PHA-Exchange> Notes- review OXFAM/World Bank strategy

[claudio at hcmc.netnam.vn]

Garance Upham <g_upham at club-internet.fr>:

> Notes on World Bank Strategy to “Strengthen” Health services.
> OXFAM’s review is excellent.
A few notes on the broader context:
> 
> World Bank is acting as executor of pharma/medical and related monopolies
> seeking to milk profits out of the region under WB 
> domination.
> 
> 1) The World Bank’s strategy happens to fit like a glove to the
> pharmaceutical industry and biomedical industry’s demands for 
> strengthening of health services.
> Since the majority of developing nations are applying pressure for
> alternative systems to TRIPS/WTO, the US-EU is not just 
> resisting through backroom and front pressures on WHO
 The World Bank is
> mandated to act to reform health system in accordance 
> with IFPMA, the International Fed of Pharm. Manufacturers Ass.
> It is important to remember the overriding power of industry
> For example 900 lobbyist in Washington DC, for a Congress that has 500
> members.. Several million dollars per year by Gates- 
> Microsoft just to lobby the European Parliament on the issue of open
> licenses. The majority of small and medium size industries 
> and even some of the bigger ones where in favor of open licenses, because
> otherwise the costs to industry is so high. Yet the EU 
> commission went with Microsoft against its own constituents.
> 
> Advanced Market Commitment, funding industry to manufacture and distribute
> vaccines such as against rotaviruses
 instead of 
> improving water access (as Maria Guzman would say)
> 
> 2) One of the most telling sentence that the WB is working for industry is
> the proposal for Advanced Market Commitment (AMC) 
> instruments. This idea floated by the G8 was heartedly embraced by IFPMA: 
> “The AMC concept thus helps companies to overcome some 
> of the scientific and market barriers to developing new vaccines for diseases
> that predominantly affect poorer countries,” said 
> Dr. Harvey E. Bale Jr., Director General of the IFPMA.
> http://www.ifpma.org/News/NewsReleaseDetail.aspx?nID=4762
> The Bank acts as the implementor of combined IMF dictates and industry’s
> demands. In the Bank’s verbiage, it acts to: “• 
> Contribute to ensuring financial sustainability in the health sector and the
> sector’s contribution to sound country fiscal policy 
> and to country global competitiveness.  • Contribute to improving governance
> and reducing corruption in the health sector. "
> 
> 
> The Bank favors PPP, where Gates is always given as example of working
> partnership:
> 	
> 3) Gates is TOTALLY working with IFPMA on issues of TRIPS/WTO and all matters
> related to Intellectual Property rights.
> 10That Gates is funding some good (and bad) health projects, and the Gates
> Foundation is bigger than the WHO in capacities, and 
> playing niceties to public NGOS, should not make one forget that they are an
> implacable enemy of anything and anyone challenging 
> IP rights at WHO or elsewhere.
> GATES was notoriously behind the GAIN initiative, which basically proposes to
> replace the need for decent food intake for the 
> world poor by ‘micronutrients’ dogma added by food giant into their marketing
> of poor products.
> The World Bank document makes explicit mention of  “basic nutrition
> interventions (including micronutrients)”.
> 
> 
> The Bank’s key objective of good “Governance and accountability” is a façade
> for the call to do away with public health systems.
> 
> 3) The overriding theme of ‘good governance and accountability’ . For more,
> the Bank refers to the WDR 2004 “Making Services Work 
> for the Poor”, a report which provoked the extreme anger of Public Services
> International (the network of 10 million health 
> workers), they renamed it “Making the Poor Work for their Services”.
> http://www.world-psi.org/TemplateEn.cfm?
Template=/ContentManagement/ContentDisplay.cfm&ContentID=10039
> The WDR 2004 report was an 
> all out attack on the notion of public services itself. To wit,the box in the
> WB report entitled: What are Governance and 
> Corruption in the Health Sector?
> 
> 
> “There is no contradiction between a health system approach and a priority
> single-disease approach—when well implemented.” The WB 
> document insist.
> 
> 4) The failed single disease approach in global health policy will be
> REINFORCED notably through mechanisms of public funding 
> globally to purchase drugs from big pharma. In terms of Alma Ata objectives,
> this is absolute disaster.
> This clears up the side of the Bank in the debate between universal health
> system strengthening and single disease approaches. 
> Note that it is intimately linked with the reinforcement of PPP, since Roll
> Back Malaria, Stop TB etc etc are all PPP.
> 
> The Bank uses all the key words of the free market..
> 
> 5) There is heavy emphasis on ‘clients’, consumer power, this goes hand in
> glove with industry promotion of a behavioral MARKETING 
> approach to disease control, with language such as ‘empowering the consumer’
> etc.
> 
> 
> Last but not least, the implementation of free market dogma and ‘iron fist
> control’ over reorganized health systems is extremely 
> dangerous for world health, since it will worsen the ongoing collapse in
> infection control within health care structures.
> 
> 6) WHO estimates are that 25% of patients in Sub Saharan Africa will contract
> a nosocomial infection – that can include extremely 
> drug resistant TB- This collapse in infection control is due to two main
> factors: effect of SAP on public health and.. user fees. 
> Wherever State authorities have not acted to suppress these user fees, there
> is no point offering free TB drugs/treatment or free 
> ART for People with AIDS, if at the point of ‘entry’ a user fee subsists, no
> matter how small. This means poor patients go 
> sporadically into health care structures for their treatment, and in the case
> of ART and TB, for example, this has catastrophic 
> effect on resistance.
> 
> 
> A little background
> Note on point 1- the HIV debate Drugs Vs Health system strengthening
>   The debate over whether to first ship drugs and foster generic use, or to
> strengthen health services for delivery has been 
> raging in the AIDS community for 10 years. Militants mostly spoke of drugs
> now, access now, the industry replied that prices were 
> not the main impediment to ART access, but that health systems were
> inherently incapable at present of rolling out treatments that 
> were complex and life long. At first, one could say each side had part of the
> truth.
> In the Durban International AIDS conference, the Afro American Institute and
> other progressive spokespersons did argue for 
> strengthening health services, pointing out that if health systems were
> incapable of treating TB or diarrhea or common ailments, 
> rolling out ART without dealing with the other problems was not going to
> work.
> Cuba gov’t and institutions argued, or course, that what was needed was BOTH
> access to cheap treatment now, AND strengthening of 
> basic health services AND strengthening of a body of physicians trained to
> roll out ART.
> At the Tamil Nadu University AIDS INDIA conference last year, I heard a very
> heated debate between the WHO HIV treatment director 
> C. Gilks- saying Drugs now -and an Indian expert professor (I would need to
> did out his name from my file for anyone interested) 
> who pleaded very convincingly that India would need to train minimally 5000
> ART specialists before engaging in massive treatment 
> campaign, because ART is very complex, difficult, needs for diagnostic tools,
> resistance surveillance, incompatibility with TB 
> treatment etc, and doctors.
> 
> NOW, the World Bank is coming back as the crushing machine of US-EU at the
> service of industry to reorganize health systems in a 
> way as will favor private interest capacities are making a fast buck.
> Implementation of these outrageous prescriptions could mean 
> many million more deaths in poor countries.
> 
> 




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