have access to adequate sanitation,'' he is quoted as having said in a
WHO media release.
According to the WSSCC, if the prevailing scenario is to be reversed, a
''people-centred approach'' needs to be followed, thus ensuring greater
public involvement in decision-making. And already, the WSSCC has two
success stories to serve as models under its 'Water for People' initiative.
''In the Indian state of Gujarat, for example, we have shown that rolling
out water and sanitation services according to the precepts of (the 'Water
for People' initiative) has had a dramatic impact on the health and
well-being of the state's citizens,'' says Jolly.
Furthermore, he adds, it has also brought down the costs of ''improved water
and sanitation services'' and mobilised ''local resources to handle local
problems''.
In Uganda, on the other hand, the initiative has been led by non-
governmental organisations (NGOs) in the water and sanitation sector.
Consequently, it has resulted in communities drafting a blueprint to satisfy
their needs for safe water and adequate sanitation.
''Their recommendations were divided between those actions which the
communities could do themselves, and those requiring external assistance,''
states a WSSCC report.
According to David Sanders, however, such initiatives to combat water-borne
diseases do not sit well with the health care industry, given its emphasis
on the ''curative aspects'' of health.
And he argues, furthermore, in a background paper prepared for the PHA in
Bangladesh, that such logic has also been embraced by public health policy
makers.
''Hence, oral rehydration therapy for diarrhoea management is proposed as an
essential component of a core health package while water and sanitation,
which have indirect and less easily quantifiable impact on diarrhoea, are
deemed 'cost-ineffective' and therefore not recommended as an area for
public sector investment,'' writes Sanders, the Africa regional co-ordinator
of the International Peoples Health Council.
So the PHA provides a useful forum for members of the health community in
the developing world to question such thinking, consequently helping to
secure the right to safe water and basic sanitation for all. (END/IPS/HE/mmm/da/00
BMJ 2000;321:1361-1362 (2 December )
Editorials
The People's Health Assembly
Revitalising the promise of "Health for All"
In 1978, 134 health ministers from around the world signed the Alma Ata
declaration that set a deadline for the year 2000 for achieving a level of
health that would enable all of the world's people to "lead a socially
and economically productive life."1 The strategy to achieve the goal
would be the implementation of primary health care, with its emphasis on
community participation, and tackling the underlying causes of diseases,
such as poverty, illiteracy, and poor sanitation. This week, at Gonoshasthya
Kendra People's Health Centre (whose pioneering work formed a case study for
the Alma Ata declaration), a People's Health Assembly will convene to
discuss the failure to achieve "Health for All," and plan what to
do next.
Much of the problem lies in the persistence of poverty and a continuing
lack of effective health services. Average per capita incomes in sub-Saharan
Africa are lower than they were at the end of the 1960s, and half of the
region's population must now survive on less than 40p (56 cents) a day.2
AIDS is ravaging a continent beset by rising levels of malaria and
tuberculosis; many health services have collapsed. Child mortality is no
longer dropping and in some cases the trends have been reversed. Despite
important gains in political freedom in the countries of the former Soviet
bloc, the transitions to market economies have often had disastrous
consequences and are estimated to have resulted in nearly three million
deaths.3 Latin America and east Asia have endured the fallout from economic
crashes, and south Asia has extremely high levels of malnutrition,
deprivation, and disease.4 Poverty and widening disparities in income remain
a cause for concern in industrialised countries, even as national wealth
continues to grow. Worldwide 800 million people still lack access to health
services.4
But despite an abject failure to reach the target, we should not ditch
the principles laid down at Alma Ata. Its principles were already being
applied in several countries before the declaration was written, with
impressive gains in life expectancy and other health indicators in Sri
Lanka, China, Cuba, Zimbabwe, Costa Rica, and Malaysia.5 Other studies have
shown the importance of community participation in health and demonstrate
its ability to reach the maximum number of people, particularly the poorest
and most vulnerable.6
Yet sadly lip service has too often been paid to the principles of the
Alma Ata declaration while in reality primary health care has been starved
of resources.5 The People's Health Assembly hopes this will change. A
process before the assembly has gathered case studies and analysis of how
primary health care can be successfully implemented and the threats it
faces; at this event this learning experience will continue at 200 workshops
presented by participants at regional and national meetings. But perhaps
most importantly, it aims to kick off an advocacy movement that will defend
people's right to health and ensure that the vision of Alma Ata becomes a
reality.
Such a movement is badly needed: new threats to health are continually
emerging. Globalisation has been accompanied by an increase in income
inequalities between and within nations4-7 and has left governments weak and
cowering under fiscal constraints. Basic principles for financing and
providing universal health care are under threat everywhere as health care
becomes a commodity and the private sector moves in.8 Drastic environmental
problems, such as the changing climate and the depletion of the ozone layer,
threaten essential life supporting systems and are likely to hurt poor and
marginalized people first.9
Virulent diseases emerge and re-emerge. Action by everyone concerned with
health is needed on all these fronts.
At the international level the World Health Organization could still act
as a beacon of hope in turbulent times, just as it did in 1978. But its
position has been weakened over the past two decades, and other
organisations, most notably the World Bank, have taken the lead in
formulating international health policy, sometimes with malign effects. The
WHO needs to assert its principles once more. As a start it could encourage
governments, non-governmental organisations, and international agencies to
work towards a vision of health for all; stress the need for partnerships
between health care and other sectors; and advocate the need for major
investments in health, especially increases in human resource development,
without which the Alma Ata declaration will remain a statement of intent.
The WHO's partnership with transnational pharmaceutical companies needs
to be re-examined, as the inclusion of industry representatives on critical
policy committees especially the drug pricing, vaccine production, health
care costing, and selection of the essential drugs lists rightly viewed with
suspicion. The WHO must be an open and democratic organisation that can also
respond to the grass roots: listening to the people should not be difficult
for Gro Harlem Brundtland, a former politician, and it is regrettable that
she is not attending the People's Health Assembly. Her success as director
general depends on the growth of popular health movements all over the
globe, which will be able to back up her call to make health central to the
development process.10
As a result of the assembly, we hope to see the formulation of advocacy
agendas at local, national, and international levels, as well as an increase
in the sharing of knowledge and experience between people committed to the
principles of primary health care. Above all we feel it is critical that the
assembly assembles broad-based networks for change, which can implement the
vision of Alma Ata more effectively. We hope that the Assembly will prove to
be a significant step towards revitalising the powerful vision of
"Health for All" and we encourage everyone who shares our fears
and aims to join us.
Zafrullah Chowdhury, projects coordinator.
Gonoshasthaya Kendra, P O Mirzanagar, Savar, 1344-Dhaka, Bangladesh
Michael Rowson, assistant director.
Medact, 601 Holloway Road, London N19 4DJ, United Kingdom ( mikerowson@medact.org )
-
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Cornia GA, Paniccia R. The transition mortality crisis: evidence,
interpretation and policy responses. In:
Cornia GA, Paniccia R, eds. The mortality crisis in transitional
economies. Oxford: Oxford University Press, 2000 p3-37
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UNDP. Human Development Report 1997. In: Oxford: Oxford University
Press, 1997
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Mehrotra S. Health and education policies in high-achieving countries:
some lessons. In: Mehrotra S, Jolly R, eds. Development with a human face:
experiences in social achievement and economic growth. Oxford: Oxford
University Press, 2000 p63-112
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Rohde J, Chatterjee M, Morley D. Community Health and Development. In:
Rohde J, Chatterjee M, Morley D, eds. Reaching Health for All. Delhi: Oxford
University Press, 1993 p.7-9
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Cornia GA. Liberalisation, globalisation and income distribution.
United Nations University World Institute for Development Economics
Research, Working Paper 157, March 1999
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Turshen M. Privatising health services in Africa. New Brunswick:
Rutgers University Press, 1999.
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United Nations Development Programme. Human Development Report 1998.
Oxford: OUP, 1998
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World Health Organization. Health: a precious asset - accelerating
follow-up to the World Summit for Social Development. Geneva: WHO, 2000.
© BMJ 2000
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