From cschuftan at phmovement.org Tue May 22 03:11:55 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Tue, 22 May 2018 17:11:55 +0700 Subject: PHM-Exch> =?utf-8?b?VHJhbnNsYXRpbmcg4oCcSGVhbHRoIGZvciBBbGzigJ0g?= =?utf-8?q?into_the_Present_and_Future?= Message-ID: C_o_n_s_u_l_t_a_t_i_o_n_ _s_t_a_t_e_m_e_n_t_ _o_f_ _t_h_e_ _c_i_v_i_l_ _s_o_c_i_e_t_y_ _w_o_r_k_s_h_o_p_ _?4_0_ _Y_e_a_r_s_ _o_f_ _A_l_m_a_-_A_t_a_:_ _T_r_a_n_s_l_a_t_i_n_g_ _?H_e_a_l_t_h_ _f_o_r_ _A_l_l_? _i_n_t_o_ _t_h_e_ _P_r_e_s_e_n_t_ _a_n_d_ _F_u_t_u_r_e_?,_ _G_e_n_e_v_a_,_ _E_c_u_m_e_n_i_c_a_l_ _C_e_n_t_r_e_,_ _1_8_ _M_a_y_ _2_0_1_8_ _ S_u_m_m_a_r_y_ _ *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. However, after 40 years, inequality, poverty, exploitation, violence and injustice are still keeping one Billion people from accessing health care. To achieve health for all, inequities have to be overcome, powerful interests to be challenged, and political and economic priorities must be transformed to achieve health for all. *Realising the vision of Alma Ata is more urgent than ever: * ? _Applying the principles of Primary Health Care as declared at Alma Ata 1978 is critical in achieving health for all by 2030. ? _Community engagement and ownership is the key to health for all and essential for building resilient health systems that allow all people to access the health care they need. ? _A skilled and motivated health workforce is at the centre of health systems at all levels. It must be recognized that community health workers play an essential part in realising universal health coverage and health for all. ? _Strong people?s organisations and movements are fundamental to strong health systems. ? _Access to essential medicines of good quality at an affordable price is part of health for all. Policies must ensure that research costs are delinked from the price of drugs and everyone has the right to access essential medicines. ? _Health for all demands inter-sectoral collaboration and must provide access to prevention, promotion, treatment, care, rehabilitation and palliative care to everyone within a sustainable framework. ? _Health is not only a matter of human rights, it is a matter of justice and requires a redistribution of wealth and significant changes in the global economic order. ? _Equity in health and social justice must be the basis for all decision making. ? _To ensure access to health services to all, service provision through public and not-for-profit providers must be given the primacy in health system planning and implementation. The ambiguities regarding UHC must be resolved with health care financing policies structured to prevent the commodification and marketisation of health care. *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. Realising the vision of Alma Ata and health for all is more urgent than ever: *Primary Health Care and Universal Health Coverage * *?P_r_i_m_a_r_y_ _h_e_a_l_t_h_ _c_a_r_e_ _i_s_ _e_s_s_e_n_t_i_a_l_ _h_e_a_l_t_h_ _c_a_r_e_ _b_a_s_e_d_ _o_n_ _p_r_a_c_t_i_c_a_l_,_ _s_c_i_e_n_t_i_f_i_c_a_l_l_y_ _s_o_u_n_d_ _a_n_d_ _s_o_c_i_a_l_l_y_ _a_c_c_e_p_t_a_b_l_e_ _m_e_t_h_o_d_s_ _a_n_d_ _t_e_c_h_n_o_l_o_g_y_ _m_a_d_e_ _u_n_i_v_e_r_s_a_l_l_y_ _a_c_c_e_s_s_i_b_l_e_ _t_o_ _i_n_d_i_v_i_d_u_a_l_s_ _a_n_d_ _f_a_m_i_l_i_e_s_ _i_n_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _t_h_r_o_u_g_h_ _t_h_e_i_r_ _f_u_l_l_ _p_a_r_t_i_c_i_p_a_t_i_o_n_ _a_n_d_ _a_t_ _a_ _c_o_s_t_ _t_h_a_t_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _a_n_d_ _c_o_u_n_t_r_y_ _c_a_n_ _a_f_f_o_r_d_ _t_o_ _m_a_i_n_t_a_i_n_ _a_t_ _e_v_e_r_y_ _s_t_a_g_e_ _o_f_ _t_h_e_i_r_ _d_e_v_e_l_o_p_m_e_n_t_ _i_n_ _t_h_e_ _s_p_i_r_i_t_ _o_f_ _s_e_l_f_-_r_e_l_i_a_n_c_e_ _a_n_d_ _s_e_l_f_-_d_e_t_e_r_m_i_n_a_t_i_o_n_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The Primary Health Care (PHC) principles affirm health as a human right based on equity and social justice, implemented through community engagement, health promotion, the appropriate use of resources, and inter-sectoral action based on a ?New International Economic Order? with the vision of health for all by the year 2000. The Declaration, however, came at a time of major global economic changes including the economic slow-down of the 1970ies, the debt crisis and structural adjustments. Shortly after Alma Ata UNICEF and the Rockefeller Foundation declared ?Selective Primary Health Care? instead of ?Comprehensive Primary Health Care?, which under structural adjustments became the dominant paradigm and model of PHC. Structural adjustment programs led to a reduction of staff, narrow benefit packages and a lack of resources in the public sector and weakened already weak health systems. The advent of the HIV epidemic led to isolated but impressive community based responses even before the advent of antiretrovirals. These were applying PHC principles dealing with HIV prevention, home based care, destigmatisation, treatment literacy a.o. addressing the challenges of HIV. Global health initiatives such as the GFATM or Gavi contributed to a considerable increase of funding but these have been mainly earmarked for vertical programmes especially in the area of HIV, Malaria or TB. Besides all the positive effects that were achieved, this has been associated with a migration of resources and personnel from public primary care systems to globally funded programs. In 2010, WHO introduced the concept of Universal Health Coverage (UHC), which was defined as access to health services without financial hardship. While in general, the notion of UHC seems consistent with WHO?s concept of Health for All in Primary Health Care, a key issue that remains unresolved is the primacy provided to public or non-for-profit services under PHC and conversely the larger role envisioned to private for-profit providers while implementing UHC. Hence, in many countries public services are being replaced by private for-profit providers. Especially concerning is the increase of corporate chains of providers, mainly supported by private insurance. While impressive medical and technological advances have taken place around the world, improvements in the health status of the people have been moderate and inconsistent between and within countries. The biomedical and technical approach to health has its limitations in actually improving health especially among marginalised and poor populations and has contributed to a neglect of other determinants of health. Health systems must be built on the principles of comprehensive primary health care that includes community engagement, adequate healthcare infrastructure, skilled, supported and motivated health workforce, access to essential drugs of good quality that are rationally used in addition to new advancements and technologies that must be accessible to all. *Communities: From objects of health care to full participation and ownership * *?T_h_e_ _p_e_o_p_l_e_ _h_a_v_e_ _t_h_e_ _r_i_g_h_t_ _a_n_d_ _d_u_t_y_ _t_o_ _p_a_r_t_i_c_i_p_a_t_e_ _i_n_d_i_v_i_d_u_a_l_l_y_ _a_n_d_ _c_o_l_l_e_c_t_i_v_e_l_y_ _i_n_ _t_h_e_ _p_l_a_n_n_i_n_g_ _a_n_d_ _i_m_p_l_e_m_e_n_t_a_t_i_o_n_ _o_f_ _t_h_e_i_r_ _h_e_a_l_t_h_ _c_a_r_e_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Communities are at the heart of PHC and must be the *owners and partners *in making health for all a reality. People and communities own their health and therefore health planning, promotion and provision need to be carried out by people and with people, rather than for people. They must not be reduced to mere consumers of health services and health systems must be accountable to people and the communities they serve. However, communities are changing rapidly and in many settings new ways in which community ownership is expressed need to be developed. Strong people?s organisations and movements are fundamental to more democratic, transparent and accountable decision?making processes in health. Community health workers are an important link between communities and the formal health system. They play an essential role in order to strengthen local health services and make them accessible to all. Therefore, community health workers must be recognised in their specific role, supported, trained and remunerated accordingly. Community health workers must become part of a skilled and motivated health workforce. In the light of changing demographics globally, global health worker migration and a gap in trained health work force, health systems must ensure an environment that will be enable and retain skilled and motivated health workers at all levels. *Justice, cooperation and solidarity * *?T_h_e_ _e_x_i_s_t_i_n_g_ _g_r_o_s_s_ _i_n_e_q_u_a_l_i_t_y_ _i_n_ _t_h_e_ _h_e_a_l_t_h_ _s_t_a_t_u_s_ _o_f_ _t_h_e_ _p_e_o_p_l_e_ _p_a_r_t_i_c_u_l_a_r_l_y_ _b_e_t_w_e_e_n_ _d_e_v_e_l_o_p_e_d_ _a_n_d_ _d_e_v_e_l_o_p_i_n_g_ _c_o_u_n_t_r_i_e_s_ _a_s_ _w_e_l_l_ _a_s_ _w_i_t_h_i_n_ _c_o_u_n_t_r_i_e_s_ _i_s_ _p_o_l_i_t_i_c_a_l_l_y_,_ _s_o_c_i_a_l_l_y_ _a_n_d_ _e_c_o_n_o_m_i_c_a_l_l_y_ _u_n_a_c_c_e_p_t_a_b_l_e_ _a_n_d_ _i_s_,_ _t_h_e_r_e_f_o_r_e_,_ _o_f_ _c_o_m_m_o_n_ _c_o_n_c_e_r_n_ _t_o_ _a_l_l_ _c_o_u_n_t_r_i_e_s_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Health is not only a matter of human rights, but also of justice. Governments who are not making provision for decent health care are denying justice to their people. The Alma Ata declaration recognised the need to restructure the global economic order to address inequalities and enable countries to generate resources for decent health care and tackle the root causes of poor health. This still remains a critically important task today. In contrast to the New International Economic Order referred to in the Declaration the dominant contemporary paradigm of export led development has contributed to loss of tax receipts at country level because of the competition for investment which drives reduced tax rates and constant pressure to reduce the cost of production or extraction. These have led to a deterioration of people?s living circumstances and contributed to ill health, instability or even war. It is vital that we build solidarity between people within and across nations and regions. The existing system of international aid and the associated charity narrative legitimise an unfair economic framework which prevents national self-determination and weakens the building of strong and resilient local health systems. Health for all requires the redistribution of wealth nationally and globally. Public financing is essential for health for all. This requires tax justice that will clamp down on tax avoidance and control tax competition between countries. The regulation of transnational corporations through appropriate agreements is essential. Trade justice for health will require trade agreements that protect from extortionate drug prices and not provide corporate impunity through investor state dispute settlements. A reform of research and development financing is required which enables the delinking of research costs from profits from drug sales. Drug policies must support production capacity in low and medium income countries. The provision of health care is costly in any society. A health system based on primary health care principles will be able to achieve health for all at a reasonable cost even while countries develop the capacity for more technological intensive health care. *Beyond the health sector: Addressing root causes and determinants of health inequity * *?T_h_e_ _a_t_t_a_i_n_m_e_n_t_ _o_f_ _t_h_e_ _h_i_g_h_e_s_t_ _p_o_s_s_i_b_l_e_ _l_e_v_e_l_ _o_f_ _h_e_a_l_t_h_ _i_s_ _a_ _m_o_s_t_ _i_m_p_o_r_t_a_n_t_ _w_o_r_l_d_-_w_i_d_e_ _s_o_c_i_a_l_ _g_o_a_l_ _w_h_o_s_e_ _r_e_a_l_i_z_a_t_i_o_n_ _r_e_q_u_i_r_e_s_ _t_h_e_ _a_c_t_i_o_n_ _o_f_ _m_a_n_y_ _o_t_h_e_r_ _s_o_c_i_a_l_ _a_n_d_ _e_c_o_n_o_m_i_c_ _s_e_c_t_o_r_s_ _i_n_ _a_d_d_i_t_i_o_n_ _t_o_ _t_h_e_ _h_e_a_l_t_h_ _s_e_c_t_o_r_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The WHO?s Commission on Social Determinants of Health in 2008 demonstrated that poor health is not randomly distributed, but rather follows a predictable pattern with systematic differences among social groups (i.e. gender, class, race/ethnicity) caused by unequal exposure to, and distribution of, social determinants of health (SDH). Social justice is a matter of life and death. Addressing root causes of health inequity and investing in society, is the only way that health for all and sustainable development can be achieved. The broader context, shaped since the late 1980s by neoliberal economic globalization has profoundly influenced our health situation today. This can be seen in the impact of globalization on social justice, the effect of climate change on livelihoods; the loss of biodiversity, the detrimental effects of agribusiness on peasant farmers and small-holder farmers, who provide most of the world?s food; the impact of land grabbing and the grabbing of water bodies by big business; the influence of patriarchy on society; tax evasion leading to the lack of public funds; the unbridled growth of the arms trade; and the effects of migration to name only a few. All these issues require collaboration across sectors and policies that will address the root causes of illness and the determinants of health inequity. The current global economic order has become dominated by a greatly expanded financial sector leading to price instability due to speculation and reduced policy space because of the reach of market sentiment. It has seen the deregulation of corporations and of trading relations and the commodification and marketization of services which should be based in human relationships and handled as public goods. As in the Alma Ata Declaration, we are calling for a new global economic order (NGEO) to facilitate a safe and just space for humanity. This NGEO would be a means for securing global common goods. The NGEO would guarantee a social foundation for all while at the same time an ecological ceiling so that planetary boundaries are respected. This embedded economy would follow a human rights based approach. It would regulate global public ?bads?, economic externalities that damage the living environment and drive poverty. It would redistribute the enormous wealth and capital available in the world ensuring essential public services and social protection. The NGEO would be regenerative and circular in nature as to remain within the ecological ceilings that planet earth provides while providing a dignified living for all. Today, we have a clear vision on how to overcome these challenges through transformative policies; through the building of people?s movements; and the facilitation of people-to-people connections and solidarity. Examples of such movements include the Women?s March; the tax justice movement, the Global Network for the Right to Food and Nutrition; the Treaty Alliance, the Treatment Action Campaign and others. They are positive examples of a way forward. It is only with the mobilization and convergence of people?s movements and a process of dialogue on national, regional and international level that health equity can become a reality. We call upon governments and people from across the globe to take forward the principles of Primary Health Care that are so clearly articulated in the Alma Ata Declaration. -------------- next part -------------- An HTML attachment was scrubbed... URL: From cschuftan at phmovement.org Tue May 22 23:03:46 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Wed, 23 May 2018 13:03:46 +0700 Subject: PHM-Exch> [PHM NEWS] GHW5 serialized summary (3) Message-ID: For 6 weeks, the PHM-exchange will, on a weekly basis, bring you summaries of all the chapters of its recently published Global Health Watch 5. By the time the last installment is sent out, PHM expects to be able to post the full text of GHW5 electronically for your reading and perusal. We encourage you to read, use and share this material since it provides crucial advocacy contents. *As in the case of all previous Global Health Watches, GHW5 does nothing but build on PHM?s People?s Charter for Health launched in the year 2000. * *All Watches tell activists worldwide what issues worry PHM and its partners, why we denounce them, what consequences loom in the future if nothing is done about them, what (if anything) is being done about them and what actions PHM calls for and supports.* *GHW5 presents to you a decisive global health critique and outlook not easily found elsewhere.* *B5. HOW PPPs UNDERMINE PUBLIC SERVICES* Experiences here come from Sweden. Systematically extracting additional benefits from already agreed health PPPs with the government is typical of the private sector tactics; this is done by creating a series of additional sub-contracts within. The cost of the partnership thus increases with each additional sub-contract while the process becomes less transparent. These deals have always been shrouded in secrecy. Classically, in these PPPs, shortages of nursing personnel are a bottleneck. This shortage is due to low wages and low increments in wages for nurses on top of tough working conditions for them. The latter are never prioritized while funds are diverted to consulting firms and expensive contractors. Large amounts of money are being spent on hiring management consulting firms that are often over-paid. To the detriment of beneficiaries, PPPs in the hospital business have been successful and are being promoted through the IMF, the World Bank and the EU. One example is in Lesotho where half the country?s health budget goes towards funding a large PPP venture in the capital city. Xx *B6. ACCESS TO HEALTHCARE OF MIGRANTS* Experiences here come from Europe. Migrants exclusion from healthcare has as a consequence that markedly fewer migrants attempt to access the healthcare systems as most are wrongfully denied their rights. Add to this their lack of access to adequate housing and food. Their temporary identity documents barely cover emergency medical problems; preventive care is not available; thousands of children have not been immunized. Access to PHC is difficult, but much more so is access to secondary and tertiary healthcare facilities mainly, but not only due to their lack of documentation. Xenophobia has also been on the rise. Hate discourses use migrants as scape goats for what are the countries? problems. Clearly, undocumented migrants are being blamed to divert attention of the public from unpopular social sector cutbacks. Protecting the right to health for all is of paramount importance here. Austerity measures in Europe have greatly reduced investments in healthcare; migrants are left at the shorter end of the stick. Migrants? perception of their lack of rights results in them desisting from demanding assistance even if needed. Add to this complex administrative processes tedious and difficult to understand and translations services most often not being available --all impeding access. The necessity to provide proof of residence is another huge barrier. The restrictive interpret of laws by healthcare personnel has further resulted in asylum seekers being denied care. State institutions are, with some exceptions, obliged to report undocumented migrants to migration authorities. This is a clincher. It is not enough to offer health services and make them claimable; one needs to promote and actively inform people if such resources are to become truly accessible. All this amounts to a grave breach of human rights as being perpetrated. Mobilized public interest CSOs have been actively advocating to ensure a universal system for every person. Xxx *B7. INFORMALIZATION OF EMPLOYMENT IN PUBLIC HEALTH SERVICES.* Examples here come from South Asia. The state has been retreating from the provision of healthcare in more places than we suspect. Public budgets are dwindling and the remuneration of health workers is decreasing in relation to total health expenditures globally. Women are among the worst impacted by downward pressures on remuneration. The trend that comes as a consequence is the informalization of employment in the health sector. Employment to retirement in the public health sector is dwindling; short-term contracts are in. PHM notes that insecurity of tenure in the case of informal employment makes it more difficult for workers to join or form unions. Without the right to unionize and to engage in collective bargaining, health workers remain vulnerable to exploitation by their employers. Informal employment relations are first sought to unskilled workers. As informalization spreads, ward attendants and cleaning staff are also affected and hired temporarily. Laboratory staff and nurses are affected at the end of the chain. Informalization of the health workforce, weakening of public healthcare institutions and the expansion of the role of the private sector are actually interlinked in multiple and complex ways. Note that the under-funded and extensive deployment of community health workers (CHWs) in rural areas goes hand in hand with their irregular working hours and their inadequate remuneration. The latter is a key factor in their attrition. The remuneration issue has become a bitter struggle for them in some places with associations having been formed to fight for wage-based remuneration and other labor rights such as paid leave and pensions. Their discontent cannot be brushed aside. For long-term sustainability (recruitment and retention), their formal recognition with full rights is to be supported. (Some CHWs are paid special bonuses and stipends for refreshments during immunization campaigns, but this is hardly enough). GHW5 notes that lower-caste and minority women are mostly excluded from the selection process. This, despite the fact that CHWs in the health system amount to a hidden subsidy towards society at large. Finally, migration is a key driver of the current global health workforce crisis with workers being pushed to the private sector and/or seeking greener pastures overseas. Only through engagement of the larger public health community with the demands of organized health workers can both decent work and quality services be effectively realized. Xxx *A. **BEYOND HEALTHCARE.* *C1. CLIMATE CHANGE, ENVIRONMENTAL DEGRADATION AND HEALTH. * Ubiquitous slick corporate social responsibility campaigns keep claiming the above to be an exaggerated fabrication. So, market driven enterprises continue to merrily jeopardize the spaces and places where people work, play and live. Children, women and the elderly are particularly exposed. Attempts at controls are systematically opposed. GHW5 is worried, among other, about outdoor and indoor air pollution, the overuse and contamination of water, slash and burn operations, toxic waste disposal, the plastic contamination of oceans, land degradation, deforestation and so many other 21st century planetary worries affecting public health. partly exposed All these have explicit underlying political determinants that ultimately affect the allocation of resource in our societies. As relates to climate change, it is noted that the same is exacerbating existing health problems including secondary consequences such as vector-borne diseases, food shortages and food insecurity and particularly population displacements. The most likely affected, no surprise, will be the impoverished, the socially excluded and the otherwise vulnerable groups including indigenous people (that are also at the forefront resisting abuses). PHM emphasizes that it is a misconception to continue saying that population size or growth per-se drives these issues. Climate change is deeply shaped by TNCs and the life styles of the rich. Environmental degradation and its health consequences are thus borne by those excluded from power and decision-making with the greatest advantages accruing to the more powerful. Recycling and composting, home gardening, use of energy efficient appliances and of public transport, biking, walking and lowering thermostats in winter, are just some of the recommendations for affluent societies. But all these need a motivation to make these behavioral changes -and the same is simply not there. A caveat here would be the fact that individual or household-level solutions do not affect the real underlying structural determinants, the ones that drive global environmental degradation. Pro-TNC policies and subsidies for sure aggravate the situation. We are thus left with confronting agribusiness, energy, mining and other industrial interests through litigation, divestment campaigns, advocacy, protests and other methods. An example is the actions of La Via Campesina in its work for food sovereignty, preservation of natural resources, sustainable agriculture, gender equality, land rights, resistance against displacements and fair economic relations. Special mention must be made of the Buen Vivir indigenous movement in the Andean regions of South and Central America. It questions conventional assumptions about growth and development and calls for living well in harmony with the natural environment and within existing resources. What is thus needed is a paradigm shift that questions the global political economy and provides ecological alternatives. Shifting values will mean pressuring political processes towards the building of societies that favor equity over growth. Our civilization is at a crucial crossroad. Addressing the related health issues will require intense political struggle to face the political recalcitrance to transformative change by the largest polluters, importantly TNCs who continue doing business as usual. Xxx *C2. GENDERED APPROACH TO REPRODUCTIVE AND SEXUAL HEALTH AND RIGHTS* Women?s health is regrettably and persistently relegated to issues of maternal health and family planning, the latter especially for married women. Coercion and social inequalities resulting in social hierarchies are deep-rooted and these continue to grow within and across countries. Add to this, challenges due to the rise in religious and political fundamentalisms and you get a picture of how patriarchy is still prevalent. Protection of the bodily integrity of women and their freedom from violence, as well as their access to safe abortion also stand threatened. While the SDGs call to ?leave no one behind? is a worthy aspirational call, neither are the SDGs targets and indicators exhaustive nor do they have a true transformative potential. Sad to say, but public healthcare systems have historically been at the center of fostering such discriminations and violations of the health and human rights, not only of women, but also of the other groups with marginalized sexualities and gender identities. Attention is called upon the specific needs of LGBT persons. Sex workers are even more stigmatized and have difficulty in accessing healthcare, especially in situations of violence. Sex workers? access to institutions of law and order and of justice in situations of violence are further very limited. Sex workers are organizing though since their access and quality of healthcare are virtually absent for them. Mind you, sex work is frequently conflated with human trafficking issues. For all these reasons, there is a need to chart the future trajectory of activism around sexual and reproductive health rights (SRHR) afresh. There is a need to forge alliances and solidarities to resist retrograde steps that threaten SRHR. Mobilizations for the development of shadow reports by public interest CSOs to the UN UPR and CEDAW review committees. Countries that have not signed/ratified some of the international treaties that accord protection regarding SRHR must become targets of strategic CSOs mobilization. -------------- next part -------------- An HTML attachment was scrubbed... URL: From cschuftan at phmovement.org Tue May 22 03:11:55 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Tue, 22 May 2018 17:11:55 +0700 Subject: PHM-Exch> =?utf-8?b?VHJhbnNsYXRpbmcg4oCcSGVhbHRoIGZvciBBbGzigJ0g?= =?utf-8?q?into_the_Present_and_Future?= Message-ID: C_o_n_s_u_l_t_a_t_i_o_n_ _s_t_a_t_e_m_e_n_t_ _o_f_ _t_h_e_ _c_i_v_i_l_ _s_o_c_i_e_t_y_ _w_o_r_k_s_h_o_p_ _?4_0_ _Y_e_a_r_s_ _o_f_ _A_l_m_a_-_A_t_a_:_ _T_r_a_n_s_l_a_t_i_n_g_ _?H_e_a_l_t_h_ _f_o_r_ _A_l_l_? _i_n_t_o_ _t_h_e_ _P_r_e_s_e_n_t_ _a_n_d_ _F_u_t_u_r_e_?,_ _G_e_n_e_v_a_,_ _E_c_u_m_e_n_i_c_a_l_ _C_e_n_t_r_e_,_ _1_8_ _M_a_y_ _2_0_1_8_ _ S_u_m_m_a_r_y_ _ *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. However, after 40 years, inequality, poverty, exploitation, violence and injustice are still keeping one Billion people from accessing health care. To achieve health for all, inequities have to be overcome, powerful interests to be challenged, and political and economic priorities must be transformed to achieve health for all. *Realising the vision of Alma Ata is more urgent than ever: * ? _Applying the principles of Primary Health Care as declared at Alma Ata 1978 is critical in achieving health for all by 2030. ? _Community engagement and ownership is the key to health for all and essential for building resilient health systems that allow all people to access the health care they need. ? _A skilled and motivated health workforce is at the centre of health systems at all levels. It must be recognized that community health workers play an essential part in realising universal health coverage and health for all. ? _Strong people?s organisations and movements are fundamental to strong health systems. ? _Access to essential medicines of good quality at an affordable price is part of health for all. Policies must ensure that research costs are delinked from the price of drugs and everyone has the right to access essential medicines. ? _Health for all demands inter-sectoral collaboration and must provide access to prevention, promotion, treatment, care, rehabilitation and palliative care to everyone within a sustainable framework. ? _Health is not only a matter of human rights, it is a matter of justice and requires a redistribution of wealth and significant changes in the global economic order. ? _Equity in health and social justice must be the basis for all decision making. ? _To ensure access to health services to all, service provision through public and not-for-profit providers must be given the primacy in health system planning and implementation. The ambiguities regarding UHC must be resolved with health care financing policies structured to prevent the commodification and marketisation of health care. *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. Realising the vision of Alma Ata and health for all is more urgent than ever: *Primary Health Care and Universal Health Coverage * *?P_r_i_m_a_r_y_ _h_e_a_l_t_h_ _c_a_r_e_ _i_s_ _e_s_s_e_n_t_i_a_l_ _h_e_a_l_t_h_ _c_a_r_e_ _b_a_s_e_d_ _o_n_ _p_r_a_c_t_i_c_a_l_,_ _s_c_i_e_n_t_i_f_i_c_a_l_l_y_ _s_o_u_n_d_ _a_n_d_ _s_o_c_i_a_l_l_y_ _a_c_c_e_p_t_a_b_l_e_ _m_e_t_h_o_d_s_ _a_n_d_ _t_e_c_h_n_o_l_o_g_y_ _m_a_d_e_ _u_n_i_v_e_r_s_a_l_l_y_ _a_c_c_e_s_s_i_b_l_e_ _t_o_ _i_n_d_i_v_i_d_u_a_l_s_ _a_n_d_ _f_a_m_i_l_i_e_s_ _i_n_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _t_h_r_o_u_g_h_ _t_h_e_i_r_ _f_u_l_l_ _p_a_r_t_i_c_i_p_a_t_i_o_n_ _a_n_d_ _a_t_ _a_ _c_o_s_t_ _t_h_a_t_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _a_n_d_ _c_o_u_n_t_r_y_ _c_a_n_ _a_f_f_o_r_d_ _t_o_ _m_a_i_n_t_a_i_n_ _a_t_ _e_v_e_r_y_ _s_t_a_g_e_ _o_f_ _t_h_e_i_r_ _d_e_v_e_l_o_p_m_e_n_t_ _i_n_ _t_h_e_ _s_p_i_r_i_t_ _o_f_ _s_e_l_f_-_r_e_l_i_a_n_c_e_ _a_n_d_ _s_e_l_f_-_d_e_t_e_r_m_i_n_a_t_i_o_n_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The Primary Health Care (PHC) principles affirm health as a human right based on equity and social justice, implemented through community engagement, health promotion, the appropriate use of resources, and inter-sectoral action based on a ?New International Economic Order? with the vision of health for all by the year 2000. The Declaration, however, came at a time of major global economic changes including the economic slow-down of the 1970ies, the debt crisis and structural adjustments. Shortly after Alma Ata UNICEF and the Rockefeller Foundation declared ?Selective Primary Health Care? instead of ?Comprehensive Primary Health Care?, which under structural adjustments became the dominant paradigm and model of PHC. Structural adjustment programs led to a reduction of staff, narrow benefit packages and a lack of resources in the public sector and weakened already weak health systems. The advent of the HIV epidemic led to isolated but impressive community based responses even before the advent of antiretrovirals. These were applying PHC principles dealing with HIV prevention, home based care, destigmatisation, treatment literacy a.o. addressing the challenges of HIV. Global health initiatives such as the GFATM or Gavi contributed to a considerable increase of funding but these have been mainly earmarked for vertical programmes especially in the area of HIV, Malaria or TB. Besides all the positive effects that were achieved, this has been associated with a migration of resources and personnel from public primary care systems to globally funded programs. In 2010, WHO introduced the concept of Universal Health Coverage (UHC), which was defined as access to health services without financial hardship. While in general, the notion of UHC seems consistent with WHO?s concept of Health for All in Primary Health Care, a key issue that remains unresolved is the primacy provided to public or non-for-profit services under PHC and conversely the larger role envisioned to private for-profit providers while implementing UHC. Hence, in many countries public services are being replaced by private for-profit providers. Especially concerning is the increase of corporate chains of providers, mainly supported by private insurance. While impressive medical and technological advances have taken place around the world, improvements in the health status of the people have been moderate and inconsistent between and within countries. The biomedical and technical approach to health has its limitations in actually improving health especially among marginalised and poor populations and has contributed to a neglect of other determinants of health. Health systems must be built on the principles of comprehensive primary health care that includes community engagement, adequate healthcare infrastructure, skilled, supported and motivated health workforce, access to essential drugs of good quality that are rationally used in addition to new advancements and technologies that must be accessible to all. *Communities: From objects of health care to full participation and ownership * *?T_h_e_ _p_e_o_p_l_e_ _h_a_v_e_ _t_h_e_ _r_i_g_h_t_ _a_n_d_ _d_u_t_y_ _t_o_ _p_a_r_t_i_c_i_p_a_t_e_ _i_n_d_i_v_i_d_u_a_l_l_y_ _a_n_d_ _c_o_l_l_e_c_t_i_v_e_l_y_ _i_n_ _t_h_e_ _p_l_a_n_n_i_n_g_ _a_n_d_ _i_m_p_l_e_m_e_n_t_a_t_i_o_n_ _o_f_ _t_h_e_i_r_ _h_e_a_l_t_h_ _c_a_r_e_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Communities are at the heart of PHC and must be the *owners and partners *in making health for all a reality. People and communities own their health and therefore health planning, promotion and provision need to be carried out by people and with people, rather than for people. They must not be reduced to mere consumers of health services and health systems must be accountable to people and the communities they serve. However, communities are changing rapidly and in many settings new ways in which community ownership is expressed need to be developed. Strong people?s organisations and movements are fundamental to more democratic, transparent and accountable decision?making processes in health. Community health workers are an important link between communities and the formal health system. They play an essential role in order to strengthen local health services and make them accessible to all. Therefore, community health workers must be recognised in their specific role, supported, trained and remunerated accordingly. Community health workers must become part of a skilled and motivated health workforce. In the light of changing demographics globally, global health worker migration and a gap in trained health work force, health systems must ensure an environment that will be enable and retain skilled and motivated health workers at all levels. *Justice, cooperation and solidarity * *?T_h_e_ _e_x_i_s_t_i_n_g_ _g_r_o_s_s_ _i_n_e_q_u_a_l_i_t_y_ _i_n_ _t_h_e_ _h_e_a_l_t_h_ _s_t_a_t_u_s_ _o_f_ _t_h_e_ _p_e_o_p_l_e_ _p_a_r_t_i_c_u_l_a_r_l_y_ _b_e_t_w_e_e_n_ _d_e_v_e_l_o_p_e_d_ _a_n_d_ _d_e_v_e_l_o_p_i_n_g_ _c_o_u_n_t_r_i_e_s_ _a_s_ _w_e_l_l_ _a_s_ _w_i_t_h_i_n_ _c_o_u_n_t_r_i_e_s_ _i_s_ _p_o_l_i_t_i_c_a_l_l_y_,_ _s_o_c_i_a_l_l_y_ _a_n_d_ _e_c_o_n_o_m_i_c_a_l_l_y_ _u_n_a_c_c_e_p_t_a_b_l_e_ _a_n_d_ _i_s_,_ _t_h_e_r_e_f_o_r_e_,_ _o_f_ _c_o_m_m_o_n_ _c_o_n_c_e_r_n_ _t_o_ _a_l_l_ _c_o_u_n_t_r_i_e_s_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Health is not only a matter of human rights, but also of justice. Governments who are not making provision for decent health care are denying justice to their people. The Alma Ata declaration recognised the need to restructure the global economic order to address inequalities and enable countries to generate resources for decent health care and tackle the root causes of poor health. This still remains a critically important task today. In contrast to the New International Economic Order referred to in the Declaration the dominant contemporary paradigm of export led development has contributed to loss of tax receipts at country level because of the competition for investment which drives reduced tax rates and constant pressure to reduce the cost of production or extraction. These have led to a deterioration of people?s living circumstances and contributed to ill health, instability or even war. It is vital that we build solidarity between people within and across nations and regions. The existing system of international aid and the associated charity narrative legitimise an unfair economic framework which prevents national self-determination and weakens the building of strong and resilient local health systems. Health for all requires the redistribution of wealth nationally and globally. Public financing is essential for health for all. This requires tax justice that will clamp down on tax avoidance and control tax competition between countries. The regulation of transnational corporations through appropriate agreements is essential. Trade justice for health will require trade agreements that protect from extortionate drug prices and not provide corporate impunity through investor state dispute settlements. A reform of research and development financing is required which enables the delinking of research costs from profits from drug sales. Drug policies must support production capacity in low and medium income countries. The provision of health care is costly in any society. A health system based on primary health care principles will be able to achieve health for all at a reasonable cost even while countries develop the capacity for more technological intensive health care. *Beyond the health sector: Addressing root causes and determinants of health inequity * *?T_h_e_ _a_t_t_a_i_n_m_e_n_t_ _o_f_ _t_h_e_ _h_i_g_h_e_s_t_ _p_o_s_s_i_b_l_e_ _l_e_v_e_l_ _o_f_ _h_e_a_l_t_h_ _i_s_ _a_ _m_o_s_t_ _i_m_p_o_r_t_a_n_t_ _w_o_r_l_d_-_w_i_d_e_ _s_o_c_i_a_l_ _g_o_a_l_ _w_h_o_s_e_ _r_e_a_l_i_z_a_t_i_o_n_ _r_e_q_u_i_r_e_s_ _t_h_e_ _a_c_t_i_o_n_ _o_f_ _m_a_n_y_ _o_t_h_e_r_ _s_o_c_i_a_l_ _a_n_d_ _e_c_o_n_o_m_i_c_ _s_e_c_t_o_r_s_ _i_n_ _a_d_d_i_t_i_o_n_ _t_o_ _t_h_e_ _h_e_a_l_t_h_ _s_e_c_t_o_r_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The WHO?s Commission on Social Determinants of Health in 2008 demonstrated that poor health is not randomly distributed, but rather follows a predictable pattern with systematic differences among social groups (i.e. gender, class, race/ethnicity) caused by unequal exposure to, and distribution of, social determinants of health (SDH). Social justice is a matter of life and death. Addressing root causes of health inequity and investing in society, is the only way that health for all and sustainable development can be achieved. The broader context, shaped since the late 1980s by neoliberal economic globalization has profoundly influenced our health situation today. This can be seen in the impact of globalization on social justice, the effect of climate change on livelihoods; the loss of biodiversity, the detrimental effects of agribusiness on peasant farmers and small-holder farmers, who provide most of the world?s food; the impact of land grabbing and the grabbing of water bodies by big business; the influence of patriarchy on society; tax evasion leading to the lack of public funds; the unbridled growth of the arms trade; and the effects of migration to name only a few. All these issues require collaboration across sectors and policies that will address the root causes of illness and the determinants of health inequity. The current global economic order has become dominated by a greatly expanded financial sector leading to price instability due to speculation and reduced policy space because of the reach of market sentiment. It has seen the deregulation of corporations and of trading relations and the commodification and marketization of services which should be based in human relationships and handled as public goods. As in the Alma Ata Declaration, we are calling for a new global economic order (NGEO) to facilitate a safe and just space for humanity. This NGEO would be a means for securing global common goods. The NGEO would guarantee a social foundation for all while at the same time an ecological ceiling so that planetary boundaries are respected. This embedded economy would follow a human rights based approach. It would regulate global public ?bads?, economic externalities that damage the living environment and drive poverty. It would redistribute the enormous wealth and capital available in the world ensuring essential public services and social protection. The NGEO would be regenerative and circular in nature as to remain within the ecological ceilings that planet earth provides while providing a dignified living for all. Today, we have a clear vision on how to overcome these challenges through transformative policies; through the building of people?s movements; and the facilitation of people-to-people connections and solidarity. Examples of such movements include the Women?s March; the tax justice movement, the Global Network for the Right to Food and Nutrition; the Treaty Alliance, the Treatment Action Campaign and others. They are positive examples of a way forward. It is only with the mobilization and convergence of people?s movements and a process of dialogue on national, regional and international level that health equity can become a reality. We call upon governments and people from across the globe to take forward the principles of Primary Health Care that are so clearly articulated in the Alma Ata Declaration. -------------- next part -------------- An HTML attachment was scrubbed... URL: From cschuftan at phmovement.org Tue May 22 23:03:46 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Wed, 23 May 2018 13:03:46 +0700 Subject: PHM-Exch> [PHM NEWS] GHW5 serialized summary (3) Message-ID: For 6 weeks, the PHM-exchange will, on a weekly basis, bring you summaries of all the chapters of its recently published Global Health Watch 5. By the time the last installment is sent out, PHM expects to be able to post the full text of GHW5 electronically for your reading and perusal. We encourage you to read, use and share this material since it provides crucial advocacy contents. *As in the case of all previous Global Health Watches, GHW5 does nothing but build on PHM?s People?s Charter for Health launched in the year 2000. * *All Watches tell activists worldwide what issues worry PHM and its partners, why we denounce them, what consequences loom in the future if nothing is done about them, what (if anything) is being done about them and what actions PHM calls for and supports.* *GHW5 presents to you a decisive global health critique and outlook not easily found elsewhere.* *B5. HOW PPPs UNDERMINE PUBLIC SERVICES* Experiences here come from Sweden. Systematically extracting additional benefits from already agreed health PPPs with the government is typical of the private sector tactics; this is done by creating a series of additional sub-contracts within. The cost of the partnership thus increases with each additional sub-contract while the process becomes less transparent. These deals have always been shrouded in secrecy. Classically, in these PPPs, shortages of nursing personnel are a bottleneck. This shortage is due to low wages and low increments in wages for nurses on top of tough working conditions for them. The latter are never prioritized while funds are diverted to consulting firms and expensive contractors. Large amounts of money are being spent on hiring management consulting firms that are often over-paid. To the detriment of beneficiaries, PPPs in the hospital business have been successful and are being promoted through the IMF, the World Bank and the EU. One example is in Lesotho where half the country?s health budget goes towards funding a large PPP venture in the capital city. Xx *B6. ACCESS TO HEALTHCARE OF MIGRANTS* Experiences here come from Europe. Migrants exclusion from healthcare has as a consequence that markedly fewer migrants attempt to access the healthcare systems as most are wrongfully denied their rights. Add to this their lack of access to adequate housing and food. Their temporary identity documents barely cover emergency medical problems; preventive care is not available; thousands of children have not been immunized. Access to PHC is difficult, but much more so is access to secondary and tertiary healthcare facilities mainly, but not only due to their lack of documentation. Xenophobia has also been on the rise. Hate discourses use migrants as scape goats for what are the countries? problems. Clearly, undocumented migrants are being blamed to divert attention of the public from unpopular social sector cutbacks. Protecting the right to health for all is of paramount importance here. Austerity measures in Europe have greatly reduced investments in healthcare; migrants are left at the shorter end of the stick. Migrants? perception of their lack of rights results in them desisting from demanding assistance even if needed. Add to this complex administrative processes tedious and difficult to understand and translations services most often not being available --all impeding access. The necessity to provide proof of residence is another huge barrier. The restrictive interpret of laws by healthcare personnel has further resulted in asylum seekers being denied care. State institutions are, with some exceptions, obliged to report undocumented migrants to migration authorities. This is a clincher. It is not enough to offer health services and make them claimable; one needs to promote and actively inform people if such resources are to become truly accessible. All this amounts to a grave breach of human rights as being perpetrated. Mobilized public interest CSOs have been actively advocating to ensure a universal system for every person. Xxx *B7. INFORMALIZATION OF EMPLOYMENT IN PUBLIC HEALTH SERVICES.* Examples here come from South Asia. The state has been retreating from the provision of healthcare in more places than we suspect. Public budgets are dwindling and the remuneration of health workers is decreasing in relation to total health expenditures globally. Women are among the worst impacted by downward pressures on remuneration. The trend that comes as a consequence is the informalization of employment in the health sector. Employment to retirement in the public health sector is dwindling; short-term contracts are in. PHM notes that insecurity of tenure in the case of informal employment makes it more difficult for workers to join or form unions. Without the right to unionize and to engage in collective bargaining, health workers remain vulnerable to exploitation by their employers. Informal employment relations are first sought to unskilled workers. As informalization spreads, ward attendants and cleaning staff are also affected and hired temporarily. Laboratory staff and nurses are affected at the end of the chain. Informalization of the health workforce, weakening of public healthcare institutions and the expansion of the role of the private sector are actually interlinked in multiple and complex ways. Note that the under-funded and extensive deployment of community health workers (CHWs) in rural areas goes hand in hand with their irregular working hours and their inadequate remuneration. The latter is a key factor in their attrition. The remuneration issue has become a bitter struggle for them in some places with associations having been formed to fight for wage-based remuneration and other labor rights such as paid leave and pensions. Their discontent cannot be brushed aside. For long-term sustainability (recruitment and retention), their formal recognition with full rights is to be supported. (Some CHWs are paid special bonuses and stipends for refreshments during immunization campaigns, but this is hardly enough). GHW5 notes that lower-caste and minority women are mostly excluded from the selection process. This, despite the fact that CHWs in the health system amount to a hidden subsidy towards society at large. Finally, migration is a key driver of the current global health workforce crisis with workers being pushed to the private sector and/or seeking greener pastures overseas. Only through engagement of the larger public health community with the demands of organized health workers can both decent work and quality services be effectively realized. Xxx *A. **BEYOND HEALTHCARE.* *C1. CLIMATE CHANGE, ENVIRONMENTAL DEGRADATION AND HEALTH. * Ubiquitous slick corporate social responsibility campaigns keep claiming the above to be an exaggerated fabrication. So, market driven enterprises continue to merrily jeopardize the spaces and places where people work, play and live. Children, women and the elderly are particularly exposed. Attempts at controls are systematically opposed. GHW5 is worried, among other, about outdoor and indoor air pollution, the overuse and contamination of water, slash and burn operations, toxic waste disposal, the plastic contamination of oceans, land degradation, deforestation and so many other 21st century planetary worries affecting public health. partly exposed All these have explicit underlying political determinants that ultimately affect the allocation of resource in our societies. As relates to climate change, it is noted that the same is exacerbating existing health problems including secondary consequences such as vector-borne diseases, food shortages and food insecurity and particularly population displacements. The most likely affected, no surprise, will be the impoverished, the socially excluded and the otherwise vulnerable groups including indigenous people (that are also at the forefront resisting abuses). PHM emphasizes that it is a misconception to continue saying that population size or growth per-se drives these issues. Climate change is deeply shaped by TNCs and the life styles of the rich. Environmental degradation and its health consequences are thus borne by those excluded from power and decision-making with the greatest advantages accruing to the more powerful. Recycling and composting, home gardening, use of energy efficient appliances and of public transport, biking, walking and lowering thermostats in winter, are just some of the recommendations for affluent societies. But all these need a motivation to make these behavioral changes -and the same is simply not there. A caveat here would be the fact that individual or household-level solutions do not affect the real underlying structural determinants, the ones that drive global environmental degradation. Pro-TNC policies and subsidies for sure aggravate the situation. We are thus left with confronting agribusiness, energy, mining and other industrial interests through litigation, divestment campaigns, advocacy, protests and other methods. An example is the actions of La Via Campesina in its work for food sovereignty, preservation of natural resources, sustainable agriculture, gender equality, land rights, resistance against displacements and fair economic relations. Special mention must be made of the Buen Vivir indigenous movement in the Andean regions of South and Central America. It questions conventional assumptions about growth and development and calls for living well in harmony with the natural environment and within existing resources. What is thus needed is a paradigm shift that questions the global political economy and provides ecological alternatives. Shifting values will mean pressuring political processes towards the building of societies that favor equity over growth. Our civilization is at a crucial crossroad. Addressing the related health issues will require intense political struggle to face the political recalcitrance to transformative change by the largest polluters, importantly TNCs who continue doing business as usual. Xxx *C2. GENDERED APPROACH TO REPRODUCTIVE AND SEXUAL HEALTH AND RIGHTS* Women?s health is regrettably and persistently relegated to issues of maternal health and family planning, the latter especially for married women. Coercion and social inequalities resulting in social hierarchies are deep-rooted and these continue to grow within and across countries. Add to this, challenges due to the rise in religious and political fundamentalisms and you get a picture of how patriarchy is still prevalent. Protection of the bodily integrity of women and their freedom from violence, as well as their access to safe abortion also stand threatened. While the SDGs call to ?leave no one behind? is a worthy aspirational call, neither are the SDGs targets and indicators exhaustive nor do they have a true transformative potential. Sad to say, but public healthcare systems have historically been at the center of fostering such discriminations and violations of the health and human rights, not only of women, but also of the other groups with marginalized sexualities and gender identities. Attention is called upon the specific needs of LGBT persons. Sex workers are even more stigmatized and have difficulty in accessing healthcare, especially in situations of violence. Sex workers? access to institutions of law and order and of justice in situations of violence are further very limited. Sex workers are organizing though since their access and quality of healthcare are virtually absent for them. Mind you, sex work is frequently conflated with human trafficking issues. For all these reasons, there is a need to chart the future trajectory of activism around sexual and reproductive health rights (SRHR) afresh. There is a need to forge alliances and solidarities to resist retrograde steps that threaten SRHR. Mobilizations for the development of shadow reports by public interest CSOs to the UN UPR and CEDAW review committees. Countries that have not signed/ratified some of the international treaties that accord protection regarding SRHR must become targets of strategic CSOs mobilization. -------------- next part -------------- An HTML attachment was scrubbed... URL: From cschuftan at phmovement.org Tue May 22 03:11:55 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Tue, 22 May 2018 17:11:55 +0700 Subject: PHM-Exch> =?utf-8?b?VHJhbnNsYXRpbmcg4oCcSGVhbHRoIGZvciBBbGzigJ0g?= =?utf-8?q?into_the_Present_and_Future?= Message-ID: C_o_n_s_u_l_t_a_t_i_o_n_ _s_t_a_t_e_m_e_n_t_ _o_f_ _t_h_e_ _c_i_v_i_l_ _s_o_c_i_e_t_y_ _w_o_r_k_s_h_o_p_ _?4_0_ _Y_e_a_r_s_ _o_f_ _A_l_m_a_-_A_t_a_:_ _T_r_a_n_s_l_a_t_i_n_g_ _?H_e_a_l_t_h_ _f_o_r_ _A_l_l_? _i_n_t_o_ _t_h_e_ _P_r_e_s_e_n_t_ _a_n_d_ _F_u_t_u_r_e_?,_ _G_e_n_e_v_a_,_ _E_c_u_m_e_n_i_c_a_l_ _C_e_n_t_r_e_,_ _1_8_ _M_a_y_ _2_0_1_8_ _ S_u_m_m_a_r_y_ _ *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. However, after 40 years, inequality, poverty, exploitation, violence and injustice are still keeping one Billion people from accessing health care. To achieve health for all, inequities have to be overcome, powerful interests to be challenged, and political and economic priorities must be transformed to achieve health for all. *Realising the vision of Alma Ata is more urgent than ever: * ? _Applying the principles of Primary Health Care as declared at Alma Ata 1978 is critical in achieving health for all by 2030. ? _Community engagement and ownership is the key to health for all and essential for building resilient health systems that allow all people to access the health care they need. ? _A skilled and motivated health workforce is at the centre of health systems at all levels. It must be recognized that community health workers play an essential part in realising universal health coverage and health for all. ? _Strong people?s organisations and movements are fundamental to strong health systems. ? _Access to essential medicines of good quality at an affordable price is part of health for all. Policies must ensure that research costs are delinked from the price of drugs and everyone has the right to access essential medicines. ? _Health for all demands inter-sectoral collaboration and must provide access to prevention, promotion, treatment, care, rehabilitation and palliative care to everyone within a sustainable framework. ? _Health is not only a matter of human rights, it is a matter of justice and requires a redistribution of wealth and significant changes in the global economic order. ? _Equity in health and social justice must be the basis for all decision making. ? _To ensure access to health services to all, service provision through public and not-for-profit providers must be given the primacy in health system planning and implementation. The ambiguities regarding UHC must be resolved with health care financing policies structured to prevent the commodification and marketisation of health care. *Translating ?Health for All? into the Present and Future * Health is a fundamental human right ? enshrined in the WHO constitution and the declaration of Alma Ata. Realising the vision of Alma Ata and health for all is more urgent than ever: *Primary Health Care and Universal Health Coverage * *?P_r_i_m_a_r_y_ _h_e_a_l_t_h_ _c_a_r_e_ _i_s_ _e_s_s_e_n_t_i_a_l_ _h_e_a_l_t_h_ _c_a_r_e_ _b_a_s_e_d_ _o_n_ _p_r_a_c_t_i_c_a_l_,_ _s_c_i_e_n_t_i_f_i_c_a_l_l_y_ _s_o_u_n_d_ _a_n_d_ _s_o_c_i_a_l_l_y_ _a_c_c_e_p_t_a_b_l_e_ _m_e_t_h_o_d_s_ _a_n_d_ _t_e_c_h_n_o_l_o_g_y_ _m_a_d_e_ _u_n_i_v_e_r_s_a_l_l_y_ _a_c_c_e_s_s_i_b_l_e_ _t_o_ _i_n_d_i_v_i_d_u_a_l_s_ _a_n_d_ _f_a_m_i_l_i_e_s_ _i_n_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _t_h_r_o_u_g_h_ _t_h_e_i_r_ _f_u_l_l_ _p_a_r_t_i_c_i_p_a_t_i_o_n_ _a_n_d_ _a_t_ _a_ _c_o_s_t_ _t_h_a_t_ _t_h_e_ _c_o_m_m_u_n_i_t_y_ _a_n_d_ _c_o_u_n_t_r_y_ _c_a_n_ _a_f_f_o_r_d_ _t_o_ _m_a_i_n_t_a_i_n_ _a_t_ _e_v_e_r_y_ _s_t_a_g_e_ _o_f_ _t_h_e_i_r_ _d_e_v_e_l_o_p_m_e_n_t_ _i_n_ _t_h_e_ _s_p_i_r_i_t_ _o_f_ _s_e_l_f_-_r_e_l_i_a_n_c_e_ _a_n_d_ _s_e_l_f_-_d_e_t_e_r_m_i_n_a_t_i_o_n_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The Primary Health Care (PHC) principles affirm health as a human right based on equity and social justice, implemented through community engagement, health promotion, the appropriate use of resources, and inter-sectoral action based on a ?New International Economic Order? with the vision of health for all by the year 2000. The Declaration, however, came at a time of major global economic changes including the economic slow-down of the 1970ies, the debt crisis and structural adjustments. Shortly after Alma Ata UNICEF and the Rockefeller Foundation declared ?Selective Primary Health Care? instead of ?Comprehensive Primary Health Care?, which under structural adjustments became the dominant paradigm and model of PHC. Structural adjustment programs led to a reduction of staff, narrow benefit packages and a lack of resources in the public sector and weakened already weak health systems. The advent of the HIV epidemic led to isolated but impressive community based responses even before the advent of antiretrovirals. These were applying PHC principles dealing with HIV prevention, home based care, destigmatisation, treatment literacy a.o. addressing the challenges of HIV. Global health initiatives such as the GFATM or Gavi contributed to a considerable increase of funding but these have been mainly earmarked for vertical programmes especially in the area of HIV, Malaria or TB. Besides all the positive effects that were achieved, this has been associated with a migration of resources and personnel from public primary care systems to globally funded programs. In 2010, WHO introduced the concept of Universal Health Coverage (UHC), which was defined as access to health services without financial hardship. While in general, the notion of UHC seems consistent with WHO?s concept of Health for All in Primary Health Care, a key issue that remains unresolved is the primacy provided to public or non-for-profit services under PHC and conversely the larger role envisioned to private for-profit providers while implementing UHC. Hence, in many countries public services are being replaced by private for-profit providers. Especially concerning is the increase of corporate chains of providers, mainly supported by private insurance. While impressive medical and technological advances have taken place around the world, improvements in the health status of the people have been moderate and inconsistent between and within countries. The biomedical and technical approach to health has its limitations in actually improving health especially among marginalised and poor populations and has contributed to a neglect of other determinants of health. Health systems must be built on the principles of comprehensive primary health care that includes community engagement, adequate healthcare infrastructure, skilled, supported and motivated health workforce, access to essential drugs of good quality that are rationally used in addition to new advancements and technologies that must be accessible to all. *Communities: From objects of health care to full participation and ownership * *?T_h_e_ _p_e_o_p_l_e_ _h_a_v_e_ _t_h_e_ _r_i_g_h_t_ _a_n_d_ _d_u_t_y_ _t_o_ _p_a_r_t_i_c_i_p_a_t_e_ _i_n_d_i_v_i_d_u_a_l_l_y_ _a_n_d_ _c_o_l_l_e_c_t_i_v_e_l_y_ _i_n_ _t_h_e_ _p_l_a_n_n_i_n_g_ _a_n_d_ _i_m_p_l_e_m_e_n_t_a_t_i_o_n_ _o_f_ _t_h_e_i_r_ _h_e_a_l_t_h_ _c_a_r_e_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Communities are at the heart of PHC and must be the *owners and partners *in making health for all a reality. People and communities own their health and therefore health planning, promotion and provision need to be carried out by people and with people, rather than for people. They must not be reduced to mere consumers of health services and health systems must be accountable to people and the communities they serve. However, communities are changing rapidly and in many settings new ways in which community ownership is expressed need to be developed. Strong people?s organisations and movements are fundamental to more democratic, transparent and accountable decision?making processes in health. Community health workers are an important link between communities and the formal health system. They play an essential role in order to strengthen local health services and make them accessible to all. Therefore, community health workers must be recognised in their specific role, supported, trained and remunerated accordingly. Community health workers must become part of a skilled and motivated health workforce. In the light of changing demographics globally, global health worker migration and a gap in trained health work force, health systems must ensure an environment that will be enable and retain skilled and motivated health workers at all levels. *Justice, cooperation and solidarity * *?T_h_e_ _e_x_i_s_t_i_n_g_ _g_r_o_s_s_ _i_n_e_q_u_a_l_i_t_y_ _i_n_ _t_h_e_ _h_e_a_l_t_h_ _s_t_a_t_u_s_ _o_f_ _t_h_e_ _p_e_o_p_l_e_ _p_a_r_t_i_c_u_l_a_r_l_y_ _b_e_t_w_e_e_n_ _d_e_v_e_l_o_p_e_d_ _a_n_d_ _d_e_v_e_l_o_p_i_n_g_ _c_o_u_n_t_r_i_e_s_ _a_s_ _w_e_l_l_ _a_s_ _w_i_t_h_i_n_ _c_o_u_n_t_r_i_e_s_ _i_s_ _p_o_l_i_t_i_c_a_l_l_y_,_ _s_o_c_i_a_l_l_y_ _a_n_d_ _e_c_o_n_o_m_i_c_a_l_l_y_ _u_n_a_c_c_e_p_t_a_b_l_e_ _a_n_d_ _i_s_,_ _t_h_e_r_e_f_o_r_e_,_ _o_f_ _c_o_m_m_o_n_ _c_o_n_c_e_r_n_ _t_o_ _a_l_l_ _c_o_u_n_t_r_i_e_s_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* Health is not only a matter of human rights, but also of justice. Governments who are not making provision for decent health care are denying justice to their people. The Alma Ata declaration recognised the need to restructure the global economic order to address inequalities and enable countries to generate resources for decent health care and tackle the root causes of poor health. This still remains a critically important task today. In contrast to the New International Economic Order referred to in the Declaration the dominant contemporary paradigm of export led development has contributed to loss of tax receipts at country level because of the competition for investment which drives reduced tax rates and constant pressure to reduce the cost of production or extraction. These have led to a deterioration of people?s living circumstances and contributed to ill health, instability or even war. It is vital that we build solidarity between people within and across nations and regions. The existing system of international aid and the associated charity narrative legitimise an unfair economic framework which prevents national self-determination and weakens the building of strong and resilient local health systems. Health for all requires the redistribution of wealth nationally and globally. Public financing is essential for health for all. This requires tax justice that will clamp down on tax avoidance and control tax competition between countries. The regulation of transnational corporations through appropriate agreements is essential. Trade justice for health will require trade agreements that protect from extortionate drug prices and not provide corporate impunity through investor state dispute settlements. A reform of research and development financing is required which enables the delinking of research costs from profits from drug sales. Drug policies must support production capacity in low and medium income countries. The provision of health care is costly in any society. A health system based on primary health care principles will be able to achieve health for all at a reasonable cost even while countries develop the capacity for more technological intensive health care. *Beyond the health sector: Addressing root causes and determinants of health inequity * *?T_h_e_ _a_t_t_a_i_n_m_e_n_t_ _o_f_ _t_h_e_ _h_i_g_h_e_s_t_ _p_o_s_s_i_b_l_e_ _l_e_v_e_l_ _o_f_ _h_e_a_l_t_h_ _i_s_ _a_ _m_o_s_t_ _i_m_p_o_r_t_a_n_t_ _w_o_r_l_d_-_w_i_d_e_ _s_o_c_i_a_l_ _g_o_a_l_ _w_h_o_s_e_ _r_e_a_l_i_z_a_t_i_o_n_ _r_e_q_u_i_r_e_s_ _t_h_e_ _a_c_t_i_o_n_ _o_f_ _m_a_n_y_ _o_t_h_e_r_ _s_o_c_i_a_l_ _a_n_d_ _e_c_o_n_o_m_i_c_ _s_e_c_t_o_r_s_ _i_n_ _a_d_d_i_t_i_o_n_ _t_o_ _t_h_e_ _h_e_a_l_t_h_ _s_e_c_t_o_r_._? _(_D_e_c_l_a_r_a_t_i_o_n_ _o_f_ _A_l_m_a_-_A_t_a_)_ _* The WHO?s Commission on Social Determinants of Health in 2008 demonstrated that poor health is not randomly distributed, but rather follows a predictable pattern with systematic differences among social groups (i.e. gender, class, race/ethnicity) caused by unequal exposure to, and distribution of, social determinants of health (SDH). Social justice is a matter of life and death. Addressing root causes of health inequity and investing in society, is the only way that health for all and sustainable development can be achieved. The broader context, shaped since the late 1980s by neoliberal economic globalization has profoundly influenced our health situation today. This can be seen in the impact of globalization on social justice, the effect of climate change on livelihoods; the loss of biodiversity, the detrimental effects of agribusiness on peasant farmers and small-holder farmers, who provide most of the world?s food; the impact of land grabbing and the grabbing of water bodies by big business; the influence of patriarchy on society; tax evasion leading to the lack of public funds; the unbridled growth of the arms trade; and the effects of migration to name only a few. All these issues require collaboration across sectors and policies that will address the root causes of illness and the determinants of health inequity. The current global economic order has become dominated by a greatly expanded financial sector leading to price instability due to speculation and reduced policy space because of the reach of market sentiment. It has seen the deregulation of corporations and of trading relations and the commodification and marketization of services which should be based in human relationships and handled as public goods. As in the Alma Ata Declaration, we are calling for a new global economic order (NGEO) to facilitate a safe and just space for humanity. This NGEO would be a means for securing global common goods. The NGEO would guarantee a social foundation for all while at the same time an ecological ceiling so that planetary boundaries are respected. This embedded economy would follow a human rights based approach. It would regulate global public ?bads?, economic externalities that damage the living environment and drive poverty. It would redistribute the enormous wealth and capital available in the world ensuring essential public services and social protection. The NGEO would be regenerative and circular in nature as to remain within the ecological ceilings that planet earth provides while providing a dignified living for all. Today, we have a clear vision on how to overcome these challenges through transformative policies; through the building of people?s movements; and the facilitation of people-to-people connections and solidarity. Examples of such movements include the Women?s March; the tax justice movement, the Global Network for the Right to Food and Nutrition; the Treaty Alliance, the Treatment Action Campaign and others. They are positive examples of a way forward. It is only with the mobilization and convergence of people?s movements and a process of dialogue on national, regional and international level that health equity can become a reality. We call upon governments and people from across the globe to take forward the principles of Primary Health Care that are so clearly articulated in the Alma Ata Declaration. -------------- next part -------------- An HTML attachment was scrubbed... URL: From cschuftan at phmovement.org Tue May 22 23:03:46 2018 From: cschuftan at phmovement.org (Claudio Schuftan) Date: Wed, 23 May 2018 13:03:46 +0700 Subject: PHM-Exch> [PHM NEWS] GHW5 serialized summary (3) Message-ID: For 6 weeks, the PHM-exchange will, on a weekly basis, bring you summaries of all the chapters of its recently published Global Health Watch 5. By the time the last installment is sent out, PHM expects to be able to post the full text of GHW5 electronically for your reading and perusal. We encourage you to read, use and share this material since it provides crucial advocacy contents. *As in the case of all previous Global Health Watches, GHW5 does nothing but build on PHM?s People?s Charter for Health launched in the year 2000. * *All Watches tell activists worldwide what issues worry PHM and its partners, why we denounce them, what consequences loom in the future if nothing is done about them, what (if anything) is being done about them and what actions PHM calls for and supports.* *GHW5 presents to you a decisive global health critique and outlook not easily found elsewhere.* *B5. HOW PPPs UNDERMINE PUBLIC SERVICES* Experiences here come from Sweden. Systematically extracting additional benefits from already agreed health PPPs with the government is typical of the private sector tactics; this is done by creating a series of additional sub-contracts within. The cost of the partnership thus increases with each additional sub-contract while the process becomes less transparent. These deals have always been shrouded in secrecy. Classically, in these PPPs, shortages of nursing personnel are a bottleneck. This shortage is due to low wages and low increments in wages for nurses on top of tough working conditions for them. The latter are never prioritized while funds are diverted to consulting firms and expensive contractors. Large amounts of money are being spent on hiring management consulting firms that are often over-paid. To the detriment of beneficiaries, PPPs in the hospital business have been successful and are being promoted through the IMF, the World Bank and the EU. One example is in Lesotho where half the country?s health budget goes towards funding a large PPP venture in the capital city. Xx *B6. ACCESS TO HEALTHCARE OF MIGRANTS* Experiences here come from Europe. Migrants exclusion from healthcare has as a consequence that markedly fewer migrants attempt to access the healthcare systems as most are wrongfully denied their rights. Add to this their lack of access to adequate housing and food. Their temporary identity documents barely cover emergency medical problems; preventive care is not available; thousands of children have not been immunized. Access to PHC is difficult, but much more so is access to secondary and tertiary healthcare facilities mainly, but not only due to their lack of documentation. Xenophobia has also been on the rise. Hate discourses use migrants as scape goats for what are the countries? problems. Clearly, undocumented migrants are being blamed to divert attention of the public from unpopular social sector cutbacks. Protecting the right to health for all is of paramount importance here. Austerity measures in Europe have greatly reduced investments in healthcare; migrants are left at the shorter end of the stick. Migrants? perception of their lack of rights results in them desisting from demanding assistance even if needed. Add to this complex administrative processes tedious and difficult to understand and translations services most often not being available --all impeding access. The necessity to provide proof of residence is another huge barrier. The restrictive interpret of laws by healthcare personnel has further resulted in asylum seekers being denied care. State institutions are, with some exceptions, obliged to report undocumented migrants to migration authorities. This is a clincher. It is not enough to offer health services and make them claimable; one needs to promote and actively inform people if such resources are to become truly accessible. All this amounts to a grave breach of human rights as being perpetrated. Mobilized public interest CSOs have been actively advocating to ensure a universal system for every person. Xxx *B7. INFORMALIZATION OF EMPLOYMENT IN PUBLIC HEALTH SERVICES.* Examples here come from South Asia. The state has been retreating from the provision of healthcare in more places than we suspect. Public budgets are dwindling and the remuneration of health workers is decreasing in relation to total health expenditures globally. Women are among the worst impacted by downward pressures on remuneration. The trend that comes as a consequence is the informalization of employment in the health sector. Employment to retirement in the public health sector is dwindling; short-term contracts are in. PHM notes that insecurity of tenure in the case of informal employment makes it more difficult for workers to join or form unions. Without the right to unionize and to engage in collective bargaining, health workers remain vulnerable to exploitation by their employers. Informal employment relations are first sought to unskilled workers. As informalization spreads, ward attendants and cleaning staff are also affected and hired temporarily. Laboratory staff and nurses are affected at the end of the chain. Informalization of the health workforce, weakening of public healthcare institutions and the expansion of the role of the private sector are actually interlinked in multiple and complex ways. Note that the under-funded and extensive deployment of community health workers (CHWs) in rural areas goes hand in hand with their irregular working hours and their inadequate remuneration. The latter is a key factor in their attrition. The remuneration issue has become a bitter struggle for them in some places with associations having been formed to fight for wage-based remuneration and other labor rights such as paid leave and pensions. Their discontent cannot be brushed aside. For long-term sustainability (recruitment and retention), their formal recognition with full rights is to be supported. (Some CHWs are paid special bonuses and stipends for refreshments during immunization campaigns, but this is hardly enough). GHW5 notes that lower-caste and minority women are mostly excluded from the selection process. This, despite the fact that CHWs in the health system amount to a hidden subsidy towards society at large. Finally, migration is a key driver of the current global health workforce crisis with workers being pushed to the private sector and/or seeking greener pastures overseas. Only through engagement of the larger public health community with the demands of organized health workers can both decent work and quality services be effectively realized. Xxx *A. **BEYOND HEALTHCARE.* *C1. CLIMATE CHANGE, ENVIRONMENTAL DEGRADATION AND HEALTH. * Ubiquitous slick corporate social responsibility campaigns keep claiming the above to be an exaggerated fabrication. So, market driven enterprises continue to merrily jeopardize the spaces and places where people work, play and live. Children, women and the elderly are particularly exposed. Attempts at controls are systematically opposed. GHW5 is worried, among other, about outdoor and indoor air pollution, the overuse and contamination of water, slash and burn operations, toxic waste disposal, the plastic contamination of oceans, land degradation, deforestation and so many other 21st century planetary worries affecting public health. partly exposed All these have explicit underlying political determinants that ultimately affect the allocation of resource in our societies. As relates to climate change, it is noted that the same is exacerbating existing health problems including secondary consequences such as vector-borne diseases, food shortages and food insecurity and particularly population displacements. The most likely affected, no surprise, will be the impoverished, the socially excluded and the otherwise vulnerable groups including indigenous people (that are also at the forefront resisting abuses). PHM emphasizes that it is a misconception to continue saying that population size or growth per-se drives these issues. Climate change is deeply shaped by TNCs and the life styles of the rich. Environmental degradation and its health consequences are thus borne by those excluded from power and decision-making with the greatest advantages accruing to the more powerful. Recycling and composting, home gardening, use of energy efficient appliances and of public transport, biking, walking and lowering thermostats in winter, are just some of the recommendations for affluent societies. But all these need a motivation to make these behavioral changes -and the same is simply not there. A caveat here would be the fact that individual or household-level solutions do not affect the real underlying structural determinants, the ones that drive global environmental degradation. Pro-TNC policies and subsidies for sure aggravate the situation. We are thus left with confronting agribusiness, energy, mining and other industrial interests through litigation, divestment campaigns, advocacy, protests and other methods. An example is the actions of La Via Campesina in its work for food sovereignty, preservation of natural resources, sustainable agriculture, gender equality, land rights, resistance against displacements and fair economic relations. Special mention must be made of the Buen Vivir indigenous movement in the Andean regions of South and Central America. It questions conventional assumptions about growth and development and calls for living well in harmony with the natural environment and within existing resources. What is thus needed is a paradigm shift that questions the global political economy and provides ecological alternatives. Shifting values will mean pressuring political processes towards the building of societies that favor equity over growth. Our civilization is at a crucial crossroad. Addressing the related health issues will require intense political struggle to face the political recalcitrance to transformative change by the largest polluters, importantly TNCs who continue doing business as usual. Xxx *C2. GENDERED APPROACH TO REPRODUCTIVE AND SEXUAL HEALTH AND RIGHTS* Women?s health is regrettably and persistently relegated to issues of maternal health and family planning, the latter especially for married women. Coercion and social inequalities resulting in social hierarchies are deep-rooted and these continue to grow within and across countries. Add to this, challenges due to the rise in religious and political fundamentalisms and you get a picture of how patriarchy is still prevalent. Protection of the bodily integrity of women and their freedom from violence, as well as their access to safe abortion also stand threatened. While the SDGs call to ?leave no one behind? is a worthy aspirational call, neither are the SDGs targets and indicators exhaustive nor do they have a true transformative potential. Sad to say, but public healthcare systems have historically been at the center of fostering such discriminations and violations of the health and human rights, not only of women, but also of the other groups with marginalized sexualities and gender identities. Attention is called upon the specific needs of LGBT persons. Sex workers are even more stigmatized and have difficulty in accessing healthcare, especially in situations of violence. Sex workers? access to institutions of law and order and of justice in situations of violence are further very limited. Sex workers are organizing though since their access and quality of healthcare are virtually absent for them. Mind you, sex work is frequently conflated with human trafficking issues. For all these reasons, there is a need to chart the future trajectory of activism around sexual and reproductive health rights (SRHR) afresh. There is a need to forge alliances and solidarities to resist retrograde steps that threaten SRHR. Mobilizations for the development of shadow reports by public interest CSOs to the UN UPR and CEDAW review committees. Countries that have not signed/ratified some of the international treaties that accord protection regarding SRHR must become targets of strategic CSOs mobilization. -------------- next part -------------- An HTML attachment was scrubbed... URL: