The Equity Challenge

Health for All? or Health for those who can pay? The Equity Challenge before US! Ravi Narayan Community Health Advisor, Society for Community Health Awareness, Research and Action (SOCHARA) India. Conference - “From Alma Ata to the Millennium Declaration” 15th August 2007, Buenos Aires

What are the people saying? “ From Alma Ata to the Millennium Declaration” Less Food No Jobs No water Source: Community Health Cell, Bangalore (www.sochara.org)

“ From Alma Ata to the Millennium Declaration” What evidence? Whose evidence? WHO decides? Source: Community Health Cell, Bangalore (www.sochara.org)

“ From Alma Ata to the Millennium Declaration”

“ From Alma Ata to the Millennium Declaration” Source: Community Health Cell, Bangalore (www.sochara.org)

What evidence?

Disease?

Ill-health?

Or social determinants like

Poverty?

Gender bias?

Conflict?

Stigma?

Social exclusion?

Case study Use of bednets among indigenous people in Mandla, India Source: Singh N., et al MRC (ICMR) 1993 “ From Alma Ata to the Millennium Declaration”

Tribal population behaviour in Mandla Community survey of bednet use Activity during peak mosquito biting time

Night Mahua collection

Sleep in fields

Tendu leaf collection

Fishing

16%

12%

21%

8%

1200 people out of 2000 are outside the bednet during peak mosquito biting time! -Source: Singh N., et al MRC (ICMR) 1993 “ From Alma Ata to the Millennium Declaration”

Tribal population behavior in Mandla Community survey of bed net users Reasons for non use

Fatigue due to hard field work

Suffocation inside net

Intoxication

Spread on floor

Wrapped around body

Used as pillow

57.85%

9.87%

1.92%

1%

20.9%

2.8%

-Source: Singh N., et al MRC (ICMR) 1993 “ From Alma Ata to the Millennium Declaration”

Evidence What? Whose? Who decides? The people are sharing evidence with the malaria programme bednet researchers about poverty, survival, marginalisation and other social determinants. “ From Alma Ata to the Millennium Declaration”

What is our interpretation?

Social marketing and health promotion of bednets for malaria to keep them in.

or

Poverty alleviation in the context of sustainable development and responsive primary health care to make the programme more accessible, relevant and affordable.

Collecting evidence on social determinants in all its complexity “ From Alma Ata to the Millennium Declaration”

The People’s Charter for Health “ Health is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill health and the deaths of the poor and marginalized people”. “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

The People’s Charter for Health “ Health and human rights should prevail over economical and political concerns…… … ..Calls for provision of Universal and Comprehensive PHC irrespective of People’s ability to pay”. “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

The People’s Charter for Health “ Strong people’s organizations and movements are fundamental to more democratic, transparent and accountable decision making processes…. … .They have an important role in policy development and monitoring of its implementation”. “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

“ Strengthen health systems in the context of access, quality and equity” “ Establish Comprehensive PHC based on Alma Ata and updated to address gender, environment, disability, mental health, traditional systems and other issues”. “ From Alma Ata to the Millennium Declaration” The Mumbai Declaration 2004 Source: www.phmovement.org

People’s Charter on HIV/AIDS 2004 “ HIV and AIDS is a development issue that calls for social and political action. It is also a public health issue that requires people-oriented health and medical interventions. Such responses require democracy, pro-people inter-sectoral policies, good governance, people’s participation and effective communication. They should be rooted in internationally accepted human rights and humanitarian norms.” “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

The Cuenca Declaration 2005 “ Implement comprehensive community-based PHC (with a Rights Perspective) supported by legislation…. … .Provide healthy environments to respect and guarantee the health rights of all…. … .Address the crisis of human resources for health by code of practice on ethical recruitment and financial compensation to exporting countries”…. “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

The Cuenca Declaration 2005 “ Establish and fully implement universal health care financing mechanisms at national level in all countries to provide protection for the whole population. … … .WHO to support and promote the above by advocating for removal of economic and political obstacles at global, regional and national levels that adversely affects government social policies”…. “ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

The way ahead….

Fair and just global governance

Action on international and national inequalities

Strengthening public sector in the face of commercialization

Healthy and robust Health Leadership towards PHC

Strengthening synergy between sectors

Global Health Watch 2005-06 Alternative World Health Report Source: www.ghwatch.org

PHC in the New Millennium New Challenges

Health as a human right

Tackling broader determinants of health – Economic, Social and Political challenges

Tackling environmental challenges and unsustainable developments

Countering war, violence, conflict and natural disasters.

Rediscovering Universal and Comprehensive Primary Health Care

People’s organisations, People’s Movements and Civil Society involvement in dialogue, analysis, action, monitoring and evaluation.

“ From Alma Ata to the Millennium Declaration” Source: www.phmovement.org

PHC in the New Millennium-New Partnerships

WHO, WHO-CSDH and the WPO ( World’s People’s Networks, Campaigns, Movements and Organisations.) –at National, Regional and International levels.

Networks to strengthen the search for alternatives

Health as human rights campaigns

Health for All irrespective of ability to pay

Countering LPG strategies of WBO/WTO

and other top down market driven programmes

Greater inter-sectoral coordination and strategy between UN organisations in search of a new international economic, political, and social order.

PHC in the New Millennium New Paradigms

From Selective PHC back to Comprehensive PHC

From WBO/WTO back to WHO/PHM

From MDGs to New International Sustainable development strategies.

From ‘Vertical Globalization’ from above to ‘Inclusive Globalization’ from below.

From Drugs and Technology to Health promotion and Social Vaccines

From ‘Health Market’ to ‘People’s Health’

“ From Alma Ata to the Millennium Declaration” PAHO “PHC” Document - 2007 Why Renew PHC? For many in the region there is a feeling that, “health is a social, economic and political issue and, above all, a fundamental right, and inequality, poverty, exploitation, violence, and injustice are at the root ill-health and the death of poor and marginalized people” pp: (Quoting People’s Charter for Health from “Alma Ata Anniversary Pack”, PHM, 2003.)

“ From Alma Ata to the Millennium Declaration” PAHO “PHC” Document - 2007 Approach to PHC “ Social and political focus of PHC should be inclusive, dynamic, transparent and supported by legislation and financial commitments if they are to achieve equitable health improvements”. (Quoting People’s Health Assembly background paper, PHM 2000.)

“ From Alma Ata to the Millennium Declaration” PAHO “PHC” Document - 2007