Health Focus/Development: Reviewing Another Broken Promise - Media Coverage
Health Focus/Development: 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 blue-print 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
