PHM-Exch> WHR 2010 - Health systems financing: the path to universal coverage (4)

[Claudio Schuftan]

From: Jo Kreysler <jokreysler at hotmail.com>

IS THERE PROGRESS FROM “HEALTH FOR ALL” OF 1978 ?



WHO’s ‘World Health Reports’ (WHR) are clearly one of the most important

publications on specific aspects of health progress globally. This is now
the second

time after 2000 that Primary Health Care is revisited in WHR : this time
regarding

important – mainly financial and economic – aspects to achieve an overall
goal:

universal health coverage.

It is quite frightening to learn from the DG …”that 20 – 40 per cent of all
health

spending is currently wasted”…... She tells us …..“the report identifies
continued

reliance on direct payments…as by far the greatest obstacle to progress….”.

We also learn that “any effective strategy for health financing need to be
home-

grown”… , that “health systems are complex adaptive systems”…, and that
….”no

one in need of health care……should risk financial ruin….”.

Alma Ata’s, “Health for All” (the earlier version of ‘Universal Health
Coverage’) was launched at a time, when Primary Health Care was relatively
simple and straight forward. Then, the appeal was one for global solidarity
in health matters, an issue which for some visionaries, like Halfdan Mahler,
seemed achievable. Thirty years later, we seem further away from global
equity, and it looks like, solidarity is progressively replaced by economic
and financial ‘system solutions’. This erosion is at the centre of concern
for a growing number of health professionals, like David Werner, member of
the ‘Peoples Health Movement’, who stated in a comment to WHR 2010:

…..”The facts are in. WHO’s recommendations for far-reaching policy changes

are clear, if politically toothless. As ever, the biggest obstacle is the
short-sighted

resistance of the rich and powerful to what they selfishly condemn as
socialized

medicine. What it comes down to is that the Free Market System is
incompatible

with health for all – and in the long run with Health for Anyone”.



Alma Ata and ‘Health for All’ is mentioned only once in WHR 2010 in the
first

sentence of the Executive Summary (p. ix), referring to “….contributing to
quality of

life ….and to global peace and security”. This makes one wonder, whether
this was

all WHO has learned from PHC.



In the section “Where are we now?” (p. x), we learn that …”more than half of
the

world’s population lacks any type of formal social protection…”(and
therefore

guaranteed access to professional healthcare) and only “5 – 10% of people
are

covered in sub-Saharan Africa and southern Asia…”. “Closing the coverage gap
for

children under-five, particularly for routine immunizations, would save more
than 16

million lives….” It would be interesting to know, what the comparative
figures were in

the nineteen-eighties.



The report identifies three fundamental, interrelated problems, which

restrict ‘Universal Coverage’:

1. Availability of Resources

2. Overreliance on direct payment at the time people need care, and

3. Inefficient and inequitable use of resources.



A variety of well-known system solutions are offered in the section “How do
we fix

this?”

However, basic political issues, putting the individual in the centre of
decision-

making are not addressed. In the section “A message of hope” (p. xxi), we

learn that there is no “magic bullet”. “Hope” in this context means to
conform to

technocratic solutions and expectations of the various health systems as
defined by

current country experiences and analyses. Man is clearly no more in the
center of

self-determination. That is the basic change in analysis, tone and style
between 1978

and now.



What have we learned from the past experience?


JOACHIM KREYSLER
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