Title: Civil Society and Global Health: Trying to identify matching or overlapping issues
1Civil 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
2Historical 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.
3The 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.
4The 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.
5A 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.
6A 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).
7The 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.
8The 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.
9The 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.
10Consequences 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?
11Consequences of the devils pact
- 2. Additional aid remains unspent. A vicious
circle
12Trying 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.
13Can 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.
14A 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. -
15A 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
16A 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).
17A 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.
18A 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).
19A 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.
20Back 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
21Back 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