PHA-Exchange> Food for thought reactions

[Aviva]

From: "DBanerjee" <nhpp at bol.net.in>
 [excerpts]

 It is my conviction that health activism must have solid scientific
foundations. I thank you, Claudio, for taking initiative in raising some
important issues in your `food for thought' pieces. I hope other concerned
readers will also respond to the ideas put forward by you. I am contributing
some additional `food':

> 1. You have defined and discussed the 'four Es': equality, equity, ethics
and  efficiency. Your are perhaps aware that there are different views on
these definitions. These terms have gained currency during the past decade
or so, apparently to cover-up the retreat  from the commitments made in the
Alma Ata Declaration. This becomes
 apparent when one relates these lofty principles to the actual ground
situation prevailing among the poor of the world. Preoccupying oneself with
such refined discourses amounts to a cruel joke on the helplessness of
hundreds of millions of the world's poor who do not get  critically needed
health care potable water, sanitation and housing. To what extent
 have all the learned debates on equality, equity and ethics contributed to
improve the health status of these people? The learned debates become not
only futile, but also downright counter-productive.
It is therefore very apt that the concerned heath workers meeting at the
Asian Social Forum at Hyderabad considered implementing the Alma Ata
Declaration and Health For All Now! as the theme for action in 2003.
>
> 2. We know that in the Global Village that is being set up by the rich
countries, the rich are going to  have  the dominant position. They use
their muscle power to dictate the economic, political and cultural lives of
the poor; they will manipulate information to ensure that the well reasoned
arguments presented by honest intellectuals l are banished from the memory
screens and that those put forward by servile 'researchers' are projected as
'the' pearls of wisdom. How do principles of equality, equity and ethics fit
in
such a global `order'?
>
> 3. We have to constantly keep in mind that despite assertions of
considering health as a fundamental right of all the people of the world,
the neoliberal system has relentlessly put pressure on the poor countries to
cut down government
expenditure on health and have encouraged further growth the private health
sector by offering them subsidies of various kinds. To exhort the poor to
pay for their health needs (no free
lunch for you!) is infamous.Health activists have to avoid this trap when
they discuss financing health  services in poor countries.

> 4.   You have tried to draw a line between `cost sharing' and `cost
recovery. There could be different interpretations of these terms. It is, at
best, an academic exercise. We ought to keep on haranguing the governments
of the poor countries to take steps to ensure that health becomes a
fundamental human right of all the people.
>
When making the poor pay for their health services, to
my knowledge, there are few, if any, instances of success of such ill-fated
ventures; then why resurrect the old ghost?
>
> I will warmly welcome comments and criticism from you and other readwers.
>
> With regards
>
> Sincerely yours,
> D Banerji
> Emeritus Professor JNU,
> New Delhi