PHA-Exchange> Right to health speech at ESF

[Aviva]

-----Original Message-----
From: sunil.deepak at aifo.it
To: aviva at netnam.vn, pha-exchange at KABISSA.ORG
Date: Thu, 27 Nov 2003 12:27:36 +0100
Subject: Right to health speech at ESF

Dear all, I am sharing with you my speech at European Social Forum in
Paris
during the seminar on the Right to Health. Regards, Sunil

Right to Health - From Alma Ata to Doha
Dr. Sunil Deepak 

Alma Ata Declaration
 
The Alma Ata declaration in 1978 proposed a new concept of health, what
we
can call today the human rights approach to health, health seen as a
human
right. Today, when health and health services are seen as a commodity,
since
they are "non-productive" expenses for the State and health care
systems all
over the world, not just in developing countries are threatened by
market-economy thinking and are being prostituted, the declaration of
Alma
Ata and its emphasis on primary health care assumes special
significance.

The Alma Ata declaration came from a long series of field experiences,
mainly from developing countries, especially in the post-colonial
periods,
when newly independent countries in Africa, Asia and Americas were
often
motivated by ideals of equality, justice and progress of their people
and
activists were going to rural areas, to work with people and to
understand
their needs. Experiments with bare foot doctors in China, the work of
Paulo
Freire in Brazil with his pedagogy of oppression and the philosophy of
Sarvodaya enunciated by Mahatma Gandhi in India, are linked to the
ideas of
Alma Ata declaration. In some ways, perhaps the mass protests by young
people in Europe in late sixties were also linked to it.

Negation of ideals of Alma Ata Declaration

There are two basic ideas in Alma Ata declaration - the State
responsibility
to guarantee basic health services and the fundamental importance of
people's control in deciding about their health needs and health
services.
While the State responsibility to provide basic health services was
accepted
initially, the ideas of people's control over their health needs and
health
services were rejected by medical professionals and were never
implemented.
Even the State responsibility is under attack over the last twenty
years
through Structural Adjustment Programmes  (SAPs) forced by
international
financial institutions like International Monetary Fund and World Bank
on
countries crushed under the burden of external debt, asking countries
to
reduce their "non-productive" expenses like health care, education and
social services. Concerned about the rising public expenditure, they
want
services to be reduced but at the same time, do not ask for any
reductions
in defence budgets and military expenses, perhaps because that would
hurt
the export income of developed countries?

The negative forces of economic globalisation, promoting privatisation
and
corporatisation of services have further strengthened this tendency of
reducing national commitments towards health rights of people,
especially
the poorest and most vulnerable population groups.

The trend of creating new international bodies and commissions like
Global
Fund, duplicating the work of World Health Organisation, means creation
of
vertical programmes, looking for standard universal donor-driven
approaches
to problems like AIDS, malaria and tuberculosis. This has two dangers -
on
one hand, it takes essential resources away from basic health services
for
investing in special interventions, which can be "measured and
controlled"
by donors. On the other hand, it negates the holistic nature of human
body
and the complex mechanisms governing health and disease states, by
giving
partial answers to problems. The emphasis of AIDS programmes on
condoms, TB
programmes on DOTs and malaria programmes on chemically treated bednets
are
examples of such an approach. None of these measures is wrong, but
diseases
can not be fought and controlled by only single measures and the
approaches
must be holistic and multi-sectoral.

As it is, the national budgets for health services are decreasing and
even
from the diminished budgets, most resources go for a few big hospitals
in
capitals and big cities. For example, in Kenya, more than 40% of
national
health budget goes only for the Kenyotta hospital in Nairobi, while the
primary health care services receive a meagre 1.5% of this budget.

Without effective basic health services in communities, how can the
vertical
programmes reach them? Even if we have drugs, if there are no health
centres
or health services or health workers, how are the poor going to receive
these?

Fight for Right to Health

The areas for the fight for right to health must necessarily be
multi-sectoral. We can not just look only at health services for
guaranteeing health care to people if people do not have drinking water
or
sanitation services. For example, every year more than 10 million
children
die due to causes that can be easily prevented - most of these deaths
are
due to diseases like diarrhoea and respiratory infections. More than
50% of
these are concentrated in just six countries and almost 25% only in one
country (India) - all in areas where there is lack of access to
drinking
water, very low literacy especially for women and girls and high levels
of
poverty.

In fact poverty and hunger are the biggest killers. Experiences have
shown
that hunger is there not because there is not enough food, but also
because
poor do not have the capacity to buy the food. For example in India,
hunger
deaths were reported from Kalahandi district in Orissa and Indian
newspapers
reported that parents were selling their children for as low as 300
rupees
(about 6 Euros), to be able to survive. Yet in the same year, Kalahandi
district had the highest yield of rice ever and warehouses were
over-flowing
with rice.

People and organisations fighting for right to health must make links
with
those engaged in fight for right to food, right to water, right to
seeds,
use of genetic sciences, use of patents, issues of biopiracy, right to
basic
education, role of international financial institutions, impact of
chemicals
on the environment, etc. since these all affect the health and
well-being of
people.

There is a special need to be careful about the claims of big companies
and
institutions since they have learned the language of development and
use
words like well-being, holistic, empowerment, etc. as a mask to
continue
doing their work. The publicity campaign of petrol giant Shell about
its
support for poor children in Africa, the big corporations creating
public-benefit foundations are all examples of this. It is easy to fall
in
this trap, as shown by the agreement between UNICEF and Macdonald for
helping the poor children of the world, cancelled only because of mass
popular protests and letters in the media.

Institutions like World Bank come with nice reports like World
Development
report, using all the right words and showing concern about the poor
and
vulnerable groups. They even give some token millions for supporting
work in
favour of these poor and vulnerable groups. Yet, at the same time,
their
policies of forcing poor countries to accept the logic of Structural
Adjustment Programmes, cutting down of health, education and social
budgets,
privatisation of essential services like water supply, continues
unabated,
not withstanding the enormous amount of evidence already available
showing
the harmful impact of such measures on the poor of these countries.

The developed world makes big promises in front of the TV cameras and
yet
they do not honour their commitments. In 1991, they agreed to lower the
infant mortality to less than 70 per thousand by the year 2000. In
2000, it
was found that the infant mortality had actually increased in many
countries
of sub-Saharan Africa and the vaccination coverage had gone down. So in
2001, they have made even a better promise - to reduce infant mortality
by
two-thirds by the year 2015. The strategy is to cover the lies with
even
bigger lies.

Challenges

In such a situation the challenges are many. One of the challenges is
that
of not losing the big picture, of forgetting the inter-connectedness of
issues and focussing only on our own areas of interest. Networking and
linking with others engaged in fight against negative effects of
economic
globalisation is a must.

While we need to continue to talk about Alma Ata and its ideals, we
have to
update it with all the changes occurring in the world in the 25 years
after
the declaration. Ideas of what is health and what health services are
needed
by people have changed and we have to look at that. For example, Brazil
has
initiated one of the biggest reform processes in the world by promoting
decentralisation and delegating decision making power to
municipalities.
This is in line with ideas of people's control contained in Alma Ata
declaration. Yet, municipalities, if they believe in bio-medical model
of
health care based on big hospitals and sophisticated technology, they
will
continue to ignore basic health services and issues of equity and
access to
the poor groups. We have to look at issues like this and develop
strategies.

It is not enough to think of the things, which are not working with the
present system but we have also to come with ideas of alternative
systems.