Do Health Systems serve people’s Health?

1. Do Health Systems serve people’s Health? Hani Serag Global Secretariat Coordinator People’s Health Movement A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

2. “Health for All”. . Enforced Promise, Intentional, Denial, Silence . . . ! • In 1978, at the Alma-Ata Conference, 134 countries in association with WHO and UNICEF called for 'Health for All by the Year 2000' and selected PHC as the best tool to achieve it. • Unfortunately, that dream never came true. • Health status of Third World populations has not improved. In many cases it has further deteriorated. • We are facing a global health crisis, characterized by growing inequalities within and between countries. • New threats to health are continually emerging. This is compounded by negative forces of globalization which prevent the equitable distribution of resources necessary for people's health, particularly the poor. • Within the health sector, failure to implement the principles of PHC has significantly aggravated the global health crisis. • Governments and the international community are fully responsible for this failure. • In particular, WHO did not inform people all over the world why was the failure and who is responsible for it! A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

3. Declines in life expectancy between 1990 & 1999 100 million school-age children remain out of school more than 1,000 women still die for each 100,000 live birthsin twenty developing countries, A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

4. Trends in infant mortality, 1970-1999 Source: World Bank, World Development Indicators 2001 A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

5. Infant Mortality in Sub-Saharan Africa Source: UNICEF: State of the World’s Children 2001 A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

6. U.S. Mortality Rates Among Infants, by Race/Ethnicity of Mother: 1980-2001Source: National Center for Health Statistics A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

7. Risk of Death by Income group in the USAIncome group 0 is the poorest and 8 the richest Source: Technical Consultation on Measurement of Health Inequalities – Background Paper (WHO, 2001) A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

8. Unequal Access A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

9. WTO RegimeExample of the TRIPs and Trips+ • Imposition of stricter legislation related to pharmaceutical production and supply, being driven and reinforced by the parallel adoption and/or expansion of IPR laws as required by the WTO TRIPs, and now being made even stricter through bilateral treaties (TRIPs-Plus). • Previously, the production and commercialization of drugs were driven by state legislation, defining what could be sold and under what conditions, for the prime purposes of setting national priorities and ensuring quality assurance. • With this wave of new laws and increased scope of IPR regimes, conditions are being created for the private industry to control world markets and set requirements for what producers can and cannot do, and what consumers can access. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

10. Top 10 Pharmaceutical Companies by Sales, 2004 Source: Scrip’s Pharmaceutical League Tables 2005 provided by PJB Publications; company profit data (not necessarily limited to pharma sales) from 2005 Fortune Global 500. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

11. Globally, the 1990s witnessed a dramatic increase in concentration in the pharmaceutical and other industries, with a sharp rise in further mergers and acquisitions amongst companies in these vital field continuing over the last several years in particular. • Recent analyses indicate that what looks like buying and selling between countries is, in fact mostly the redistribution of capital among subsidiaries of the same parent multinational corporations. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

12. World Health Assembly Adopts Resolution Tying Public Health To Trade Policy • India suggested adding a new paragraph urging member states, “to reflect all the flexibilities permitted under international trade agreements in national laws to address public health concerns.” It also suggested adding “multi-stakeholder” in to make the resolution read: “to promote multi-stakeholder dialogue” on trade and health. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

13. The United States said the issue of flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was already “more than adequately covered” in other resolutions, including the research and development resolution that also was adopted today. It proposed deleting the Indian paragraph. • Australia also said that India’s proposal was already dealt with other places in the resolution. Moreover, it said that the TRIPS Agreement offered the member countries the opportunity “to take up flexibilities but does not require them to do so.” A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

14. As a compromise, India proposed adding its point, in a somewhat watered-down version, to another paragraph referring to trade agreements, then reading: “using the flexibilities inherent in them.” The US suggested adding, “considering where appropriate” to be added before this. • This was agreed and the resolution was adopted. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

15. Demographic and Health Indicators • Population = 80,335,036 • Birth Rate: 22.53 births/1,000 • Death Rate: 5.11 deaths/1,000 • Infant Mortality: 29.5 deaths/1,000 live births • Life Expectancy at Birth: total: 71.57 years • male: 69.04 years • female: 74.22 years • Literacy: total: 71.4% male: 83% female: 59.4% A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

16. Health Systems: Characteristics • Different parallel systems responding to different ideological eras. • MOH Facilities (preventive and curative) – 5000 facilities – even geographically distributed. • University Hospitals (Curative) • Teaching Hospitals (curative) • Health Insurance facilities (mostly curative) • Other public • Private – Hospitals and clinics (curative) A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

17. Health Insurance • Covers 50% of the population: • Employees (Government, public sector, and partially private sector) • Retired • School Students • Widows • Service provision organization • Premiums are being collected by the Ministry of Social Affairs A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

18. Current reform • Open door policies started one year after the last war(1974) • Privatization process has been started long time ago in Egypt – first the industrial assets, then some infrastructure like electricity and telephones. • Health, education and water were left public. • The “partners” of the restructure adjustment (USAID, WB and EU) pushed for further steps. • Many reports suggested that the health care systems in Egypt should be unified in one system based on the insurance. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

19. Dismantling of Health Insurance System and Organization • The “Laws” regulating the health insurance organization and system were cancelled by a “Ministerial Decree” against the constitution! • The Ministerial Decree converted the current organization from a service provider to a monetary organization: • To collect the premiums); • To loose its huge infra structure (each facility will be a stand along financial unit). • To rent the health services from all kinds of providers according to previously made criteria for quality. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

20. Expected consequences • Fragmentation of the current health insurance organization into small financially separated facilities which is believed to make them unable to meet: • The cost-effectiveness criteria based on which they will be evaluated. • The quality criteria that most probably will be made to meet big, equipped facilities. • Most probably they will be sold or kept not functioning. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

21. Expected consequences • Different packages with different premiums (systematically classifies people according their financial affordability). • The new set-up will greatly meet the wishes of the multi-nationals (no more purchase medicines and equipment through a big bid – market prices will apply). A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

22. What does Health System do? (Voices from the US) What the insurance companies have done is to reverse the business, so that the public at large insures the insurance companies. Gerry Spence, 2004 What we call health "insurance" in this country was never designed to insure the consumer.  Instead, its purpose is to insure steady, reliable incomes for health care providers.  True health insurance is the economist's equivalent of a unicorn - we can describe it, but none of us has actually seen it. John C Goodman, 2004 A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

23. First People’s Health Assembly • Several international organizations, civil society movements, NGOs and women's groups decided to work together towards “Health for All”. • With others committed to the principles of PHC and people's perspectives, they organized the People's Health Assembly, 4-8 December 2000 in People's Health Centre of GK, Savar, Bangladesh. • 1453 participants from 92 countries came to the Assembly, a culmination of 18 months of preparatory action around the globe, including thousands of village meetings, district level workshops and national gatherings. • At the Assembly, they reviewed their problems and difficulties, shared their experiences and plans, and formulated and endorsed the People's Charter for Health. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

24. People’s Health MovementStruggle for “Health for All”through Evidence-Based Action • Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world – • a world in which a healthy life for all is a reality; • a world that respects, appreciates and celebrates all life and diversity; • a world that enables the flowering of people's talents and abilities to enrich each other; • a world in which people's voices guide the decisions that shape our lives. • There are more than enough resources to achieve this vision. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

25. 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 poor and marginalized people. • Health for all means that powerful interests have to be challenged, that globalization has to be opposed, and that political and economic priorities have to be drastically changed. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”

26. People’s Charter for Health • The Charter is now the common tool of a worldwide citizen's movement committed to making the Alma-Ata dream a reality. • The charter published now in 33 languages(Arabic, Bangla, Chinese, Danish, Dutch, English, Farsi, Filipino, Finnish, French, German, Greek, Guarani, Hausa, Hindi, Indonesian, Italian, Japanese, Kannada, Malayalam, Nepalese, Ndebele, Portuguese, Quichua, Russian, Serbian, Sinhala, Spanish, Swahili, Swedish, Turkish, Vietnamese, Urdu). • We encourage and invite everyone who shares our concerns and aims to join us by endorsing the Charter. A different World Is Possible . . Is It? “IPHU – Atlanta, June 2007”