<div class="gmail_quote"><span class="Apple-style-span" style="font-size: large;">From: <b class="gmail_sendername">MMI Executive Secretariat</b> <span dir="ltr"><<a href="mailto:office@medicusmundi.org">office@medicusmundi.org</a>></span><br>
</span><div lang="DE-CH" link="blue" vlink="purple"><div><p><span class="Apple-style-span" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">From: </span></span><span class="Apple-style-span" style="font-family: 'Times New Roman', serif; font-size: large; color: rgb(31, 73, 125); "><a href="mailto:remco.van.de.pas@wemos.nl" target="_blank"><span style="color: rgb(31, 73, 125); text-decoration: none; ">remco.van.de.pas@wemos.nl</span></a></span></p>
<p><span class="Apple-style-span" style="font-family: 'Times New Roman', serif; font-size: large; color: rgb(31, 73, 125); ">There is some shift in health systems thinking, both for the good and the bad. The good one: More than 60 years after the adoption of the WHO constitution and more than 30 years after the Alma Ata declaration the right to health as an entitlement that every human on this planet has is back on the political stage. Universal health coverage has become an issue – and the topic of this year’s World Health Report.</span></p>
<p style="margin-bottom:6.0pt;text-align:justify"><img width="131" height="130" align="right" hspace="6" style="margin-left:5px"><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">Recently, a “joint action and learning initiative on national and global responsibilities for health” has been initiated (4). It wants to research and provide action on the following key questions: </span></span></p>
<p style="margin-left:17.85pt;text-align:justify"><span lang="EN-GB" style="font-family: Symbol; color: rgb(31, 73, 125); "><span><span class="Apple-style-span" style="font-size: large;">·<span style="font:7.0pt "Times New Roman""> </span></span></span></span><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">What are the essential services and goods guaranteed to every human being under the human right to health?</span></span></p>
<p style="margin-left:17.85pt;text-align:justify"><span lang="EN-GB" style="font-family: Symbol; color: rgb(31, 73, 125); "><span><span class="Apple-style-span" style="font-size: large;">·<span style="font:7.0pt "Times New Roman""> </span></span></span></span><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">What is the responsibility that all states have for the health of their own populations?</span></span></p>
<p style="margin-left:17.85pt;text-align:justify"><span lang="EN-GB" style="font-family: Symbol; color: rgb(31, 73, 125); "><span><span class="Apple-style-span" style="font-size: large;">·<span style="font:7.0pt "Times New Roman""> </span></span></span></span><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">What is the responsibility of all countries to ensure the health of the world’s population?</span></span></p>
<p style="margin-right:0cm;margin-bottom:6.0pt;margin-left:18.0pt;text-align:justify"><span lang="EN-GB" style="font-family: Symbol; color: rgb(31, 73, 125); "><span><span class="Apple-style-span" style="font-size: large;">·<span style="font:7.0pt "Times New Roman""> </span></span></span></span><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">What kind of global health governance is needed to ensure that all states live up to their mutual responsibilities?</span></span></p>
<p style="margin-bottom:6.0pt;text-align:justify"><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">Basically the initiative breaks away from the concept that health care is a matter of self-determination and autonomy of states and that international assistance should only temporarily support countries financially to overcome the health problems they face. From a rights-based perspective there is mutual obligation and dependence between the international community and states to guarantee universal health coverage. On the other hand, well functioning health systems should not only provide people with qualitative care for better health outcomes, but should also protect them against catastrophic health-care expenditures. This idea is further explained in a background paper of the recent forum on health systems research. It describes the difference between national universal health coverage (a state obligation) and global universal health coverage (including international responsibilities). The authors promote consorted global health action as health is a global public good. The public good concept, like the human security concept, emphasises that consorted global action can contribute to international political stability as communicable diseases containment, national social cohesion, economic growth and reduced population growth benefit from this action. </span></span></p>
<p style="margin-bottom:6.0pt;text-align:justify"><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;"> According to one African activist, three sets of actors are necessary to improve health and country ownership in Africa: African governments should take up their responsibilities as they committed themselves to several international health declarations; civil society in Africa must become stronger to hold their governments accountable for their right obligations on health; although some of the international community supports country ownership, others still see African counterparts as enclaves to extend their own missions and are very patronizing.</span></span></p>
<p style="margin-bottom:6.0pt;text-align:justify"><span lang="EN-GB" style="font-family: 'Times New Roman', serif; color: rgb(31, 73, 125); "><span class="Apple-style-span" style="font-size: large;">What is intriguing during these international health gatherings is the big difference between the health reality in so many places in the world versus the bubbles in which the global health elites reside and talk about equity, universal coverage and strengthening systems for the poor. After the workshops and seminars that offer discussion on how to move forward the state of the health in the world, the donors, policymakers, academics and NGOs come together over a copious buffet where some alcohol smoothens out disagreements if they already exist. We, representing the “global health community” in those meetings, should keep our focus very much on why we are there and that we bear accountability for those who entrust us to be there. Strategic action plans or concrete policies should come out of these meetings that will really matter to reduce the gap in health equities. Missed are debates on and definitions of what universal health coverage actually means. Does it mean coverage to a selected number of health care interventions or a right based package of appropriate, curative, promotive, preventive, integrated, participative and rehabilitative health care as envisaged in the Primary Health Care concept of Alma Ata?</span></span></p>
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