PHA-Exchange> PHM and the MDGs

[Claudio]

From: Bala  (edited)

As a health activist I wish to take up an issue of critical importance to developing countries.

The proposed global summit on health research will be one of the means to achieve the ultimate health related millenium development goals (MDGs).  PHM should, therefore, first clearly define the ends or what the health related MDGs are.  The means will depend on the ends.

As far as PHM and the millions of people concerned, the end or goal is Health for All Now based on comprehensive primary health care.  But the health related MDGs are far removed from PHC and closely related to the conclusions and recommendations of the Commission on Macroeconomics and Health (CMH).  For example, the Members of the Millennium Project Task Force 5 on "Major Diseases and Access to Medicines" were told that the Report of CMH would be guiding their work.

Here lies the dilemma PHM faces.  

A.    PHM has stated its position on the Report of the Commission on Macroeconomics and Health.  

The Pack prepared by PHM for the 25th Alma Ata Anniversary contains three articles.  I wish to refer to.
  1.. David Sanders - "Twenty five years of Primary Health Care:Lessons Learned and Proposals for Revitalization" - PHM position paper.  David Sanders states that the strategy of "Selective Primary Health Care" - has reinforced the "Medical model" and de-emphasized equitable social and economic development, inter-sectoral collaboration, community participation and the need to establish sustainable decentralized structures and systems". 
  2.. Debabar Banerji - "Reflections on Twenty fifth Anniversary of the Alma Ata Declaration". Banerji has described the Report as "Ahistorical, apolitical & atheoretical" and argued that it has ignored earlier work done in the field and ignored such major developments in the health services as the Alma Ata Declaration. It has adopted a selective approach to conform to a preconceived ideology 
  3.. David Werner - The Alma Ata Declaration and the Goal for Health for All 25 years later.  Keeping the Dream Alive".  Werner points out that PHC as outlined in Alma Ata has been resisted by the powerful decision makers at national and international levels.  This resistance could be looked at in terms of four inter-related attacks.  One of these was the introduction of selective PHC focusing on a few cost-effective top down technological fixes.
B.    The PHM secretariat circulated a memo on the Report of CHM to its partners.  Among others it stated "The Commissioners saw ill-health as a drain on world development and therefore wanted action to reduce this drain on world development.  These people do not see ill-health as a denial of a fundamental human right.   WHO, the UN agency mandated to make health for all a reality, has spent its resources inviting top economists who do not see health as a fundamental human right, but as a drain on economic growth and development.  Their only concern is to develop strategies and formulate action plans so that public health instead of being an impediment to world development will be a factor that will contribute to economic growth.  It is therefore not surprising that the Commission ended up by recommending selected vertical outcome-oriented approaches around communicable diseases although experience has shown us that selective vertical interventions to tackle specific diseases have never been successful.  In this context, we wish to quote Deharati Guha - Spir, the Director of the WHO Collaborating Centre for Research on Epidemiological Disasters" "Targeting malaria, tuberculosis and HIV/AIDS will not generally improve health in poor countries.  Vertical disease programmes that ignore context were discredited some 30 years ago.  Why aren't we learning from experience?" (1)  Prof Jeffrey Sachs, Chairman of the Commission has re-invented selected vertical interventions that have been discredited several years ago and proposed a multibillion dollar investment fund to implement the Commission's recommendations".


C.    The Government of India in its Health Policy Pronouncement of 2002 has admitted that vertical programmes have not only been highly expensive, but they have also further decimated the general health service.  Worse still, they have fallen far short of the objective for which they were launched.

What will be the health related MDGs the proposed summit on health research focus on?  Will it be the selective vertical outcome oriented approaches outlined in the Report of CMH or will it be comprehensive PHC as described in the Peoples' Charter for Health?  This is the dilemma PHM faces.  I do not find an answer anywhere in the communications we have.

PHM, therefore,  should emphasize that the health related MDG is Health for all Now based on comprehensive PHC.  This is not negotiable.  PHM rejects attempts to re-introduce selective PHC in the form of donor funded top down high tech vertical programmes.  These have failed everywhere.

Enormous research and country experiences have been distilled in the very comprehensive People's Charter for health.  There, is therefore no knowledge production gap as far as PHC is concerned.  But there is a serious knowledge application gap.  Neither WHO, UNICEF nor any national government have so far made any attempt to make the knowledge on PHC available to health policy makers, administrators, practitioners and to the community at large.  The need for the People's Health Assembly (PHA) - December 2000 arose because governments, WHO & UNICEF ignored their committement made at Alma Ata in 1978.  The People's Charter for Health was the outcome of the PHA.

The simple answer is that there is no knowledge production gap as far as PHC and equitable health is concerned.  But there are serious political, economic and social constraints in the application of this available knowledge - what we have is a knowledge application gap.

My random thoughts are to convey my views that the proposed summit on health research should focus on application of available knowledge on PHC to ensure equitable health for all which should be identified as the health related MDG.


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