PHM-Exch> Food for a Sherlock Holmes thought

[Claudio Schuftan]

Human Rights Reader 223
  ‘ELEMENTAL WATSON’: HEALTH SECTOR REFORM HAS, SO FAR, IGNORED  THE HUMAN
RIGHT TO HEALTH.

* *

1. Ministries of health around the world claim they have carried out ‘a’
health sector reform; they argue that by doing so, they have decentralized
and devolved the governance of the health sector closer to the beneficiaries
and thus have furthered the human right to health (RTH). *[But have they
really?].*



2. They further claim the stimuli for these reforms come (came) from the
beneficiaries themselves. *[But nothing could be further away from the
truth].*



3. In many countries worldwide, contradictions between ministries of health
and the-people-they-say-they-serve have not changed a bit with the (more
often than not foreign-driven) health sector reforms applied in the last two
decades.



4. A dialectical analysis of the situation would bring this up clearly.  But
we do not think dialectically anymore; dialectics (analyzing inherent
contradictions) is supposed to have died with the fall of communism in the
Soviet Union. But dialectics is independent of communism; it is an
analytical tool that brings out the contradicting interests of social
classes in a given society....and the health sector is a sector that --from
the human rights perspective-- badly needs to be looked at dialectically if
we are ever to solve its multiple (and growing) problems.



5. Issues of how power and control are exerted are (and have always been)
behind the state of affairs we see right now in how the health sector, in
no-matter what country, violates the RTH.



6. Who wins/who loses? What aspects of the RTH are being violated? How and
through what mechanisms are they being violated?, and  Why does such a state
of affairs continue? --these are the kind of questions we are *not* asking,
my dear Watson.



7. We need to bring up such an analysis of dialectical relations in health
to find the current disparity favoring the rich, because decisions and
inputs (or the lack of them) are mostly controlled by those in power.  Why
is such an analysis (and action thereupon) needed? *[Because no lasting
social progress has ever come from the ‘benevolence’ of the haves].*



8. Only once we shift our analysis, for it to focus on the inherent
contradictions of the health care sector and of the political system that
upholds it, will we realize that we are facing a skewed relationship in
which groups of claim holders, that are supposed to be involved in a
struggle for their human rights, are not engaged in a real struggle right
now.  This results in there not being a  real opposition from them to the
policies imposed on them from above (and from abroad --and from
international organizations at that).  Ergo,
beneficiaries-that-are-not-benefiting are passive in defending their RTH.



*So, what is needed to get into a dialectical analysis and into the actions
flowing from it? *



9. We need to get involved with claim holders in consciousness
raising, in  increasing
their political awareness of why-they-are-where-they-are. (Using the “Yes,
but why?” didactic technique is a good approach: We ask people for the
causes of what they see/experience as the unmet needs in their health care;
as they respond, we then keep asking “yes, but why that?” and so on, to
their subsequent responses until they get to the underlying and basic,
structural causes that eventually reveal the more hidden power issues).



10. Otherwise, we have to open up the dialogue towards topics of:

·      equity, and health as a human right,

·      effective decentralization and devolution of power (democratization)
*[the latter two already called for by the Alma Ata Declaration 30 years
ago...]*,

·      the role of Globalization on the current state of affairs in health,

·      the role of international financial institutions (WB/IMF), the WTO
and the role of donors, the UN system and NGOs…



11. And on the more technically side, cover topics such as:

·      the fee-for-service system versus social health insurance,

·      local health systems development and primary health care in the 21st
century,

·      essential drugs, over-prescription and abuse of injections,

·      community-managed health programs and co-management of health
facilities,

·      joint-decision making…



12. These are just some of the tactics to follow to more dialectically and
proactively engage in redressing violations to the human right to health.
More elements to use in the struggle should and will come from the claim
holders themselves once they are mobilized.  We, my dear Watson, should not
be prescriptive, but just help open this new avenue for claim holders
to *express
themselves. **

*: We do not even have to reinvent the wheel: see the People’s Charter for
Health at www.phmovement.org



13. In short: What is needed now is a start-over, a movement, a grassroots
revolution in health.

‘Elemental Watson’!



Claudio Schuftan, Ho Chi Minh City
cschuftan at phmovement.org
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