Health reforms based on market principles have been introduced widely in both developed and developing countries over the past 20 years. In developing countries, international donors have insisted on health reform as a precondition of providing external aid. The reform packages that have been introduced have been strikingly similar across countries as wide apart as Uganda, Bolivia, and Russia. Uganda embarked on market based health reforms in 1994. These reforms have not only failed to improve health services and the health of the population but have arguably been the key factor behind their deterioration. What can we learn from Uganda's experience?
Health equity in economic and trade policies
Learning from failed health reform in Uganda
The potential impact of US-SACU FTA negotiations on public health in southern Africa
This Working Paper was written by Tenu Avafia, a tralac researcher, and examines the potential impact of the proposed Free Trade Agreement (FTA) between SACU and the United States from the perspective of public health. Avafia examines the ongoing negotiations and expresses concerns about the possible impact of the FTA on public health in the SACU region, particularly, the impact that the proposed FTA is likely to have on the ability of SACU countries to source the most affordable essential medicines required to address urgent public health concerns. Avafia goes on to say that it would be imprudent to enter into a bilateral agreement that contains less favourable provisions on essential medicines than those found in the multilateral arena such as the Doha Declaration on TRIPs and Public Health and the WTO General Council Decision of 30 August 2003.
Victims of HIV/AIDS Should Not Suffer From Trade Rules
Botswana was warned last month by a UN Committee that trade agreements should not undermine Botswana’s ability to ensure access to affordable treatment for children or other people with HIV/AIDS. The UN Committee on the Rights of the Child, in a document made public, strongly recommended that Botswana ensure that “regional and other free trade agreements do not have a negative impact on the implementation of children’s rights.” Most importantly, it warned Botswana that trade agreements should not “affect the possibility of providing children and other victims of HIV/AIDS with effective medicines for free or at the lowest price possible.”
Further details: /newsletter/id/30677
Poverty Reduction Strategy Papers and health: not living up to expectations
A new report by Medact and Wemos highlights some of the issues that need to be taken into account in order to make the PRSP process work for health. 'Pushing the boundaries: health and the next round of PRSPs' draws on case studies in seven countries: Bangladesh, Bolivia, Ethiopia, Ghana, Kenya, Nicaragua and Uganda. Till now, the PRSP process has failed to make significant improvements to health. But in some areas and in some countries there are positive developments. Ghana's health budget has risen and user fees are abolished in Uganda and Ghana as a result of increased policy attention for the poor. But there is a long way to go. Pushing the boundaries calls for health organisations, ministries of health, donors and international agencies to use the PRSP process to establish equitable and comprehensive health systems. Download the report from either
http://www.wemos.nl/prs or http://www.medact.org
What factors most affect health policy in South Africa?
The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult. International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces.
Who should pay for debt cancellation?
Proposals by the US government to re-divert aid funding to pay for the debt cancellation for the world's poorest countries have been criticized by the Catholic Agency for Overseas Development (CAFOD). It is understood that the US Treasury Department is going to call for 100% debt cancellation for highly indebted poor countries. However the American proposal calls for the debt relief to be offset against new aid funding for the poverty-stricken countries. Henry Northover, Public Policy Analyst, CAFOD, said: "It's not so much a 100% debt cancellation as a 100% debt makeover. Debt cancellation for the worlds poorest must be paid for by the world's richest."
Evaluating economic change
In recent years there have been enormous changes in our technology, our economy, and our society. But has there been progress? asks economist Joseph Stiglitz. In the countries that have been less successful, globalization is often viewed with suspicion. "As I have argued elsewhere, there is a great deal of validity to the complaints of those who are discontent. In much of the world, there has been in recent years a slowing of growth, an increase in poverty, a degradation of the environment, and a deterioration of national cultures and of a sense of cultural identity."
Health in an Age of Globalization
Disease has travelled with goods and people since the earliest times. Armed globalization spread disease, to the extent of eliminating entire populations. The geography of disease shaped patterns of colonization and industrialization throughout the now poor world. Many see related threats to public health from current globalization. Multilateral and bilateral trade agreements do not always adequately represent the interests of poor countries, the General Agreement on Trade in Services may restrict the freedom of signatories to shape their own health delivery systems, and it remains unclear whether current arrangements for intellectual property rights are in the interests of citizens of poor countries with HIV/AIDS.
HIPC sunset clause - Haven't we been there before?
The World Bank and IMF have produced a paper entitled "Enhanced HIPC Initiative - Possible Options Regarding the Sunset Clause", dealing with the sunset clause of the Highly Indebted Poor Countries Initiative (HIPC). The paper provides a brief background to the sunset clause and discusses the implications of its expiry at the end of the year before going on to discuss four possible policy options and concluding remarks. Eurodad, the European Network on Debt and Development, comments that any extension would: "...embarrassingly for the WB and IMF, represent the fourth extension to the initiative. We argue that this demonstrates the severe technical shortcomings (and therefore credibility) of the initiative."
Pushing the boundaries: health and the next round of PRSPs
Wemos and Medact have prepared this report to fuel the discussion on how PRSPs can be used to improve the health of the poor. The report builds on the materials from seven country studies, prepared by NGOs to gain insight into the possible added value of PRSPs for health in their countries. Based on these and other sources, the report highlights a number of issues that in our view are crucial for achieving equitable health systems and which should receive much more attention in PRS processes than they do so far. These include the coordination of development aid and international health initiatives, the debt burden and other macroeconomic constraints to increased health spending, and policy initiatives to make health care markets more socially-inclusive in low-income countries.