PHM-Exch> [PHM NEWS] GHW5 serialized summary (3)

[Claudio Schuftan]

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.
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