(Extracted from the Draft PHM Campaign Against Privatization as drafted by Dr Abhay Shukla, 2026).
[TLDR (too long didn’t read): If you are reading this, chances are it behooves you. This Reader is about the imperative task for claim holders to mobilize to stop the race to the bottom in the healthcare sector. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
–Global claim holders’ mobilization the world over is needed to challenge the privatization, the commercialization and the financialization of health systems.
—If you don’t have a strategy, you are part of someone else’s strategy.(Alvin Toffler)
Background
1. Across much of the world, especially in the countries rendered poor in the South, governments are failing to adequately fund and organize strong, universal public health systems. Austerity policies, political instability, crushing external debt and militarization have led to the hollowing out of their public health capacity. Financialized corporate capital has moved aggressively into this gap, turning healthcare into a prime site for profit extraction. Hospitals, insurance schemes, diagnostics, pharmaceuticals and various health functions are increasingly treated as financial assets,controlled by transnational corporations, investors and global financial institutions.
2. The rapid expansion of commercial providers, private insurance, public–private partnerships, multistakeholder platforms and outsourcing of services in various forms, as well as the introduction of limited ‘packages’ of care are reinforcing harms to the right to health such as:
- discrimination, exclusion and denial of services,
- high out-of-pocket payments leading to impoverishment,
- increasingly unequal access to care in more-and-more fragmented systems with rising costs and declining quality of care.
3. Today, many governments are withdrawing from the provision of equitable, universal, responsive healthcare and healthcare systems are being aggressively reorganized around the predatory incursion of capital thus deepening human rights (HR) violations, injustice and dispossession.
Some basic concepts explained
4.The privatization and commercialization of healthcare is being contested by popular forces across the world due to their massive damaging consequences for people. Linked with these processes, financialization of healthcare is being increasingly critiqued as a silent accelerator of privatization and commercialization. In recent decades, these interlinked processes have extended their global reach and domination distorting the basic dynamics of the healthcare sector and the principled ethical tenet of healthcare provisioning. Under their sway, i.e., the maximizing of returns for investors and shareholders, these predatory processes become relentlessly extractive overwhelming concerns of fair access, equality, universality and accountability in the healthcare sector.
5. But what do these concepts really mean?
- Privatization refers to the transfer of ownership, of management, or of provision of healthcare services from public to private entities. It is a process through which private actors are more involved in the provision and financing of healthcare services.
- Active privatization may involve a) full handover of public healthcare assets such as public hospitals that are sold or leased outright to private entities; b) outsourcing services like diagnostics or ambulance services that are contracted to private providers; and/or c) Public-Private Partnerships (PPPs)where private healthcare companies build, finance, and operate healthcare infrastructure or services under long-term contracts with governments.
- Passive privatization results from political neglect, underfunding and other deleterious policies that diminish the capacity and reach of the public healthcare system forcing patients to seek care from the private sector. This is often linked with an erosion of public trust and increasing out-of-pocket expenses. This may be associated with the imposition of formal user fees or the need to purchase medicines, lab tests and services from private providers due to insufficient availability of the same in the public system.
- Commercialization reflects a broader cultural and institutional shift within both public and private settings where market norms, revenue logic and competition become central. Commercialization does not always require ownership changes; it rather introduces pricing, competition and a consumer logic into healthcare delivery —whether in public hospitals driven to cost-recovery, or private providers shaped by market incentives. Note: Privatization and commercialization are closely related; privatization enables commercialization, and commercialization deepens the logic of privatization.
- Financializationof healthcare refers to the increasing role of financial markets, investment firms, and speculative capital in the healthcare sector. Financialization transforms the manner in which the healthcare sector is managed and organized shifting the focus from service provisioning to care providers becoming a class of financial assets linked with an overwhelming focus on maximizing returns for financial investors. Financialization of healthcare leads to an emphasis on maximizing short-term profits for investor rather than strengthening health systems or improving long-term patient outcomes. This has major negative impacts for the healthcare workforce, for public health systems and for society as a whole.
6. Privatization and commercialization of healthcare form a continuum with the processes of financialization by increasingly transferring healthcare from public to private control and expanding markets for healthcare. This allows global finance capital to expand investments in the private healthcare sector. In tandem, financialization deepens and upscales the processes unleashed by healthcare privatization and accelerates the conversion of healthcare into a market-driven commodity rather than a universal social good. (Adapted from PHM’s Global Health Watch-7, 2025, Chapter B1: Privatization and financialization of health systems: Challenges and public alternatives, pages 66 to 84)
How does challenging the privatization of healthcare come about and how does it feed into related resistance strategies?
7. Various anti-privatization movements are seen to be, not only limited to seeking immediate gains (like defending access to free public healthcare), but also include people seeking to correctly view privatization as a fundamental threat to public ownership and to the right to accessible, accountable healthcare, now and in the future.
8. The motivation to act can come from:
- A state-induced near collapse of public health services that has acted as a key windows-of-opportunity to pave the way for the entry of predatory capital.
- Visible acts of active privatization already under way can also become triggers for resistance, because they are experienced as moral breaches and privatization is viewed as a hegemonic project, not just a bunch of discrete technical reforms.
- Consequently, people’s resistance to privatization emerges as a defense of rights deemed inalienable and perceived as necessary to deliver broad social solidarity even moving beyond health sector-specific advocacy. (Anti-privatization struggles are, therefore, often merged with initiatives more specifically aimed at improving public health services –or even initiatives against the privatization of other sectors).
A wide range of strategies
9. Across regions and countries, anti-privatization movements have deployed a wide range of strategies, often in combination, shaped by local political conditions and their objective capacities. A sample here:
- Mass mobilization and collective actionhave remained central, including rallies, marches, public meetings (people’s tribunals) and symbolic action days as seen in South Africa, India and Europe.
- Health worker–led struggles, including those in the Philippines, have played a particularly important role in exposing the consequences of privatization from within health systems themselves.
- Different forms of mobilization have been crucial for politicizing healthcare reform, building public legitimacy, and challenging the technocratic framing of privatization.
- Alongside mobilization and creating consciousness, movements have engaged in policy advocacy and rapid-response interventions, particularly in moments when governments push public–private partnerships, insurance expansions or legislative changes, as seen in India, El Salvador and South Africa.
- Equally important has been alliance-building with trade unions, water and food sovereignty movements, feminist and social justiceorganizations, and cross-border networks, especially in Europe, situating health privatization within wider political economy struggles.
- Capacity-building initiatives including popular education workshops have underpinned these efforts by building shared analysis and long-term leadership, even if their impacts are less immediately visible.
- Narrative and media work has supported efforts with media statements framing privatization as a corporate capture of public assets and as an erosion of people’s rights.
10. Interventions such as the ones here above can delay or block damaging reforms and create space for alternative public options. Taken together, these strategies reflect an evolution from resistance to discrete privatization projects, to systemic critique of insurance and Universal Health Coverage (UHC) frameworks, to moving towards a structural political economy analysis of financialization and corporate power in healthcare. (The possible activities mentioned here are obviously not an exhaustive list, but are mentioned as examples to indicate the range of actions that may be relevant at each level).
Key actors that must be engaged
11. Across these anti-privatization interventions, participation and support for movements has been broad and often intersectional, frequently including the following constituencies:
- Local communities, patients and families, especially from urban and rural deprived, marginalized communities reliant on public hospitals and health services.
- Diverse grassroots organizations including women’s groups, farmers’ associations, indigenous people’s movements, gender minority groups, etc.
- Public health workers and unions including municipal staff, doctors and nursing associations, hospital workers opposing privatization.
- Student groups and academics including medical college faculty and students.
- Public interest civil society human rights activists and intellectuals from beyond the health sector.
- Mainstream media and social media influencers.
- Some movements have also mobilized or attracted support from political parties and/or elected representatives and parliamentarians.
12. It is indeed relevant to keep in mind these strategies and the range of participants while developing anti-privatization campaigns at various levels in a grounded manner.
13. A few ad-hoc reflections
- We need to recognize that the key challenge today is the erosion of collectivity at the grassroots level while developing such campaigns. It is relatively easy to give a call for resistance against privatization. But for these calls to be taken-up by working people who are already overwhelmed by multiple challenges in their daily lives is tough. Moreover, today we must face the fact that in the era of authoritarianism and neofascism, communities of working people are often divided, distracted, dominated and disillusioned due to powerful, ongoing hegemonic processes and influences. In this increasingly challenging context, the mere articulation of technically sound critiques is completely insufficient; the major task is building community solidarity infused with a critical consciousness. This is why we need to translate technical critiques of privatization into appealing popular narratives that will, together, become political in the deepest sense.
- Not every protest against privatization of health services is successful, or even significantly impactful. Given various, often major challenges and obstacles, it becomes important to painstakingly build a ‘critical social mass’ that can effectively impact on the system, and at least halt the current privatization proposals, while opening avenues for reclaiming already privatized public institutions.
- Resistance to privatization is likely to be most effective when it combines actions at multiple levels: grassroots mobilization, counter-knowledge production, wide dissemination of people-centered narratives, critiques from-within-the-system (by health workers and unions) and alliance-based political pressure.
- Struggles against health sector privatization and commercialization gain power when aligned with allied movements demanding related economic and social rights (like the right to food and to water), when resisting commodification of public services, resisting extractivism, the ongoing democratic erosion and the corporate capture of the state.
- At country level, wherever the basic conditions exist, support ought to be provided to ongoing campaigns and struggles against specific privatization projects (PPPs related to hospitals, medical colleges, outsourcing of services, commercial insurance expansion, etc.)
Bottom line
Aiming for a strategic escalation
14. The times demand a drastic transformation of health systems including an active countering of the prevailing global UHC agenda and the strengthening of existing public sector-centered alternatives.
15. A campaign carried out along these lines will, over time, probably evolve unevenly and not in a fully predictable manner. There will be massive diversity across country contexts since political and policy conjunctures at national levels, as well as the status of health system development and existing levels of privatization, will naturally heavily shape the choice of targets and strategies.
16. Nevertheless, the timely and strategic opportunity to connect with dispersed struggles cannot be missed. Right to health activists will have to help weave these strategies and tactics into a more visible, coherent, and explicitly political global narrative. They will also strengthen solidarity and coordination across various levels through mutual learning in a comradely manner.
17. Public ownership and management of healthcare is and will remain essential to protect health as a public good. Privatization in various forms serves corporate and commercial interests, not people. Meaningful change will not come from technocratic reforms or market-driven UHC as proposed by WHO. Transforming health systems requires transforming power and politics, through joint struggles and solidarity among communities, health workers, social movements, progressive political forces and, wherever possible, people-oriented governments.
18. The campaign must thus ultimately serve as a platform for linking grassroots resistance with the needed political economy critique and for connecting local outrage over the captured public health assets. It must unequivocally position health, not merely as a sectoral concern, but as one of the frontlines in the wider global struggles for dignity, equality, human rights and the democratic control over our collective futures, offering much-needed hope in today’s troubled world.
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
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