PHM-Exch> Prioritising Profits Reversed Health Progress

Wed Aug 25 09:11:34 PDT 2021

From: Jomo from Challenging Development+ <jomodevplus at substack.com>

Instead of a health system striving to provide universal healthcare, a
fragmented, profit-driven ‘non-system’ has emerged. The counter-revolution
against the 1978 Alma-Ata Declaration is
responsible. ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
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‌
Prioritising Profits Reversed Health Progress
<https://email.mg2.substack.com/c/eJxVkk1v4jAQhn8NuYFsx0mcQw60EW1WJbQVQtBLZPxBDImdjR0g_Po1sIddaT6kdzQz0jzDqBMH049ZZ6wL7qFyYycyLS62Ec6JPhis6CvFMxQmEMRxEvAMc0giEihbyV6Ilqomc_0ggm7YN4pRp4x-dGBMYBjUGeIh4aFMeYokgQgTAAGOEkYkJYTS5LmYDlwJzUQmzqIfjRZBk9XOdXYSzido4e1oWsPFuWsGO7PD3jrKTjNmWl_q7t4r0yunrNKHadcbqZyd9vdpVvBpLWjj6km4cOYk9CTMxfgLMrQZt6g5FUczLm_susx3qBwvir2lN75Iu5_XIi7zOfD6tcxPtmibmnttud6NqzWLyvwLrl4vim7Lm5-h2PtGfawLUOaH63IsbKFLuFNFXOiXMwu_HGs39S787vYIK_k1k-T481IM5_zzHcDkdyrhFtTue3N7W5uasY85H-Lrim0_ySVQGQIIAoIwIBhEyQzOIs6jOIzCBJNE8hggnKDYX5jvmZRcRhMM2gP671RBn1lWD9JR7auHO7uH7NFVPreDVm6shKb7RvAnVfd8jgfn6iC06P3T8Iq6DMYoTVKMIxInfyF67BhgEEOcBn4vN75LZ_-A-wNojtO->Instead
of a health system striving to provide universal healthcare, a fragmented,
profit-driven ‘non-system’ has emerged. The counter-revolution against the
1978 Alma-Ata Declaration is responsible.

Aug 24 [image: Share]
<https://email.mg2.substack.com/c/eJxVkttu4yAQhp8mvmsEGJ8ufNHWautV4x4URUlvLMwhprHBCziJ8_SLk12pKwHSfMPMaH79lDi-12bKB21dMD-1mwaeK36yHXeOm2C03NSS5ShMIIjjJGA5ZjCN0kDaWhjOeyK73JmRB8PYdJISJ7W6VmCcwjBoc5iEIGoaEoZINAQ3EJEUZrEQAlKQcHAbTEYmuaI850duJq140OWtc4NdhPcL9OTPt-4148ehG-3Sjo11hB6WVPc-NczXSG2kk1aq_d1gtJDO3pm5m-XsruWkc-0ifBpdX1s9GsoXYfGvzQLFM-85k2Pv-XWrv5Bq5bhy8--WGO4pofOOP4DTBz7HfPoFKdpMW9Qdym89rS70vCp2qJpOkj5nF_aUDV-PZVwV98Dzc1UcbNl3LfNstd5Nb2saVcUHfHs8SbKtLr6HpC8b-bouQVXsz6uptKWq4E6WcakejjT8cLTftLvwc2gQluJjKdLvr4dyPBbvLwAmvzMBt6B1n5vL81q3lL7eszE-v9Hte3oKZI4AgiBFGKQYRMkSLiPGojiMwgSniWAxQDhBsUgha6gQTEQLDPo9-k_-wOSWtqNwRPnsflbuir0dvHZ9Pyrpppor0nSc3Zziboa7qlzvueLGG5HVxOUwRlmSYRylcZLcjOGthAEGMcRZ4Ocy7atU_sMMfwDs4fIF>

*Prioritising Profits Reversed Health Progress*

By Anis Chowdhury
<https://email.mg2.substack.com/c/eJwlkMuOwyAMRb-m7CYCwqsLFrOZ34hIbBpmEoh4NMrfD20ly7auZdn3LK7iI-XLHqlU8kpTvQ60Ec-yYa2YSSuYpwCWj5pRpTQBK4AZaUgok8-IuwubrbkhOdq8hcXVkOJ7QwjDRrJakEIr0MJ4ZZDNdyOYh3n2TlDnjWSfw65BwLigxSfmK0Ukm11rPW7j943_9DjPcwhHef02RKxdca2uKb-aGMrXsqYT1pavLpBgOeWMGi6oEVTqgQ0SQKpRjv0R7UFRLjRX3jCYF-_By5ug-4MPpc2luuVvWNJOsi3L2nx1sU8fL6tvuTudet1bDPWaMLp5Q_hAqB-WbyzTAyPmzhgmVy1T_K7vQkijtP547pQEFVQxcSf9LqS-Fe1v2hPg89ha-QeayYwO>
 and Jomo Kwame Sundaram
<https://email.mg2.substack.com/c/eJwlkMuOwyAMRb-m7BoB4dUFi9nMb0QETMs0gYhHo_z9kEaybOtaln2PNRWeKR96S6WiM0312EBH2MsCtUJGrUCegtN0lAQLIZHTzBHFFQpl8hlgNWHRNTdAW5uXYE0NKX43GFNkRC9tOZ0lAeIpE4pb6RnnEpORi1mMjs7XYdNcgGhBwwfykSKgRb9q3W7jz43-9tj3fQhbOX8bItSumFZfKffmL63p_t7NCvfSojPZrF1FQVNMCVaUYcUwlwMZuHNcjHyUTEnvBKZMUuEVcbP13nl-Y3h90qG0uVRj34NNK8q62Ffz1cQ-fZ5-v3K3O_W6thjqMUE08wLuIlEvoF820xMi5A7aTaZqIuhDPhjjSkh5Ge-oGGZYEPZA_a5LfSvq05KDz7a08g-JE40H>

*SYDNEY and KUALA LUMPUR, Aug 24 2021 (IPS) *- Instead of a health system
striving to provide universal healthcare, a fragmented, profit-driven
market ‘non-system’ has emerged. The 1980s’ neo-liberal counter-revolution
against the historic 1978 Alma-Ata Declaration
<https://email.mg2.substack.com/c/eJxNUM2OhCAMfprhaABBmAOHvexrmGqLsqtgBMf49suMl02aNm3Tfj8jFJrSfrkt5cLeqS_XRi7SmRcqhXZ2ZNr7gE62RvCuMwydQmG1ZSH3fidaISyu7Aex7RiWMEIJKX4ulLKiZbOz4E2LLYAePNfSohgG_7T1nXxSC3gDw4GB4kiOXrRfKRJb3FzKlh_t10N-1zjPsznn1IRYavcPLdcWlhWgQI80LrDfJCg2G3oWnORScCsVt4pr04hGI-qu1a1R1njsuFRGdt4KHEbv0euH4uskm3wMucD424xpZbvL43z4ArFup7fsz7jy6GtdjxjKVSFhWAhvQ8rt68eifqJIlRdhD8WJKt08ldK2M-bWXx1TXPFOqCeruJjqVXQ_aU1Ir2058h9795Fe>
is
responsible.
*Alma-Ata a big step forward*
Neoliberal health reforms over the last four decades have reversed progress
at the World Health Organization (WHO) Assembly in the capital of the then
Socialist Republic of Kazakhstan, now known as Almaty.

Then, 134 WHO Member States reached a historic consensus reaffirming health
as a human right. It recognised that heath is determined by environmental,
socio-economic and political conditions, not only medical factors narrowly
understood.

The Declaration stated, “Governments have a responsibility for the health
of their people which can be fulfilled only by the provision of adequate
health and social measures”. Also, “The people have the right and duty to
participate individually and collectively in the planning and
implementation of their health care”.

Countries committed to the fundamental right of every human being to enjoy
the highest attainable standard of healthcare without discrimination. They
agreed that primary healthcare (PHC) is key to addressing crucial
determinants of health.

Alma-Ata eschewed overly ‘hospital-centric’ and ‘medicalised’ systems,
instead favouring a more ‘social approach’ to medicine. In the Cold War
divided world, the Declaration was a triumph for humanity, promising
progress for global health.

It recognised the crucial contributions of multilateral cooperation, peace,
social health determinants, health equity norms, community participation in
planning, implementation and regulation, and involving other ‘sectors’ to
promote health.

*Primary healthcare*
Some developing countries – e.g., China, Costa Rica, Cuba and Sri Lanka –
had already achieved impressive health outcomes at relatively low cost,
raising life expectancy by 15 to 20 years in under two decades.

Instead of just curative medicine and clinical care, prevention and public
health were given more emphasis. Basic health services, improved diets,
safe water, better sanitation, health education and disease prevention
became central to such initiatives.

Mainly rural community health workers (CHWs) were trained to help
communities address common health problems. Differences in national
government approaches, contexts and needs have also shaped PHC outcomes,
reach and efficacy, e.g., in delivering healthcare to the poor
<https://email.mg2.substack.com/c/eJwlkEtuxCAMhk8zLCMgvLJg0U0v0ANEBEySKQEUYKrcvmRGwvgl67c_ayqs6bx0TqWi-5vrlUFH-CsBaoUTtQLnvDtNR0mwEBI5zRxRXKG9zP4EOMwedD0boNyWsFtT9xTfE4wpMqJNezDKT0qyyQInblHUe0_xaEbOBV_4R9g0t0O0oOEF55UioKC3WnN5jF8P-t3fug3L8RxsOnpiU6wQa496bd26H7v9tJzDfEeAMSFKDb6FMGTn0a4ppgQryrBimMuBDNw5LkY-SqakdwJTJqnwqq9ovXeePxg-VjqUtpRq7O-tjE5d7NZ8NbF31_v4d7nfPnd_tLjXa4ZolgDug6V-6L5BzStEODt1N5uqiaCTnBjjSkj5odC5McywIGxCXdelPhX1Mx3JwSuHVv4BvbSPxA>
.

But despite reversals elsewhere, some efforts have continued, even
expanded. Even in the 21st century, large-scale PHC efforts have made
remarkable
health gains
<https://email.mg2.substack.com/c/eJwlkNuO4yAMhp-m3CUCQgK94KLSavcxIgdMygyBiMNUfftlUsny4bd-2foMVNxTfuszlUp-01rfJ-qIrxKwVsykFcyrt5pPktFlkcRqYZmaFfFldRnxAB90zQ3J2bbgDVSf4uUQQrGJPLVCpWZOqQVUYsJJKuvQiRkYWLdR-jkMzXqMBjX-YH6niCToZ61nuU2PG__b4_V6jWa3-DOmvPe5-IqlV4sOWqi9cz5cyr8ApRwQhz9oAuTrpeERDhgeFQZBB-cjhPG0jnjNKWdUcUGVoLMc2ThbOy_TPEmhpLML5ULyxSlmN-OcdfNN0GPnY2lbqWC-R5MOknUxz-YqxL7df5lcckey9nq06Ot7xQhbQPuhVT_QL37rjhH7m2hXqJot_C7vQsxqkfIDp-MUVNCFiTvpd23qrqi_0pE6jjO08h-UHpn7>,
e.g., Brazil’s Programa Saude da Familia and Thailand’s Universal Coverage
Scheme.

*Lalonde Report turning point*
Thus, Alma-Ata inverted health policy priorities, as 90% of health problems
were recognised as due to lifestyles, environments and human biology, with
only 10% due to the “healthcare system
<https://email.mg2.substack.com/c/eJwlkctuxCAMRb8mLCMgvLJgUama34hI7CS0CaQ8WuXvy8xIyL42sq51vLiCW0y3vWIu5Bmmcl9oA_7lA0vBRGrGNHmwfNCMKqUJWAHMSEN8ntaEeDp_2JIqkqvOh19c8TG8JoQwbCC75YtjTEk2gmQMlHHaIKIQikl0KMa3savgMSxo8RfTHQOSw-6lXLkbPjr-aM8nn_vL7bGPaWv17EsuCd3Z9O4CHNjEc0nZ86YkHRVtedRm5FoyTrUWE4atv2DthkfGn_o07IZP1XHl88dxxD-EVt_EW045o4YLagSVume9BJBqkIMWRq-gKBeaq9UwmJd1hVV2gp4b73Odc3HLd7_EkySbl72uxYX2uz1RvdqN1NTyWYMvd1vJzQfCG2J53-KFddowYGo3gskVyxQf9SiENErrN7NGWVBBFWsQmy_ENhXsVzwj4O911PwPaGCcWg>”,
as noted by Canada’s 1974 Lalonde Report
<https://email.mg2.substack.com/c/eJwlkE2OhSAQhE_z2D0DiIALFrOZaxiERplRJPyM8faDz6TTlVSnU6nP6ALLkS4Vj1zQvaZyRVABzrxBKZBQzZAmbxXtBcGcC2QVs0QOEvk8uQSwa7-pkiqgWOfNG138ET4fjEnSo1WNDgQRmJmxn62eZ2Ic4yOB0cmRWiqfYF2th2BAwR-k6wiANrWWEl_914t-tznPs4urNm-do-kW0xnd3Li-c7zVuntDyhFMeUNYumYhryimBEvKsGR4EB3pBmsH3g-9YFI4yzFlgnIniZ2Nc9YNL4b3hXa5zrlo89uZY0dJZbNWV3Ro1-Wu_LFb46npXoMv1wRBzxvYB0Z5mH7wTAsESI21nXRRhNNRjIwNkgvxdG-0GGaYEzailmuP9hXUz7EfFv7iVvM_YWiN_A>
.

The Lalonde Report reaffirmed WHO’s basic approach. Its 1946 constitution
<https://email.mg2.substack.com/c/eJwlUMtuxCAQ-5rlGPGGHDj00t-ISBiytAmkPDbK35fdSCOPPCPLshdbYU35MkcqFb1hqtcBJsJZNqgVMmoF8hScoUwRLKVCznBHtNAolMlngN2GzdTcAB1t3sJia0jxo-BcE4aeRjGNPWZ45FqP4P1spbVazpRIz7igt7FtLkBcwMAL8pUioM08az0e7OtBv_uc5zmczzSEWDsrbV2hvL1KZ97-dYTYAQVDMSVYU441x0INZBDOCckEU1wr7ySmXFHpNXHz4r3z4sHxvtKhtLlUu_wOS9pRNmV5Nl9t7N_1nfJz7iGnvvcWQ70miHbewN35613jp5FphQi51-smWw2RdFQj50JLpe64vSCOOZaEj6j7utRV0fykPTl4HVsr_2p8iNs>
had
affirmed, “Health is a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity”.

The Report’s multidimensional approach to human health marked a turning
point
<https://email.mg2.substack.com/c/eJwlkU2O5CAMhU8Tdh3xD1mwGGlUmhv0MiLBVOhOgAFSrbp9kyrJes9gWbY-r7bBPZWnyak2dMncnhlMhJ-6Q2tQ0FmhzMEZyhTBUirkDHdEC41CnX0BOGzYTSsnoHwue1htCym-OjjXhKHNOM8XxrRQi5DUCbHY1VLJVqylwp6S92B7ugBxBQMPKM8UAe1may3Xgf0Z6K2HzbmOP1saQ2z9GUqo3ZbQaitgj55vNrodenKtKroLoRXu_vnvNpNp0l0GKqhml05zpkx8UKbH7PzAbhX-n9cKA_tLUDAUU4I15VhzLNRIRuGckEwwxbXyTmLKFZVeE7es3jsvBo6POx3rudRm1-9xTQcqpq7b6ZuNvXq_YL2-O6u5-3HG0J4zRLvs4N4Y2_saL7DzHSKUfiU322aIpJOaOBcdnHpT65w55lgSPqE-16XeFc1XOpKDR97P-gt-PpuR>,
reshaping policy approaches. Similar health assessments, with more holistic
understandings, were also influential.

Reports from the UK, USA, Sweden and elsewhere
<https://email.mg2.substack.com/c/eJwlUMtuxCAM_JrlGAHhlQOHXvobEcEmS5tABGSr_H3ZjWTZlkf2eMa7hmsulz1ybeSd5nYdaBP-1Q1bw0LOimWOYPmoGVVKE7ACmJGGxDqHgri7uNlWTiTHuWzRuxZz-mwIYdhInjZ4z41XCwOhgbGwqElyKs3oYJzAhZvYnRAxebT4wnLlhGSzz9aO-hi_Hvy7R7-_IwzJL3FI2z6k-BzW_OoIo9woI1VvSbScckYNF9QIKvXABgkg1ShHLYwOoCgXmqtgGCw-BAjyIei-8qGeS23O_w4-76TY6p9naC51dH2L_Iz7D3Ov-5liu2ZMbtkQbvntdvFjyLxiwtLdhdk1yxSf9CSENErrW233R1BBFRMT6byQ-1ayP3nPgK9jO-s_qq-H8g>
 also challenged the dominant
<https://email.mg2.substack.com/c/eJwlkU2O5CAMhU8Tdh3xD1mwGGlUmhv0MiLBVOhOgAFSrbp9kyrJes9gWbY-r7bBPZWnyak2dMncnhlMhJ-6Q2tQ0FmhzMEZyhTBUirkDHdEC41CnX0BOGzYTSsnoHwue1htCym-OjjXhKHNOM8XxrRQi5DUCbHY1VLJVqylwp6S92B7ugBxBQMPKM8UAe1may3Xgf0Z6K2HzbmOP1saQ2z9GUqo3ZbQaitgj55vNrodenKtKroLoRXu_vnvNpNp0l0GKqhml05zpkx8UKbH7PzAbhX-n9cKA_tLUDAUU4I15VhzLNRIRuGckEwwxbXyTmLKFZVeE7es3jsvBo6POx3rudRm1-9xTQcqpq7b6ZuNvXq_YL2-O6u5-3HG0J4zRLvs4N4Y2_saL7DzHSKUfiU322aIpJOaOBcdnHpT65w55lgSPqE-16XeFc1XOpKDR97P-gt-PpuR>
medicalised
approach to healthcare promoted by big pharmaceutical and other
health-related businesses.

*Neo-liberal ascendance*
Developments since the 1980s have set back and reversed the Alma-Ata
commitments. Latin American and other debt crises paved the way for the
neo-liberal ‘Washington Consensus
<https://email.mg2.substack.com/c/eJwlkMtuxCAMRb9m2DXiFSALFt30F7qMCJgMbQIRj0b5-zITybIlI-twjzUV1pQvfaRS0avN9TpARzjLBrVCRq1AnoPTlEmChZDIae6IGhUKZfYZYDdh0zU3QEdbtmBNDSm-LzhXhKGnlpgoIETRhWM2YcK4pGryHHsAQQS7waa5ANGChj_IV4qANv2s9SgP9vmgX73O8xyWHKqJsWMGm_a-rOkIts9vU54hrjXFD5tigVhaQUFTTAlWlGPF8SgHMozOjYKNTHIlvROY9s8Ir4hbrPfOjw-O95UOpS2lGvv7oqCsi30238H9dX0Ffq973rnPvcVQrxmiWTZwt4p6G33LmVeIkLtpN5uqiaCTnDgflZDyTt5dccyxIHxCnetSv4r6J-3Jwd-xtfIPBmqNkw>’
counter-revolution.

‘Rescue packages’ from the International Monetary Fund and World Bank,
especially structural adjustment programmes (SAPs), demanded public
spending cuts. These reduced social spending, cutting funding
<https://email.mg2.substack.com/c/eJw1kEuOwyAMhk9TlhEQXl2wmM1cIyLYpMwkEAFplNsPbTWS5d8PWbY_7xouuVx2z7WRl5vataNNeNYVW8NCjoplimD5qBlVShOwApiRhsQ6hYK4ubjaVg4k-zGv0bsWc3pPCGHYSB6WB4nozAxKz4IyQAPGAAU_eyeFuH8WuwMiJo8Wn1iunJCs9tHaXm_j141_dzvPc0gzliGXpaf1qg23HoS4Yu3qH27vJ7_Du5LqX4cdAomWU86o4YIaQaUe2CABpBrlqIXRARTlQnMVDIPZhwBB3gTdFj7UY67N-d_B540UW_3jCM2l3l1ev7_L_fWp63ak2K4Jk5tXhA-V9oH75jQtmLB06DC5Zpnid30XQhql9QdCxyaooIp1Kn0v5D6V7E_eMuBzX4_6B2oikIs>
for
health.

Thus, many PHC, including CHW programmes did not last
<https://email.mg2.substack.com/c/eJwlkEtuxCAMhk8zLCMgvLJg0U0v0ANEBEySKQEUYKrcvmRGwvgl67c_ayqs6bx0TqWi-5vrlUFH-CsBaoUTtQLnvDtNR0mwEBI5zRxRXKG9zP4EOMwedD0boNyWsFtT9xTfE4wpMqJNezDKT0qyyQInblHUe0_xaEbOBV_4R9g0t0O0oOEF55UioKC3WnN5jF8P-t3fug3L8RxsOnpiU6wQa496bd26H7v9tJzDfEeAMSFKDb6FMGTn0a4ppgQryrBimMuBDNw5LkY-SqakdwJTJqnwqq9ovXeePxg-VjqUtpRq7O-tjE5d7NZ8NbF31_v4d7nfPnd_tLjXa4ZolgDug6V-6L5BzStEODt1N5uqiaCTnBjjSkj5odC5McywIGxCXdelPhX1Mx3JwSuHVv4BvbSPxA>.
Citing cost recovery, SAPs pressed to impose user fees and privatise health
services. The outcomes betrayed Alma-Ata’s promise of greater health
equity, and ‘Health for All’ by 2000, undermining prospects for universal
health coverage.

The World Bank’s 1993
<https://email.mg2.substack.com/c/eJwlkU2L3DAMhn_N-Bj8Fds5-LBsp6e2lKXQY3AsOZNuYgd_7DL_vt4ZEK-E5Behx95VXFO-2zOVSr5krvcTbcTPsmOtmEkrmOcNLBeaUaU0ASuBmdGQrcwhIx5u223NDcnZln3zrm4pPhxSGibIzTqhvRil4g6U4AhS4LhMWlH0gTtKn4tdgw2jR4sfmO8pItntrdazXMTLhX_vAcm3A2MtbPhMeYfFxfch5bWPfMv9FOgVxi5SGSNYVyGpoZrxqTdPCF0ZZ0bQt-vvHy-v15_XX3_o329vlE2TGPoDsllOOaOGd6Okox7YMAKMSoxCS6MDKMql5ioYBosPAcJ4kfRY-VDaUqrz74NPB8m2-FsL1cU-Xb8QPdqd0Nzz0eJW7zNGt-wIT3j1-QcPnPOKER8Hza5apvikJylHo7R-sup0JZVUMTmRvhdSd0X7Lx0J8OPcW_kPSq6ZEg>*World
Development Report
<https://email.mg2.substack.com/c/eJwlkU2L3DAMhn_N-Bj8Fds5-LBsp6e2lKXQY3AsOZNuYgd_7DL_vt4ZEK-E5Behx95VXFO-2zOVSr5krvcTbcTPsmOtmEkrmOcNLBeaUaU0ASuBmdGQrcwhIx5u223NDcnZln3zrm4pPhxSGibIzTqhvRil4g6U4AhS4LhMWlH0gTtKn4tdgw2jR4sfmO8pItntrdazXMTLhX_vAcm3A2MtbPhMeYfFxfch5bWPfMv9FOgVxi5SGSNYVyGpoZrxqTdPCF0ZZ0bQt-vvHy-v15_XX3_o329vlE2TGPoDsllOOaOGd6Okox7YMAKMSoxCS6MDKMql5ioYBosPAcJ4kfRY-VDaUqrz74NPB8m2-FsL1cU-Xb8QPdqd0Nzz0eJW7zNGt-wIT3j1-QcPnPOKER8Hza5apvikJylHo7R-sup0JZVUMTmRvhdSd0X7Lx0J8OPcW_kPSq6ZEg>*,
‘Investing in Health’, also undermined Alma-Ata. Justifying state
healthcare provisioning cuts, it promoted for-profit health financing and
other private solutions.

*Healthcare financing key*
In neoliberal dialect, strengthening health systems meant
<https://email.mg2.substack.com/c/eJwlkcmO3SAQRb-m2dkCzPQWLBJFUf4gSwtDYTuNwWLolv8-2E9iUhV1S_eUNRXWlC99plLRfcz1OkFH-C4BaoWMWoE8707TSRIshEROM0cUV2gvs88Ah9mDrrkBOtsSdmvqnuJTwZgiE9r0IhdLPV0M54A9lpORmLxAvpgkCjP-bmya2yFa0PAF-UoRUNBbrefH9OOD_u7LJdsOiLWM3ykHt5j4Oaa89oxtuRtx_QWxHwRTqggTfeNJccFkD_4BE-p2Db-6fEjnLTTUDYa_t9bws4sNpd4y6zX4lIft-T_EVvN-OxrOdLbwmBsylBZqQbummBKsKMOKYS5HMnLnuJj4JJmS3glMmaTCK-IW673z_IPhY6VjaUupxn6ONh0o62K35quJPbvePJ9wxzn3-2hxr9cM0SwB3Jt0fQ_sYT-vEOHxP5uqiaCvDpZxJaR8g-2jYJhhQdgL9b4u9aqo_6UjOfg6Qyv_Ad52rpw>
“enhancing
public-private partnerships” among other such interventions. The Bank provided
substantial financial support
<https://email.mg2.substack.com/c/eJwlkU2u4yAQhE8TlhbGGOwFi5Ge3jUQhsZmggHxk0xuP8SWENWqVquaD60q7DF_RIqlou8l6yeBCPAuHmqFjFqBLJ0RZOIjZowjI6gZl3lBrkibAU7lvKi5AUpt806r6mK4JihdxgkdYrMzw3TChGxsVisfDSeAleaLXicL7A5WzTgIGgS8IH9iAOTFUWsqj-nPg_z242Af3jF7s6nw3HNsaYh5743iKpSuBqxqvvbKOn85P6qqLhlSzPVr6EOl_qxveYDy9ZDWBdVjJbyUb_fyb6lSgmDcP9mS6YyMxEMyFjlBMBnxQiheKJ75MA6zMTOb5onThVvDMKGcMLuMZtPWGjs_KD53MpS2lar0c9DxRFkUfTRbVejd_Qvwsjs_2fVswdWPhKA2D-ZGW-8fumDLHQLkaytVxcjIyldK54VxfpPs7CmmmI10RT3XxD4VxN94RgOv5Fv5D7nfrAU>
to
fund its recommendations.

Despite Alma-Ata, the WHO’s 2000
<https://email.mg2.substack.com/c/eJwlkM2OhSAMhZ_msjSA_LlgMZt5DYNQlBkFw88Y336416Q5Tds0J-ezpsKa8q3PVCp6y1zvE3SEq-xQK2TUCuQ5OE1HSbAQEjnNHFFcoVBmnwEOE3ZdcwN0tmUP1tSQ4ueDMUVGtGlrmOHEO8mkFIslXAkulLVCWCXwND3GprkA0YKGP8h3ioB2vdV6ltf49aLfva7rGq4tDSHW97TlrhRj3BvEZ4PxDHE4nUdBU0wJVpRhxTCXAxm4c1yMfJRMSe8EpkxS4RVxi_Xeef5i-FjpUNpSqrG_g00HyrrYrflqYr-u76yfdY869360GOrdLc2yg3so1Afmh8u8QoTcIbvZVE0EneTEWM8v5RO6Y2KYYUHYhLqvS_0r6p90JAd_597KP8Xzicg>*World
Health Report
<https://email.mg2.substack.com/c/eJwlkM2OhSAMhZ_msjSA_LlgMZt5DYNQlBkFw88Y336416Q5Tds0J-ezpsKa8q3PVCp6y1zvE3SEq-xQK2TUCuQ5OE1HSbAQEjnNHFFcoVBmnwEOE3ZdcwN0tmUP1tSQ4ueDMUVGtGlrmOHEO8mkFIslXAkulLVCWCXwND3GprkA0YKGP8h3ioB2vdV6ltf49aLfva7rGq4tDSHW97TlrhRj3BvEZ4PxDHE4nUdBU0wJVpRhxTCXAxm4c1yMfJRMSe8EpkxS4RVxi_Xeef5i-FjpUNpSqrG_g00HyrrYrflqYr-u76yfdY869360GOrdLc2yg3so1Afmh8u8QoTcIbvZVE0EneTEWM8v5RO6Y2KYYUHYhLqvS_0r6p90JAd_597KP8Xzicg>*
(WHR
2000) criticised developing countries for “focusing on the public sector
and often disregarding the – frequently much larger – private provision of
care”. It argued, “Health policy and strategies need to cover the private
provision of services and private financing”.

Addressing health progress became more ‘siloed’ with the UN’s Millennium
Development Goals (MDGs) indicators’ focus on curing and preventing
particular diseases. Neither WHR 2000 nor the MDGs reiterated Alma-Ata’s
emphasis on social justice, equity and community participation.

Instead, that era
<https://email.mg2.substack.com/c/eJwlkMtqAzEMRb8m3mWwPX5l4UU3hXZV-gODY8kTtzP24EdL_r5uAkISEpfLPd41XHO52yPXRv7b0u4H2oS_dcPWsJBesSwRLJ81o0ppAlYAM9KQWJdQEHcXN9tKR3L06xa9azGnh0IIw2Zys0oFOoP0qCR3M7pgNNDApLwoRT0LT2PXIWLyaPEHyz0nJJu9tXac5pcTfx3lnI_nmCC6KZd1HD6x5l481rG_D3W71fPhDiznnM4fH291OiCQaDnljBouqBFU6olNEkCqWc5aGB1AUS40V8EwuPoQIMiToPvKp9qvtTn_Pfm8k2Krv_XQXBrf9T_04zwyL2PuPcV2XzC564bwxNGeVB-AlhUTlkEbFtcsU_yiL0JIo7R-ph-8BBVUMXEhwxfyUCX7lfcM-HNsvf4BqI2O6Q>
saw
more healthcare privatisation, public-private partnerships and contracting
out of services. After this neo-liberal eclipse, WHO’s attempted U-turn,
starting over a decade ago, has emphasised universal health care (UHC) and
socio-economic determinants, but the Alma-Ata betrayals prevail.

Thus, the Bank’s International Finance Corporation has been promoting
private investments in healthcare services and infrastructure. Deploying
billions, it buys public policy influence in Africa
<https://email.mg2.substack.com/c/eJwlkU1v5CAMhn_NcIyAmK8Dh-2qXVWqVr2s9hgRMJlsE4gCtJp_v3RGQi_I9ivjx95VXPJ5s0culXzLVG8H2oRfZcNa8SSt4DmtwfJRMSqlIsFCYFpospYpnoi7Wzdbz4bkaPO2elfXnO4OAM1GcrUYhHFzNEZ0IzcQtB_VLNHzKCTl8tHYtbBi8mjxE89bTkg2e631KJfxx4W_9BOybzumWtjwlc8tzC59DPlcesq3s48S-gtTF620NgykppQbA3I0PXiE2BWAwUj_vtPn37_eXplLjDJGOaWasvc_T2-vP9nQK8lqOeWMag5UAxVqYIMIQchRjAq0iqH_HBSXUbMw-xhDFBeg-8KH0uZSnf8YfN7JaYu_tlhd6tnlm9U93FFN_d5bWuttwuTmDcODYn0s4851WjDhfbLJVcskN8oACC2VekDrmIEClQwM6X1D7q5k_-U9B_w8tlb-Az-gm0k>
, India
<https://email.mg2.substack.com/c/eJw1Uk2P2yAQ_TX2zRbGGOwDh013o6btqqtW2quFYbBpMViAE-XfFyeqNHoMb77QPKRIMPtw55uPqTxgTPcNuINbtJAShHKPEEajOG5ZgyhlpeJENX3XlyaOOgCswliewg7ltk_WSJGMd48KQvqmLReuhgEjTbtchjqtWlCgsKItFlo1UsvnYLErA04ChyuEu3dQWr6ktMWifSnwOdvtdquNlrUP83HLkYxyzSi9cyBT9ihtJskkq2AadEWQFtVEsa6Ox_SaCs2Ezmk_hFNRig0KfPKZOF2ctHs014M4ZcdBzO1P716BPRzjMnwFYdMiRYD_zMUpI6qzccJWHwGOzKfVm9JFe37_-Vq0ry_fPt5-vf0uMP3yeTkI-326LIstDccIN6jHBPUEdaxu6k6pjrZdy0jPtKIIE4ap7hs1Sa2V7gqC1hnXcZ9iEvJvLf1aBh7lsuskXI7OhyAPOusx5nPdnUn3EZyYLKinVOmp-EO8cQYHIf8ENYrEG4oHNhDS9ZSxpzJZS4IIog0ZyjxX-Vzl-B-_5uVct7y2fzDLve0>
and
beyond.

*Philanthropy rules*
Unsurprisingly, cash-strapped governments have welcomed financial support
from supposed ‘do-gooder’ philanthropists
<https://email.mg2.substack.com/c/eJxNkM2OhCAMx59muGkAEfDAYS_7GgahKLsKBHCMb7_MzGWTpk2_0v5_RldYY75ViqWil5vrnUAFuMoOtUJGZ4E8e6voIAjmXCCrmCVylMiX2WWAQ_td1XwCSueye6Orj-G9wZgkA9oUjNYyYh22VAOfyLJo0IaZZQIB3OHPYX1aD8GAgifkOwZAu9pqTeUxfD3od7PruvoIxvYxry21bXCP6YBQW5ayfzY1Xdr8rkPdckx352Lu_o11k5AT5QzLkUy4g9Bv9UBeUUwJlrTVGR5FT_r28MiHcRBMCmc5pkxQ7iSxi3HOuvHB8LHSvpxLqdr89iYeKKtittNVHVp3fVF5lxuUucXjDL7eMwS97GA_vOoH-5vgvEKA3ATYWVdFOJ3ExNgouRAfPA0owwxzwibU7trYtoL6iUdsAtN-lj9oJ5vB>.
Many states have to cope with fragile, even crumbling health systems, often
overwhelmed by old killers and new epidemics.

Such MDGs-inspired support has typically been via ‘vertical funds’
targeting specific diseases – contrary to Alma-Ata. With more money than
WHO’s paltry budget, corporate philanthropy has been remaking policies the
world over.

Thus, the policy and ideological prejudices of the Gates Foundation, Global
Alliance for Vaccines and Immunisation and Global Fund to Fight AIDS,
Tuberculosis and Malaria have obscured Alma-Ata, also reshaping national
health priorities.

COVID-19 has unveiled some more effects of various profit-driven healthcare
inequities, chronic under-investment in PHC, and over-investment in
profit-driven healthcare. They have not only hastened the retreat from
‘health for all’ and UHC, but also made the world more vulnerable to
epidemics.

Worse, the interests and priorities of corporate philanthropy have not only
raised the costs of, and thus delayed containing the pandemic, but also
reversed much of the modest and uneven progress of recent decades, besides
worsening inequalities.

*Related IPS Articles*

·                Privatised Health Services Worsen Pandemic
<https://email.mg2.substack.com/c/eJwlkUuO7CAMRVdTzCoCwi8DBj1524j4mArdCURAKqrdP1KRLFsyvrpXB2cavHL56D3Xhq42t88OOsFZV2gNCjoqlDl6TUdJsBASec08UVyhWOdQADYTV93KAWg_7BqdaTGnr4IxRUa06EDshOmEA7c2wKTAAh4Jt0oGYEbQ29gcPkJyoOEN5ZMToFUvre2P8edB__U6z3OIe72yDQla31BMSR9Y9baX-O7WFfxzAbO25dmDv6OD-jxzqZCeu0ketuj6MYr60mJFGVYMczmQgXvPxchHyXouLzBlkoqgiLcuBB_4g-HtRYd62NqM-xtc3lDR1S1HaCb119dF4rvuIOY-tyPF9pkhGbuCvxm1G_WX2vyCBKV_gZ9N00TQSU6McSWkvJF0iAwzLAibUPf1uauS_s1b9vDe16P-BziAll0>

·                Why Some National Health Care Systems Do Better than Others
<https://email.mg2.substack.com/c/eJwlkUuu4yAQRVcTZrbA5pcBgzfpbVh8iphuGywov8i7b-IgVCUVXN3LwVuEV6mXOUpD8ikLXgeYDO-2ASJUcjaoSwpmmhWjUioSDA9MC01SW2IF2G3aDNYTyHG6LXmLqeRbwblmM1nNDE6BdkJELblnzkNfEZ5OSCoU119je4YE2YOBX6hXyUA2syIej_nnMf3p-_1-j-lon2xjBuyTiU60Nyp6ybev3YYV7Ibr4G2FoV0NYW-Du98yFFyhtn6ZJNO1jOqJU817iJGNIgQhZzH3QCoGSSeuJhk1C87HGKJ4cLq_prGdrqH1_0ZfdlJN8-sZ0eZ--vqQuMcdxNL7fuaE1wLZug3ClxF-Ud_UlhdkqP0LwmLRMDk91ZNzoaVSXyQdIqecSsafpPuG0lXZ_C17CfB7bGf7D2Fhlm4>

·                Hospital PPPs Undermine Healthcare
<https://email.mg2.substack.com/c/eJwl0E2u4yAMAODTlF0jIPxlweJt5hoRAadhJgEE5lW9_dBWsmzJ2DL6vEN45PqyJTck77Tiq4BN8GwnIEIlvUFdY7B81owqpUmwIjAjDYlt3SvA5eJpsXYgpW9n9A5jTp8NIQybyWGZ81I6bxYWnN4UzFwpocMiNqM0lfv3sOshQvJg4RfqKycgpz0Qy23-ufE_I57P5xRLe_9tSoCjwylbRqFspCO3EtGd91JKu_cUoF4xwf0Ad-LhXYUxRKLllDNquKBGUKknNskQpJrlrIXRe1CUC83VbljY_L6HXd4EvR58an1r6Py_yeeLVNv80Xd0abw-3gKf9gBYR716ivhaIbnthPC1wS_xR2t9QII66MPq0DLFF70IIQeG_lIMPEEFVUwsZNwNeWwl-zdfOcBvOXv7D3sskrI>

·                PPPs Likely to Undermine Public Health Commitments
<https://email.mg2.substack.com/c/eJwlkUuu4yAQRVcTZrYA88uAQU96GxaGIqYfxojPi7z7JjFCVdJFt27pYE2D11kunc_a0Kes7cqgE7xrhNagoF6hrMFpukiChZDIaeaI4gqFuvoCcJgQdSsdUO5bDNa0cKavgzFFFrRrypdxuJcOCycEJZZz6azwdpF4g-UONt0FSBY0_EK5zgQo6r21_Fj-POjfcd_v9xxy_ew2J2hDoZio0TAZJedcpxh-IF5TTw7KERJM90rTDia2fbLncYR2QGp1OFDQFFOCFWVYMczlTGbuHBcLXyRT0juBKZNUeEXcZr13nj8YPl50rn2rzdifeUxERVe7d99MGq-vD46vPKLXT2BPoV0rJLNFcDeodvP-oltfkKCMf3CraZoI-pRPxrgSUt5cBkmGGRaEPdHIdedwJf3vPE4Hvzn2-h9cM5eI>

·                Big Business Capturing UN SDG Agenda?
<https://email.mg2.substack.com/c/eJwlkMuOhCAQRb-m2WkAEegFi9nMbxikSpsZBcNjjH8_dJtU6ib1yL05zhZcY7rMEXMh7zaV60AT8MwbloKJ1Ixp8mD4oBiVUhEwApgeNfF5WhLibv1mSqpIjjpv3tniY_h8CKHZQF5mQWALLGyAgVMFEigoqZ9UMEFhdPQ2thU8BocG_zBdMSDZzKuU4zF8Pfh3q_M8e3_kd7Y-YGkTTpluwnhrs1-7uWYfMOfO2aPU5MPa1dBlWDu7YgDbzog3nHJGNRdUCzqqnvUjwCiHcVBCqwUk5UJxuWgGs1ta7vEh6L7yPtc5F-t-exd3kkx2r7oUG9p2fTP4jBuCqelegy_XhMHOG8JNp9yQP7ymFgdTgw-TLYZJ_lRPIUYtlbphNHyCCiqZeJLmC7F9BfMT9wj4d2w1_wN3d5MW>

https://www.ksjomo.org/post/prioritisingprofitsreversedhealthprogress
<https://email.mg2.substack.com/c/eJwlkN2OhCAMhZ9muDSA_HnBxd7saxiUouwoGKhj5u0XZ5KmTU5zetJvdghLLm975IrkbiO-D7AJrroBIhRyVihj9Jb3mlGlNPFWeGakIbGOoQDsLm4WywnkOKctzg5jTh-HEIb1ZLWDCVPw0ig3sGbtpZxNgECV0NJwwb_B7vQR0gwWXlDeOQHZ7Ip41Ef_8-C_ra7r6p71L--5y2Vpwu27R4m5RIw1puUoOUSs5T5Swa_gNlybuBSolUTLKWe0hVIjqNQd66T3UvWy18Lo4BXlQnMVDPPTHIIP8iHovvCunlNFNz-7Oe-k2DqvZ0CX2na5AXzk9v_Y5n6miO8Rkps28F80-CX8gTUukKA08n50aJnigx6EaHi0_pJo7AQVVDExkJbrc3Mle__t4XVsZ_0HB5OV3g>

http://www.ipsnews.net/2021/08/prioritising-profits-reversed-health-progress/
<https://email.mg2.substack.com/c/eJwtkU1uwyAQhU8TdrEA8-cFi256DQubwaa1wYJxoty-OKmEZqQHb97oY3YISy4ve-SK5Cojvg6wCZ51A0Qo5KxQxugt7zWjSmnirfDMSENiHUMB2F3cLJYTyHFOW5wdxpzeDiEM68lqw9T3ijNONQ9S6IkFybyhYNig9TDrT7A7fYQ0g4UHlFdOQDa7Ih63_uvGv9t5Pp9dPOq1W5cAm8IpZ61R08pRYi4RY41puR8lh4j1Xq5ZFfx9BbfheulLgVrbexLtZaeGC2oElbpjnfReql72WhgdvKJcaK6CYX6aQ_BB3gTdF97Vc6ro5t9uzjspts7rGdCldrtcMN5yYzG2vp8p4muE5KYN_AcTfmi_wY0LJCjtF_zo0DLFBz0IIY3S_1QaR0EFVUwMpOX63FzJ_uQ9e3gc21n_AAAQlsM>
<https://email.mg2.substack.com/c/eJxVUtuO2jAQ_RryVuQ4jp085AGWUoEgW7Yq7O5L5NgTMLkqtoHw9etAK7WSNSOPfeZ2juAGjm0_JF2rjTeazAwdJA1cdQXGQO9ZDX2mZIID5iNKmScTIv0ojDyls6IHqLmqEtNb8DqbV0pwo9rmgSAk8gPvlAiKWI6kYJQWEfAo8mOgVGJKqE98SZ-FuZUKGgEJXKAf2ga8KjkZ0-lJMJvgpTvntm4lXLrK6qm2uTZclFPR1u6Jd8rZi-_MmMy5R1_feuBi7GcSLE1bgvMLGNa-wPvhHVfl6twO27u4bRcfOB2uSvyI73IZd58vK5ouZsjFb-mi1KtmXX0cUsQPsXUYRTpcrtRV8cMSufstPa_C9F6idPGbbF7WnQi26lWtr_KwMtvzDr0uvt_H_yLYqxEv6v3pI3jrckxUsZuuP4sN0en7brvd8Ciodvj2i2XdvHib_WSbbJ7Pr-JS2oIgPcHUmjrTre0FuGn-7uFPvAapbD1OOY7vqQQj7KMIExQRFLKpPw2lDGkQBoxErJAUYcKwo8WXuSgKWYQTguoj_m-_Xp9ocbKF4Y17PY6ZH2HHd-Z8bRtlhgwanlcgn1IwT0U9usiO0EDvlCYzbhKf4pjFhIQRZezJvNMKQQQ5McSeqytbh2qSf9j-AkwZ5N4>
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