PHA-Exchange> full report Health Sector Reforms in North and South

[WGNRR]

Dear Friends,
Because the attachment was not included in the earlier communication, here
the pasted report below.
For your information, the event was organised by WGNRR, HOM and ISS in the
Netherlands.

Speakers:
Nadia van der Linde (WGNRR)
Loes Keysers  (ISS / WGNRR)
Maitet Ledesma (Pinay sa Holland-Gabriela / Women’s Working Group on
Balkenende Policies)
Lina Cortes Rojas (Brazilian Institute of Social and Economic Analysis /
ISS)
Manuela Murthi (National Institute of Public Health in Albania / ISS)
Saskia Bakker (HOM)

Regards,
Nadia van der Linde
Coordinator Women's Access to Health Campaign

_______________________

Health Sector reforms in North and South:
Hazardous to women’s Health Rights?

28 May is the International Day of Action for Women’s Health; an occasion
that is taken up by groups around the world to get attention for women’s
health issues. While over 80 participants gathered at ISS for a panel
discussion on the impact of health sector reforms in the Netherlands and
abroad on women’s access to health, similar activities were organized in
countries around the globe to promote and protect women’s right to sexual
and reproductive health.

Background
Health sector reform processes are taking place around the globe, in North
and South, East and West. It is important to assess the impact of these
processes on women’s access to health. Internationally, the Dutch government
has a reputation as a defender and trendsetter for women’s reproductive
rights. The aim of this debate was to explore some of the impacts of health
sector reforms on women’s health rights and discuss the apparent
contradictions between national and foreign policies, in order to ultimately
(and ambitiously) come to the sharing of strategies and ideas to counter
negative developments.

The Netherlands: Recent reforms in the health sector
Maitet Ledesma discussed how reforms and health budget cuts have turned
health as a basic human right into a ‘utopist ideal’ in the Netherlands.
“Especially for single mothers, unemployed women, homeless women, migrant
and refugee women, prostituted women and women with disabilities health care
is becoming a financial burden they cannot afford to pay for.” Public health
insurance coverage has decreased while the personal contributions have
increased. The pill and other contraceptives have (partly) been taken out of
the basic health insurance, reducing access to contraceptives for all women
but especially the already marginalized groups with less money. A
‘modernization’ of hospitals and nursing homes is being implemented,
resulting in pro-profit reforms that do not benefit the people that need the
services. “Patient care has taken a back seat to the new administration’s
drive to cut costs and make a profit.”
Health care is a major public expenditure, providing jobs to approximately
10% of the labor force in the Netherlands, the majority women. As a result
of reforms and budget cuts, health care is now increasingly arranged
informally within families. These ‘invisible caretakers’ look after the
handicapped, the chronically ill, the elderly and people who are on a
waiting list for hospitalization or institutionalization. In addition,
‘invisible caretakers’ shoulder the consequences of insufficient services in
education and childcare. The responsibilities of these care-giving women
prevent them from becoming financially independent because they can only
combine it with a part time jobs if anything at all. “While they provide the
government with valuable savings in terms of subsidies for the care of the
elderly, and shouldering the social costs of government cutbacks, their
contribution remains unrecognized and unpaid.” Migrant women, often
undocumented, have filled in many of these care-giving gaps that have
resulted from cutbacks in health budgets. “More and more, it is women from
the Third World who take over the domestic responsibilities of women in the
First World so that the latter can participate in the labor market and
become ‘productive’.” Yet these women are denied even their legal status by
the government.

Colombia: The model for effective health sector reforms?
Health sector reforms were introduced in Colombia in 1993 because the health
sector was under-funded, inefficient and limited to curative care. The
Colombian experience is often used as a ‘model for success’ for health
sector reforms in other countries. Lina Cortes Rojas explained that the
reforms have indeed had some good effects: overall health coverage has
increased in the country. However, universal access has not been attained
and especially marginalized groups still lack access. 60% of the population
of Colombia lives below the poverty line and 30% of them are not receiving
any care. The majority are women. Abortion remains illegal after the
reforms, leading to many deaths as a result of unsafe abortions.
It seems that the quantity of health services has increased, but the quality
of the services has suffered. There have been cuts in salaries and numbers
of health care professionals, and doctors are more restricted in their
exercise of medicine. The war in Colombia greatly challenges the access to
the services and limits the opportunities for making the government
accountable. All in all, women’s health status and sexual and reproductive
health - especially of poor women - has not improved in Colombia as a result
of the implemented reforms, as poverty and war were insufficiently
acknowledged in the model and women’s sexual and reproductive health not
prioritized.

Albania: From universal access to access for some
Albania, with a population of only 3 million, is the poorest country in
Europe. Manuela Murthi explained that since Albania has moved from a
communist system to an open market economy in the nineties, many changes
have taken place in the health sector. Before the nineties, the entire
population was poor but employed. Political power was limited for women, but
equally so for men. Health services were free for everyone, and the life
expectancy was relatively high at 73.9 years. However, family planning
programs were non-existent and abortion illegal. In 1991-1992, Albania began
the transition to an open market economy, leading to an increase in
unemployment, especially of women. At the same time, women’s groups became
politically active and demanded more services. Abortion was legalized in
1992 but it was the only family planning method available at that time.
Health sector reforms were initiated in 1993, and the process continues
until this day. These reforms include the privatization of pharmacies,
introduction of private medical practice, creation of mechanisms for drug
registration and licensing and the establishment of a family planning
program. The implementation of health sector reforms faces many obstacles.
People now have to pay for services that used to be free. Regulatory
frameworks and monitoring procedures for health services and quality of care
are still lacking. Despite investments by the government and donors health
infrastructure remains substandard. “Neither patient nor provider are
satisfied with the present health system.” Access and quality of services
need to be improved, as well as gender sensitive health education and
promotion.

Dutch policies: Do we practice what we preach?
Saskia Bakker introduced the phrase ‘Mary smiles, Mary cries’ to symbolize
the two faces of the Dutch government in relation to women’s health rights
that become apparent when looking at the Dutch internal and development
health policies. Generally speaking, women in the Netherlands are
privileged: there is openness about sexuality and contraception, legal and
free abortion and basic health insurance. As a result, there are few teenage
pregnancies and child and maternal mortality rates are low. In the
development policy, the Netherlands is often considered a ‘champion’ when it
comes to women’s sexual and reproductive health rights and ranks first in a
list of countries committed to development. The Dutch government is a
supporter of reproductive health and women’s rights through its commitment
to international agreements like the Cairo Program of Action and the UN
Women’s Convention (CEDAW). Reproductive health is one of the four priority
themes for the current development policy. However, also in development
cooperation we do not always practice what we preach.
In the internal policy we currently see long waiting lists for treatment in
hospitals and rising prices for health services. Policy measures have been
introduced in the health sector that negatively impact women’s health rights
like the closing down of Rutgershuizen (centers offering information and
counseling on sexuality matters), doubling of fees for public health
insurance, decreasing of coverage of the public health insurance (taking the
pill and other contraceptives and IVF out for most part), limiting of access
to health services for migrants (through the Koppelingswet), and decreasing
the benefits while increasing the costs for disabled.
Saskia highlights several human rights responsibilities that governments,
including the Dutch government, have committed themselves to. For example,
both “Health as a priority” and “Non-retrogression” are flawed in the
Netherlands as we face budget cuts and decreased services. In addition,
“Protect the vulnerable” is clearly disregarded as immigrants, refugees,
disabled, chronically ill and poor people are the hardest hit by the current
health budget cuts. So where is the coherence between what we preach to the
rest of the world and what we practice at home? The development cooperation
policy memorandum Mutual Interests, Mutual Responsibilities claims that we
are ‘mutually bound’. Perhaps the question must be: when will we finally
start to mutually learn?

Moving forward
Panelists and audience agreed that there is a need to organize demand and
lobby for change. Every woman has the right to health. Even if statistics to
prove it are lacking, the death of just one woman in childbirth as a result
of lack of access to health services shows that a health system must be
improved. Governments have the responsibility to allocate adequate funds and
set policy priorities that improve the primary health care systems with
access for all.
One of the obstacles faced in many countries is the brain drain of qualified
health professionals who leave in search for higher salaries and better
opportunities. This is undermining the health sector. Proper payment of
personnel is essential in the health sector and more incentives need to be
put in place for people to work in areas that are understaffed.
Also in relation to HIV/AIDS prevention and care access to quality health
services are essential. In some countries where anti-retroviral drugs are
available, people still lack access or discontinue taking them because of
lack of health infrastructure, support and poverty. In countries where these
drugs are not available yet, more pressure should be put on governments and
pharmaceutical companies to increase access. Examples of successful
organizing in demand of cheaper drugs are South Africa and Brazil, where
patents were unlocked as a result of pressure from civil society and drugs
are now produced locally and at much lower cost.
To improve the quality of health services, organizations of patients can
have much influence when they are well organized and offer alternatives. In
the Netherlands women’s groups successfully organized themselves for more
women-friendly gynecological checks. A coalition of women’s groups in Brazil
succeeded in getting Norplant implemented “on their terms”.
When it comes to health, people must go before profit. There are many
successes to celebrate, but much more organizing and advocacy is still
needed around the globe to improve women’s rights. Get informed and join the
action!


WGNRR Women's Global Network for Reproductive Rights
RMMDR Red Mundial de Mujeres por los Derechos Reproductivos
RMFDR	Réseau Mondial des Femmes pour les Droits sur la Reproduction

Interested in finding out about or getting involved with the Women's Access
to Health Campaign (WAHC)?
Then contact us at : wahc at wgnrr.nl

Vrolikstraat 453-D
1092 TJ Amsterdam
The Netherlands
phone (31-20) 620 96 72
fax (31-20) 622 24 50
e-mail office at wgnrr.nl
website www.wgnrr.org