PHA-Exchange> POVERTY, EQUITY AND HEALTH

[Aviva]

From: Firoze Manji <firoze at fahamu.org>
                                  <EQUINET-Newsletter at equinetafrica.org>


> POVERTY, EQUITY AND HEALTH IN SOUTHERN AFRICA
> R Loewenson, T Maistry, TARSC, Zimbabwe
>
> In 2000, EQUINET commissioned a policy review of experience concerning
> household ability to cope with the resource demands of ill health and
health
> care utilisation. A review of experience was called for concerning
household ability to cope with the resource demands of ill health and health
care utilisation.
>
> The September 2001 Regional Equinet Conference noted  that economic
measures to be takenby countries should include human development goals, and
efforts be made to reduce the disproportionate burden of poverty and ill
health borne by women.   While in part this implied including the meaningful
participation of the poor in decision-making within health systems through
representation, transparency in procedures, incorporation of community
perspectives in planning and strengthening community capacities, this needed
to be backed by  evidence on deprivation due to inequitable resource
allocation decisions, and to not prioritising primary health care,
especially when budgets are cut.
Deprivation indicators need to be incorporated into monitoring systems to
assess the links between household health,  poverty and healthcare and the
coping strategies
> used at household level.
>
> EQUINET put out a grant and called for proposals to review evidence of
poverty, equity and health links in Southern Africa, the  extent to which
these have been included in Poverty Reduction Strategy Processes and the
implications for EQUINET and for pro-poor health policies.  The grant was
awarded to Patrick Bond of Wits University.
>
> A draft outline of the review paper has been submitted. An otline is
summarised here for feedback from readers that can be reflected in the final
paper.
>
> The paper T"he impact of globalisation and neo-liberal economic policy on
> social services health status for different communities", is based on
evidence
> largely drawn from South Africa.   Analysis of   public health expenditure
> patterns, cost recovery provisions, healthcare utilisation rates and
health
> status indicates a correlation between ill health and a decline in social
> service delivery along with the increasing health burden of
impoverishment.
> The paper  critiques what it terms 'micro-neoliberalism'  or the
application
> of cost-recovery in health systems, drawing largely from evidence from
> municipal water/sanitation and electricity cost-recovery, noting
> associations with public health as reflected in cholera outbreaks and the
> susceptibility to HIV infection.
>
> The evidence of  these elements of anti- rather than pro-poor public
policy
> linked to economic policy is used as a basis for the critique of  a
'forked
> tongue' speak  in Poverty Reduction Strategy Programmes (PRSPs) and Highly
> Indebted Poor Country (HIPC) initiatives. While these call for
> 'participation and empowerment', they maintain such neoliberal economic
> models that undermine health -equity and do not enable  efforts to deal
with
> underlying causes of inequity. Whether global, international  or national,
> policies based on economic liberalisation are here critiqued as
undermining real
> measures needed to build pro-poor public health systems. The paper also
> warns that  aid for the health sector should be examined for
conditionalities that  can spur inequities.
>
> In contrast, the paper argues that dealing with poverty - equity links
call
> for a much wider overhaul of  policies on trade, debt and public
financing.
> It is argued that work on health equity should link with campaigns around
> these issues, and that in particular health professionals in Equinet
should
> link with social activists and broader development partners to raise and
> advance health equity concerns within wider economic and trade related
> campaigns.
>
> The paper will in its further redrafting look more closely at the content
> and process of the PRSP processes in Southern Africa and neighbouring
states
> to identify the issues and lessons from these processes, and highlight
more
> concretely the implications for w wider pro-poor public health strategy in
> Southern Africa.
>
> What comments do you have on the issues raised in this outline?
> What poverty-equity related policy issues or concerns are not yet
reflected
> in the paper?
>
> To what extent does the experience raised have / not have wider regional
> relevance in Africa, particularly for rural and urban communities
> facing poverty and deprivation and what is the evidence for this?
>
> What  comments do you have on strategic areas for Equinet to follow
> up work on poverty and health equity ?
>
> The full paper when completed by July will be available on the equinet
> website www.equinetafrica.org
>
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