PHA-Exch> Small Sucesses in right to health campaign in Egypt

[Claudio Schuftan]

   From:    alaashuk at yahoo.com

Dear Colleagues and friends,

It is important to celebrate small victories, no matter how partial or
temporary they maybe. As you all know, the government of Egypt had declared
its intention and insistence to introduce a new law under the banner of
"health reform". In reality, this amounted to the privatization of the
majority of the health care facilities in Egypt as well as running the whole
system on market for profit basis. In addition, a multi-tier system is
developed in which a basic package for the poor is provided while higher
packages of health services are provided for those who can afford it.

Well, reacting to the rising opposition waged by the Coalition for the Right
to Health in Egypt and with your solidarity actions, this move was at least
temporarily thwarted. At last the government has declared that it will delay
this action for at least a year. In fact not only has the action been
delayed, but many representatives of the Minister of Health have, in public
confrontations with representatives of the coalition, declared that they are
rethinking some of the essential points raised by the opposition, such as
the articles related to the *"contribution of the patients of 1/3 of the
costs as well as the multiplicity of insurance packages according to peoples
means."*

Although we know that this setback for the privatization scheme in the area
of health services is only temporary, we feel that it is important to
celebrate it, as it shows that despite the fact that the balance of forces
is very much tipped in the benefit of the forces of privatization, change
can take place when people have the will to do so. It shows that we can make
a difference despite the odds.

I would like to take this opportunity to share some of the important lessons
learnt from this battle and to look at the prospects for the coming stage of
our struggle for the right of all people to health and to health care.

Some lessons learnt

Strength of the campaign

1.      One of the most important characteristic of this campaign was and is
its strong evidence base. A huge amount of knowledge and relevant materials
were made available through many of the colleagues. This reflected the
achievements of civil society organizations previous work in monitoring and
studying the health care system in Egypt, such as the work of the
Association for Health and Environmental Development (AHED). This strong
evidence base gave much weight to the coalition member's argument and their
ability to confront the arguments of the ministry and other international
and multilateral stakeholders such as the World Bank and the USAID. This was
very clear in the confrontations that took place between the government
officials and the representatives of the movement whether in conferences,
seminars or in the media.

2.      The success in widening the ownership of the campaign. Although the
campaign started through AHED members which is a health oriented NGO, it was
soon taken on and carried out by a wide coalition whose member organizations
were very diversified and included workers organizations, political parties
(nearly all opposition political parties), women organizations, community
development, human rights …etc These are organizations which are not
necessarily engaged in health related issues. However, the campaign was
successful in showing that health is every body's' business. This new
phenomena show that a wide based and diversified movement around right to
health can develop and is developing.

3.      The wide coverage and the success in attracting the media played a
decisive role in making the arguments of the right to health coalition heard
and able to reach a wide mass base all over Egypt and isolated the arguments
of the other side

4.      The way that the public in Egypt in most cases responded positively
and rapidly to the campaign and was able to see through the "bright
camouflaged slogans "  raised by the government and the other stakeholders ,
shows us that people have learnt much from the negative experience and the
negative impact of the policies of privatization carried out in many other
sectors during the past two decades. Dissatisfaction with this dominant
neo-liberal policies is increasing. This was true despite people's
dissatisfaction
with the current state of the health care system in Egypt.

5.      International solidarity was very important despite the fact that it
was approached quit late in the process. However, this is a component which
we should build upon more for the future stage and confrontation as it can
and does carry an important weight particularly in reaching other extremely
important and decisive stakeholders such as the World Bank, the European
Union and the USAID.



Dear colleagues, this success is only a small step in the confrontation of a
huge global trend which puts market relations and profits before people. It
is also a trend whose stakeholders are powerful and insistent. We know that
this move towards privatization of the health care system, will not stop and
we have a long and hard confrontation ahead.

In order to succeed against this trend we have to address some salient
issues from the experience of the past stages of the campaign, among which
stands:



·         the need to develop a clear and practical alternatives to the
current failing and badly functioning health care system both in the public
and the private health institutions. We have to move from the vision to the
practical alternatives and to make it clear that we are for reform and
change, yet, we differ with the forces of privatization in diagnosing the
causes of the failure and definitely in the solutions they put forth.

·         The need to widen and strengthen the confrontation on the
international arena. The move towards privatization of health care services
as part of the move towards privatization of all basic services in Egypt is
part of an international dominant trend which is taking place nearly
everywhere else. Its advocates are huge international organizations and
corporations. It can not be confronted locally only but needs to be
confronted internationally both on theoretical as well as the practical
levels.

·         In addition, there is a strong need in the coming stage to work
very strongly to increasingly widen the base of opposition to privatization
of health services in Egypt and to make it a much more popular movement. The
original successes in this direction should be strongly built upon and
further developed.



Dear colleagues and partners in the PHA exchange, we would like to thank you
all for your solidarity and actions to assist us here in our confrontation
to the forces of privatization and we think that we will need to coordinate
our work together with you and to strengthen it much more in the coming
stage if there is a chance to succeed in face of these powerful global
forces and reverse the trends.

Another world is possible



Alaa Shukrallah

AHED Chairperson

PHM Global Secretariat member
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