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Civil Society and Global Health: Trying to identify matching or overlapping issues

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Historical overview of international community' attitudes regarding global health ... right an alibi to reduce the role of the state: let the people control their ... – PowerPoint PPT presentation

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Title: Civil Society and Global Health: Trying to identify matching or overlapping issues


1
Civil Society and Global HealthTrying to
identify matching or overlapping issues
  • Gorik Ooms
  • Institute of Tropical Medicine, Antwerp, Belgium
  • Department of Public Health
  • Amsterdam, September 2008

2
Historical overview of international community
attitudes regarding global health
  • Two preliminary remarks
  • 1. Theres a difference between attitudes
    regarding the implementation of interventions,
    and attitudes regarding funding. This overview
    will focus on funding.
  • 2. Does the period before 1985-1990 really count?
    Before the end of the Soviet Union as a
    super-power, international funding was mainly
    an element of the cold war support your allies,
    dont ask too many questions.

3
The end of the cold war Margaret Thatcher and
Ronald Reagan rule the world
  • During the cold war, the international community
    was divided, and did not ask too many questions
    about the use of international aid.
  • This changed during the 1980s, donors started
    looking for a common best practice, and the
    World Bank and the International Monetary Fund
    (IMF) occupied the empty stage.
  • The so-called Washington Consensus was born,
    and it was influenced by the dominant neo-liberal
    school of thought.
  • Neither Tony Blair, nor Bill Clinton,
    fundamentally challenged this school of thought.

4
The 1990s Structural Adjustment with a Human
Face
  • Broad consensus that structural adjustment went
    too far.
  • Poverty reduction seen as instrumental to
    economic growth, not as a side-effect of economic
    growth.
  • World Bank and IMF reacting like HIV a
    constantly mutating virus, adapting to external
    attacks Does structural adjustment create
    poverty? Then well call it poverty reduction
    from now on!
  • the IMF gravitated back to business as usual.
    The Independent Evaluation Office of the IMF,
    April 2007.

5
A devils pact between structural adjustment
and liberation/emancipation
  • Structural adjustment reduce the role of the
    state, reduce public expenditure, privatize
    social services (it will foster economic growth,
    and economic growth will provide social services
    One cannot build a social paradise on an
    economic graveyard).
  • Liberation/emancipation empower communities,
    make them less dependent on their (by definition
    evil) governments, and the international
    community backing those governments.

6
A devils pact between structural adjustment
and liberation/emancipation
  • The Bamako Initiative is probably the symbol of
    the devils pact for the left a way to empower
    communities, for the right an alibi to reduce the
    role of the state let the people control their
    health care (and let them pay for it).

7
The devils pact, today
  • The World Bank Obviously, then, it is not
    prudent for countries to commit to permanent
    expenditures for such items as salaries for
    nurses and doctors on the basis of uncertain
    financing flows from development assistance
    funds
  • The IMF Countries that receive significant
    flows of foreign resources for a specific sector
    (such as health care) may, as a result of the
    associated expansion of the sector, face
    additional future spending needs that may
    essentially pre-empt a share of the growth of
    future domestic budgetary resources.

8
The devils pact, today
  • Family Health International Eventually,
    countries will need to replace donor funds for
    both family planning and other elements of
    reproductive health care with in-country
    resources.
  • The International Labour Office (ILO) We know
    that the world can afford to make the right to
    social security a reality not just a dream.
    According to ILO calculations, less than 2
    percent of the global Gross Domestic Product
    (GDP) would be necessary to provide a basic set
    of social security benefits to all of the worlds
    poor. Most of the resources needed will
    obviously have to come from national resources.

9
The fight against AIDS, a fundamentally different
perspective
  • The Harvard Consensus Statement At
    approximately 1,100 per patient per year, the
    total cost of treatment for 13 million
    HIV-infected individuals in Africa within 3-5
    years would be easily managed by the worlds
    wealthiest countries. This is a small price to
    pay for treatment on a meaningful scale in the
    midst of the worst worldwide pandemic in 600
    years.
  • Michel Kazatchkine (Global Fund) The Global
    Fund has helped to change the development
    paradigm by introducing a new concept of
    sustainability. One that is not based solely on
    achieving domestic self-reliance but on sustained
    international support as well.

10
Consequences of the devils pact
  • 1. Not enough international health aid. Take
    Malawi, a low-income country with an average GDP
    of US163 per capita per year. On optimistic
    assumptions, it could generate the equivalent of
    20 of GDP as government revenue (US32 per
    capita per year), and allocate 15 of that to
    government health expenditure (US5 per capita
    per year). Minimum US40 is needed. Are donors
    willing to cover the other US35 (87.5) and
    abandon domestic financial self-reliance?

11
Consequences of the devils pact
  • 2. Additional aid remains unspent. A vicious
    circle

12
Trying to identify matching or overlapping issues
  • As long as we cannot overcome the devils pact,
    natural allies will remain unnatural enemies
  • The present fights between the proponents of
    primary health care for all and the activist for
    universal access to AIDS prevention and treatment
    are only the beginning.
  • The next fights will be between the proponents
    of comprehensive primary health care for all
    (including AIDS treatment and prevention), and
    the proponents of education for all, safe water
    for all, food security for all, housing for all.

13
Can we break the devils pact, and develop a
common vision?
  • According to ILO calculations, less than 2
    percent of the global GDP would be necessary to
    provide a basic set of social security benefits
    to all of the worlds poor.

14
A 2 cents campaign, or vision
  • Lets assume for a while that all human beings,
    living in rich or poor countries, being rich or
    poor in those countries, would agree to put 2
    cents out of every dollar or euro they earn into
    a global social protection fund.

15
A 2 cents campaign, or vision
  • Given a global GDP of almost US60 trillion per
    year, that would create a global social security
    fund of US1.2 trillion per year.
  • Given a global population of almost 7 billion
    people, that would create an entitlement of
    US171 per person per year.
  • The contribution of the average inhabitant of
    Norway (average GDP per capita per year
    US68,440) would be US1,369 minus US171 net
    contribution US1,198.
  • The contribution of the average inhabitant of
    Malawi (average GDP per capita per year US163)
    would be US3 minus US171 net contribution -
    US168

16
A 2 cents campaign, or vision
  • The turning point would be an average GDP of
    US8,550 per capita per year
  • Countries with an average GDP of US8,550 per
    capita per year or more would be net contributors
    (all high-income countries and a few
    upper-middle-income countries)
  • Countries with an average GDP of US8,550 per
    capita per year or less would be net recipients
    (all low-income and lower-middle-income
    countries).

17
A 2 cents campaign, or vision
  • US171 per capita per year could be used for
  • US43 per capita per year for health (25)
  • US43 per capita per year for education (25)
  • US34 per capita per year for food security
    (20)
  • US17 per capita per year for safe water (10)
  • US17 per capita per year for housing (10).
  • This would only create an essential social
    rights floor, on which countries can and should
    build their own social protection.

18
A 2 cents campaign, or vision
  • As a result, we could or should have
  • A US300 billion Global Health Fund (US60
    trillion x 2 x 25)
  • A US300 billion Global Education Fund (US60
    trillion x 2 x 25)
  • A US240 billion Global Food Security Fund (US60
    trillion x 2 x 20)
  • A US120 billion Global Water Fund (US60
    trillion x 2 x 10)
  • A US120 billion Global Housing Fund (US60
    trillion x 2 x 10).

19
A 2 cents campaign, or vision
  • And all it would cost would be 2 of our
    earnings. I think most of us are unable to say
    how much taxes and social security contributions
    they pay, with an error margin of 2. Most of us
    would not feel it.

20
Back to reality
  • Our common, matching or overlapping issue is the
    devils pact the stupid idea that the provision
    of essential social rights should be financed
    through domestic resources.
  • We cannot succeed in fighting the devils pact on
    the outside, as long as we allow it to remain
    alive on the inside (of Civil Society).
  • We can defeat the devils pact we did it for the
    fight against AIDS, we can do it for
    comprehensive primary health care, for education,
    for food security, for water, for housing

21
Back to reality
  • But we need a common framework, a common
    objective.
  • I know my personal ideas about a Global Health
    Fund seem far-fetched to many of you, but in fact
    we need an objective that reaches even further a
    Platform for the Realisation of Essential Social
    Rights.
  • US1.2 trillion per year is peanuts
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