PHA-Exch> Is Private Health Care the Answer to the Health Problems of the World's Poor? (3)

[Claudio Schuftan]

From: Jeff Buderer jeff at onevillagefoundation.org


A few comments on this post....

Both sides have good points about the emphasis on one or the other.

So my thought would be to consider community based health care as a third
way alternative?

I would be curious if anyone has any detailed info about such an approach or
the advocacy for such at the policymaking level.

Isn't it time we thought more creatively about health care and considered a
bottom up review of the whole way in which we see health care?

For one thing if we really encouraged people to live healthy lives whether
in affluent or nonaffluent regions much of the need for the health care
sector would disappear. My thought is that are a complex set of vested
interests which prevent real and meaningful reforms of the health care
sector in nearly every country in the world - regardless of socioeconomic
status.

The idea is to minimize layers and bureaucracy by focusing on preventative
care and also innovative investment and financial strategies that consider
the productivity issues with bad health in poor communities (so the idea is
that we need to keep cost low by making large short term investments in
infrastructure to improve the living conditions of people in low income
regions). In truth who does it really benefit in the long term to allow 2
billion human beings to have inadequate sanitation and drinking water
supplies? Of course no one but we still lack the resolve collectively as
humans to put forward a plan to solve the problem.

The point is that the problem is not only lack of development in poor
counties but the very core philosophy of modernization itself with its
competing groups and ideologies that really offer no real innovative
solutions but recycle the same old perspectives over and over. Then we
wonder why we talk about these problems again and again and never solve even
though our toleration of them is morally repugnant to us.

Given this, how might we pragmatically address this issue of health seeing
that bad health is not only a problem of the world's poor and find solutions
that can be applied globally?

Possibly it is not necessarily an issue of public verses private but rather
whether the health care providers have a sincere commitment of putting their
social and financial interests below that of those in need of health care
services. So then there is a need to address the way institutions are
designed, money is given and people are trained and certified in providing
these services.

In a sense it gets to the root of the heath and indeed healing - that it is
not only making that hippocratic oath but also understanding that healing
has been throughout most of human history been a sacred thing. If human life
is sacred and the idea of killing somebody needlessly wrong then why dont we
treat every human on this planet as such?

So my thought is the discussion needs to be reframed - it is not about
public vs private but rather about how to design a health care sector that
is offering decentralized community based solutions that can be harmonized
with a larger rethink of the development process be it in the USA or Uganda.
What it means is we need a way to give power back to the communities or to
the community level of governance. This from my perspective is a process of
thinking about what a sustainable health care (as in a society that is
ecologically and socially sustainable in its everyday operation or has made
that as its primary goal) system really acts and looks like.

Because if people don't really matter in the disbursement of health care,
and the providing of social services in a society, then it hardly matters
whether it is public or private. So to me the real issue is designing human
scale health care systems that put the people first before institutional
imperatives and individual desires for social mobility and accolodates.
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