Health rights of social groups with special health needs
- Any system of rights is relevant only if it benefits the most vulnerable or deprived. The argument is not for a proliferation of special programmes for these groups grafted onto a weak health system, but rather integrating special services for them into a strengthened health care system.
- We are talking here of the right to health care of women, of children, the health rights of HIV-AIDS affected persons, of persons with mental health problems, of differently abled persons, of unorganised sector workers, of urban deprived communities, and of the health rights of people in conflict situations, of people displaced, of migrants, of ethnic minorities.
User fees as a violation of health rights
- User fees tend to infringe on the health rights of the poor by reducing their utilisation of health services; ‘exclusion mechanisms’ (waivers) for the poor have long shown they do not work. Exemption mechanisms do not actually benefit the poor, but are often cornered by other locally more powerful groups. [The same is true for the so often recommended targeting of interventions to the poorest of the poor].
In short, user fees are seen as a regressive form of health care financing.
Public-private partnerships (PPPs): A significant erosion of health rights
- Ample evidence exists of the often poor and irrational quality of private services. Private practitioners frequently prescribe irrational drugs and diagnostic tests. Hence the insistence on an effective public regulation of the sector.
- From a health rights perspective, ‘franchising’ and particularly ‘outsourcing’ of public health care functions, are to definitely be considered a regressive step as well. Handing over major functions to the private sector may actually be a way of diluting the responsibility of the public health system. Any such dilution will have adverse consequences for poor people’s health rights.
- The challenge before the Health for All movement now is to simultaneously present a people’s response/alternative to the large scale health system reorganisation, as well as to challenge all privatisation-oriented measures while continuing to press for the fulfilment of universal access to health.
- The right to guaranteed services will only remain on paper if not persistently demanded and operationalised. People’s organisations need to watch the reorganisation process –supporting its positive aspects while critiquing the negative ones and posing alternatives at various levels as necessary. For example, drawing on the Indian experience, a People’s Rural Health Watch can be conceived of.
- In our efforts to reform the system, we have to avoid two extremes regarding restructuring measures: Avoid a blanket rejection which might lead us into isolated passivity and an inability to influence this process; and avoid the danger of cooption and absorption into the dominant health system; we have to keep continuously critiquing and exposing its various negative aspects.
- As said, in this struggle for the RTH, we need to target not only the local, but also the higher level decision makers. The only way to effectively challenge the overall thrust of health policies — and pressing for the substantial strengthening of health care in the public sector while confronting the privatization agenda– is by influencing the central political decision-making process. This includes concerted attempts to dialogue with political parties. We have to push for key positive changes and block retrogressive steps –both of the preceding by appropriately intervening in the political space.
- As also said, along with our critiques, it is a must that we develop and present well thought-out alternative plans. Such ‘People’s Health Plans’ could be developed over a period of time. They would be a logical and practically elaborated sequel to the existing People’s Charter for Health of the People’s Health Movement. (www.phmovement.org )
- Moving from an initial situation of ‘talking-among-ourselves’ to ‘talking-to-implementing-officials’ (in the form of direct dialogues and of public hearings) will confront us with the need to –from a position of greater power– talk to the political decision makers. Moving from a critique of the current health system deficiencies to a broad vision of an alternative (in the said People’s Health Plan), we will respond to the need of posing comprehensive and detailed alternative demands and strategies. Building upon such a more democratic focus on the health-system-to-be, will also require that we develop parallel effective and practical strategies to address the key social determinants of health (i.e., water, food, housing, a safe environment, etc.).
(contd.)
Claudio Schuftan, Ho Chi Minh City