<div class="gmail_quote">From: <b class="gmail_sendername">Thomas Gebauer</b> <span dir="ltr"><<a href="mailto:gebauer@medico.de">gebauer@medico.de</a>></span><br><br><br>
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<p class="MsoNormal"><b><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt;font-weight:bold">Short Report on the Ministerial
Conference "Health Systems Financing - Key to Universal Coverage" held in Berlin,
Nov. 22-23, 2010. </span></font></b></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">The conference was convened by two German Ministries
on the occasion of the presentation of the “World Health Report 2010”.
It turned out to be a most interesting gathering of almost 30 Ministers of
Health from all over the world plus government officials, politicians, some
researches and a few NGOs. </span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">Everyone agreed on the aim to achieve universal
coverage. The model that was presented by WHO concerning this doesn’t
speak about just going for “some coverage” or essential packages, but demands from
all countries to do their utmost to set up pooled funds that cover three dimensions: expanding the number of people covered, expanding the
scope of services and reducing cost sharing (direct payment such as user fees).</span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">Dr Margaret Chan had demanded to get rid of
user fees, because "user fees punish the poor". Everywhere there
are people too poor to contribute financially to health care, therefore they
need to be subsidised from pooled funds, generally tax-based health
systems. “Out of pocket” payments have to be reduced by
promoting prepayment und pooling systems (tax-based or mandatory social heath insurance).
All agreed that there is no "silver bullet" that serves as a solution
for all countries. There is no global scheme that has to
be "adopted" by all countries, but the need is to
“adapt” a way to move forward in the three dimensions
(population covered, the scope of services expanded and cost sharing reduced) at national level. This opens space for national adaptations and provides
civil society organizations with the chance to continuously challenge their governments,
e.g. to expand the scope of services. </span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">With exception of only few participants nobody mentioned private
companies as relevant actors. Achieving universal coverage requires
the strengthening of health systems. Ensuring affordable access to health
is ultimately a public responsibility and not related to private assurance
companies. </span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">To ultimately realize the right to health, governments have to create the needed fiscal space. In this regard, the
“World Health Report” mentions as possible new sources of revenue: a special
levy on large and profitable companies, a currency transaction levy, a financial
transaction tax, and the so-called sin-taxes (alcohol, tobacco). No reference is made to for profit PP Partnerships. </span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">In the context of global responsibility, the
“Report” stated that donor countries should do more to meet their
international commitments by providing a more predictable and long-term
aid-flow.</span></font></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">It should not be surprising that a ministerial
conference tends to produce documents with nice and bubbly words. Most of the
presenters mixed up risk-sharing with solidarity-actions, and when it came to
actions (with exception of the Brazilian Minster of Health), almost al preferred to be vague in their statements.</span></font><span lang="EN-GB"></span></p>
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<p class="MsoNormal"><font size="3" face="Times New Roman"><span lang="EN-GB" style="font-size:12.0pt">Nevertheless, there is an interesting shift
in the international debate on global health. 32 years after its coinage, the concept of”
Health for all” is back on the agenda.</span></font></p>
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<p class="MsoNormal"><font size="2" face="Arial"><span style="font-size:10.0pt;font-family:Arial">Thomas Gebauer<br>medico international</span></font></p><p class="MsoNormal"><font size="2" face="Arial"><span style="font-size:10.0pt;font-family:Arial"><a href="http://www.medico.de" target="_blank">www.medico.de</a></span></font></p>
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