World Bank President Jim Kim calls user fees ‘unjust and unnecessary’ #healthcare


World Bank President Jim Kim today at World Health Assembly called these fees ‘unjust and unnecessary’
 
‘The issue of point-of-service fees is critical.  Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.  This is both unjust and unnecessary.  Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind.  Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.’

World Bank Group President Jim Yong Kim’s Speech at World Health Assembly: Poverty, Health and the Human Future

World Bank Group President Jim Yong Kim

World Health Assembly

Geneva, Switzerland

May 21, 2013

As Prepared for Delivery

Poverty, Health and the Human Future

Mr. President, Director-General Dr. Margaret Chan, Excellencies, colleagues and friends:

We stand at a moment of exceptional possibility.  A moment when global health and development goals that long seemed unattainable have moved within our reach.  A moment, also, when dangers of unprecedented magnitude threaten the future of humankind.  A moment that calls us to shed resignation and routine, to rekindle the ambition that has marked the defining chapters of global public health.

A generation must rise that will drive poverty from the earth.  We can be that generation.

A generation must rise that will end the scourge of inequality that divides and destabilizes societies.  We can be that generation.

A generation must rise that will bring effective health services to every person in every community in every country in the world.  We will be that generation, and you—members of this Assembly—will lead the way.

Yes, I’m optimistic.  I’m optimistic because I know what global health has already achieved—what you have achieved.

In 2011, global average life expectancy reached 70 years, a gain of six years since 1990.  The global child mortality rate has fallen 40 percent in the same period.  In the ten years since Dr. LEE Jong-wook announced WHO’s commitment to support countries in scaling up antiretroviral treatment for AIDS, 9 million people in developing nations have gained access to this life-saving therapy.  These are just a few of the milestones of recent progress.

I have another reason to be optimistic.  I know global health is guided by the right values.

Thirty-five years ago, the Alma-Ata Conference on Primary Health Care set powerful moral and philosophical foundations for our work.  The Declaration of Alma-Ata confirmed the inseparable connection between health and the effort to build prosperity with equity, what the Declaration’s authors called “development in the spirit of social justice.”

Alma-Ata showed the importance of primary health care as a model of health action rooted in the community; responsive to the community’s needs; and attuned to its economic, social and cultural aspirations.  Alma-Ata set the bar high.  But we continue to struggle to provide effective, high-value primary health care to all our citizens.  Unfortunately, none of WHO’s 194 Member States has yet built the perfect health care system.  We can all get better and we know it.

But in the grand spirit of Alma-Ata, we must focus again on the link between health and shared prosperity.  And, this time, we must turn our loftiest aspirations into systems that build healthier, more productive, more equitable societies.

For what Alma-Ata did not do was provide concrete plans or effective metrics for delivering on its admirable goals.  In many cases, frontline efforts inspired by Alma-Ata lacked strategy; evidence-based delivery; and adequate data collection.  This shouldn’t have been surprising, and I’m certainly not criticizing global health leaders of that time.  Indeed, many of the architects of Health For All are my heroes to this day.

Today, we have resources, tools and data that our predecessors could only dream of.  This heightens our responsibility and strips us of excuses.  Today we can and must connect the values expressed at Alma-Ata to strategy and systems analysis; to what I have been calling a “science of delivery”; and to rigorous measurement.  And we must actually build healthier societies.

The setting for this work is the growing movement for Universal Health Coverage.

The aims of universal coverage are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness: whether from out-of-pocket payments for health care or loss of income when a household member falls sick.

Every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality, and affordability.  Priorities, strategies and implementation plans will differ greatly from one country to another.  In all cases, countries need to tie their plans to tough, relevant metrics.  And international partners must be ready to support you.  All of us together must prevent ‘universal coverage’ from ending up as a toothless slogan that doesn’t challenge us, force us to change, force us to get better every day.

The good news is that many countries are challenging themselves, measuring outcomes and achieving remarkable progress.  Turkey launched its “Health Transformation Program” in 2003 to provide access to affordable, quality health services for all.  Formal health insurance now covers more than 95 percent of the population.  The health reform is one of a bundle of factors that have contributed to Turkey’s health gains.  Between 2003 and 2010, Turkey cut its infant mortality rate by more than 40 percent.

Thailand’s universal coverage reform dates from 2001.  The program has substantially increased health care utilization, especially among the previously uninsured.  And, as of 2009, the program had already reduced by more than 300,000 the number of Thai people suffering catastrophic health care costs.

And let me acknowledge that Thailand launched its universal coverage program against concerns over fiscal sustainability initially raised by my own institution, the World Bank Group.  Thailand’s health leaders were determined to act boldly to provide access for their whole population.  Today the world learns from Thailand’s example.

Many other countries are also advancing.  And the growing momentum for universal health coverage coincides with a new chapter in the global fight against poverty.

Last month, the organization I lead, the World Bank Group, committed to work with countries to end absolute poverty worldwide by 2030.  For the first time, we’ve set an expiration date for extreme poverty.

And we know that fighting absolute poverty alone is not enough.  That’s why we’ve set a second goal.  We’ll work with countries to build prosperity that is equitably shared, by nurturing economic growth that favors the relatively disadvantaged in every society.  We’ll track income growth among the poorest 40 percent of the population in every country and work with country leaders to continuously improve policy and delivery, so countries can achieve economic progress that is both inclusive and sustainable – socially, fiscally, and environmentally.

To end poverty and boost shared prosperity, countries need robust, inclusive economic growth.  And to drive growth, they need to build human capital through investments in health, education and social protection for all their citizens.

To free the world from absolute poverty by 2030, countries must ensure that all of their citizens have access to quality, affordable health services.

This means that, today as never before, we have the opportunity to unite global health and the fight against poverty through action that is focused on clear goals.

Countries will take different paths towards universal health coverage.  There is no single formula.  However, today, an emerging field of global health delivery science is generating evidence and tools that offer promising options for countries.

Let me give just one example.  For decades, energy has been spent in disputes opposing disease-specific “vertical” service delivery models to integrated “horizontal” models.  Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a “diagonal” approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system.  We’ve seen diagonal models succeed in countries as different as Mexico and Rwanda.

Whether a country’s immediate priority is diabetes; malaria control; maternal health and child survival; or driving the “endgame” on HIV/AIDS, a universal coverage framework can harness disease-specific programs diagonally to strengthen the system.

As countries advance towards universal health coverage, there are two challenges we at the World Bank Group especially want to tackle with you.  These two areas are deeply connected to the goals on poverty and shared prosperity I described a moment ago.

First, let’s make sure that no family, anywhere in the world, is forced into poverty because of health care expenses.  By current best estimates, worldwide, out-of-pocket health spending forces 100 million people into extreme poverty every year, and inflicts severe financial hardship on another 150 million.  This is an overwhelming form of affliction for people, as the anguish of impoverishment compounds the suffering of illness.  Countries can end this injustice by introducing equitable models of health financing along with social protection measures such as cash transfers for vulnerable households.

Second, let’s close the gap in access to health services and public health protection for the poorest 40 percent of the population in every country.  Improving health coverage and outcomes among the poorer people of any country is critical to building their capabilities and enabling them to compete for the good jobs that will change their lives.  We have to close health gaps, if we’re serious about reducing economic inequality, energizing countries’ economies and building societies in which everyone has a fair chance.

The issue of point-of-service fees is critical.  Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.  This is both unjust and unnecessary.  Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind.  Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.

Now let me tell you five specific ways the World Bank Group will support countries in their drive towards universal health coverage.

First, we’ll continue to ramp up our analytic work and support for health systems.  Universal coverage is a systems challenge, and support for systems is where the World Bank Group can do the most to help countries improve the health of your people.

I was recently in Afghanistan, where the Bank Group has been working with the government and other partners to rebuild the country’s health system.  In Afghanistan, this abstract term ‘health system’ quickly becomes personal.  Let me tell one story. Several years ago, Shakeba, a young woman from Parwan province, gave birth at home, because there was no health center she could go to.  She developed complications and lost her baby.  Earlier this year, Shakeba gave birth to another child—in the delivery room of a recently-opened health center, with modern equipment and skilled personnel.  Shakeba and her new baby are thriving.  Improving health systems literally means life or death for many mothers and children.

The number of functioning health facilities in Afghanistan grew more than four-fold from 2002 to 2011.  During this time, the country reduced under-five mortality by more than 60 percent.

Middle-income countries may face very different challenges.  Many middle-income countries I visit are suffering from an epidemic of hospital-building.  In some countries, I’ve seen brand-new, ultra-sophisticated emergency facilities where specialists are preparing to treat, for example, complicated emergencies like diabetic ketoacidosis.  But when patients are released from these facilities, they can’t get adequate support in the routine, daily management of illnesses like diabetes, because the primary care system has been starved of financing.  It makes no sense to pour resources into responding to downstream complications, without investing in upstream prevention and disease management that could often keep those complications from happening in the first place.

When countries anchor their health systems in robust primary care and public health protection, health care costs can be controlled.  We will work with all countries to do just that.

Our second commitment is that we will support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality.

Reaching these two MDGs is a critical test of our commitment to health equity.

We must continue to focus on the MDGs, even as we prepare for the post-2015 development agenda.  The MDGs have given energy and focus to everyone in the global development community. We have not finished the job.  Now is the time to do it.

Last September at the United Nations General Assembly, I announced that the World Bank Group would work with donors to create a funding mechanism to scale up support for MDGs 4 and 5.  Since then, we have been expanding our results-based financing for health, focusing on the maternal and child health goals.  Our results-based financing fund has leveraged substantial additional resources from the International Development Association, IDA, the World Bank Group’s fund for the poorest countries.  This has been an unquestioned success: the trust fund has multiplied resources for maternal and child health.  Over the past five years, we have leveraged $1.2 billion of IDA in 28 countries, including $558 million for 17 countries since last September alone.  Now we are working with Norway, the United Kingdom and other partners to expand this effort.

Results-based financing is a smart way to do business.  It involves an up-front agreement between funders and service-providers about the expected health results.  Payment depends on the delivery of outcomes, with independent verification.  Results-based financing also allows citizens to hold providers accountable.  It puts knowledge and power in ordinary people’s hands.

These programs all have rigorous impact evaluations. In Rwanda, the impact evaluation showed officials that performance incentives not only increased the coverage and quality of services, but also improved health outcomes.  The study found that babies were putting on more weight, and that children were growing faster.

Our third commitment is that with WHO and other partners, the World Bank Group will strengthen our measurement work in areas relevant to universal health coverage.  In February, the Bank and WHO agreed to collaborate on a monitoring framework for universal coverage.  We’ll deliver that framework for consultation with countries by the time of the United Nations General Assembly in September.

We don’t have enough data.  For example, we don’t yet measure the number of people forced into poverty by health expenditures in every country each year.  We will work with countries and partners to make sure we get better data so countries can achieve better outcomes.

Fourth, we will deepen our work on what we call the science of delivery. This is a new field that the World Bank Group is helping to shape, in response to country demand.  It builds on our decades of experience working with countries to improve services for poor people.  As this field matures, it will mean that your frontline workers – the doctors and nurses, the managers and technicians – will have better tools and faster access to knowledge to provide better care for people.

Distinguished ministers, as you move towards universal coverage, tell us where you’re hitting barriers in delivery.  We’ll connect you and your teams to global networks of policymakers and implementers who have faced similar problems.  We’ll mobilize experienced experts from inside and outside the World Bank Group, including from the private sector, where much of the best delivery work happens.

Fifth and finally, the World Bank Group will continue to step up our work on improving health through action in other sectors, because we know that policies in areas such as agriculture, clean energy, education, sanitation, and women’s empowerment all greatly affect whether people lead healthy lives.

Mexico has done an impressive job in this respect.  Mexico’s Seguro Popular, for instance, works in concert with the Oportunidades cash transfer program.  Oportunidades has increased poor people’s spending capacity and reduced the depth of poverty.  It has also raised school enrollment and access to health services among the poor.  Meanwhile, Seguro Popular has reduced out-of-pocket health care payments and catastrophic health expenditures, especially for the poorest groups.  All countries can’t match Mexico’s resources.  But promising options for similar types of action exist for all countries.

When ministers of health seek to integrate expanded health coverage with efforts to reduce poverty, the World Bank Group’s policy advice, knowledge resources and convening power are at your disposal.  For instance, we can help facilitate discussions with ministries of finance.  We saw promising steps in this direction at the meeting of African health and finance ministers in Washington last month.

But specific actions from the World Bank Group must be part of a wider change in how we work together as a global health community.

The fragmentation of global health action has led to inefficiencies that many ministers here know all too well: parallel delivery structures; multiplication of monitoring systems and reporting demands; ministry officials who spend a quarter of their time managing requests from a parade of well-meaning international partners.

This fragmentation is literally killing people.  Together we must take action to fix it, now.

Aligning for better results is the approach of the International Health Partnership, or IHP+.  And it’s gaining momentum.  Earlier today, Director-General Margaret Chan and I took part in an IHP+ meeting.  It’s inspiring to see more and more countries taking charge, setting the agenda based on strong national plans, and making development partners follow the lead of governments.

We are reconfirming our shared commitment to IHP+ as the best vehicle to implement development effectiveness principles and support countries driving for results.   But, honorable ministers, we must hold each other accountable.  We all have to be ready to pound the table and demand that we stop the deadly fragmentation that has hindered the development of your health systems for far too long.  The stakes are high and the path will be difficult, but I know we can do it.

My friends,

Together, we face a moment of decision. The question is not whether the coming decades will bring sweeping change in global health, development and the fundamental conditions of our life on this planet. The only question is what direction that change will take:

Toward climate disaster or environmental sanity;

Toward economic polarization or shared prosperity;

Toward fatal exclusion or health equity.

Change will come—it’s happening now. The issue is whether we will take charge of change: become its architects, rather than its victims. The gravest danger is that we might make decisions by default, through inaction. Instead, we must make bold commitments.

Since the turn of the millennium, we have experienced a golden age in global health, shaped by the achievements of the leaders in this hall. But will history write that the golden age expired with its hopes unfulfilled, its greatest work barely begun? That it sank under the weight of economic uncertainty and leaders’ inability to change, to push ourselves beyond our old limits?

We know what the answer must be. The answer that the peoples of all our nations are waiting for—those living today and those yet to be born.

We can do so much more. We can bend the arc of history to ensure that everyone in the world has access to affordable, quality health services in a generation.

Together, let’s build health equity and economic transformation as one single structure, a citadel to shelter the human future.

Now is the time to act.

WE MUST BE the generation that delivers universal health coverage.

WE MUST BE the generation that achieves development in the spirit of social and environmental justice.

WE MUST BE the generation that breaks down the walls of poverty’s prison, and in their place builds health, dignity and prosperity for all people.

Thank you.

#India – Unhealthy Health Governance


EPW Vol – XLVIII No. 20, May 18, 2013 | Ravi Duggal
Global Health Governance by Jeremy Youde (Cambridge, UK: Polity Press), 2012; pp 176, $26.95 (paperback).

Ravi Duggal (rduggal57@gmail.com) is an independent health researcher and is associated with the International Budget Partnership and the People’s Health Movement.

Good governance has in recent times emerged as the new mantra to address the failures of public systems. Especially so, in the arena of public health where there is a clear divide between the front line providers of healthcare who face the public and the bureaucracy that makes the decisions. There is growing literature both at the country level1and globally2 on the criticality of governance in delivering efficient and good quality services. Jeremy Youde’s book is an addition to this literature focusing on global governance in health.

Global Issues

Governance implies the exercise of political and administrative authority and within countries this is derived from the sovereignty of the nation state. At the global level such sovereignty is absent and this poses a major challenge to address inter-country or global issues. In the health arena there are numerous global challenges and the difficulties in meeting them hinge on governance failure.

In a recent article in the New England Journal of MedicineFrenk and Moon have identified three global health challenges that are difficult to realise because of governance failure – the unfinished agenda of infections, undernutrition and reproductive health problems; rising global burden of non-communicable diseases and associated risk factors like smoking and obesity; and the challenges arising out of globalisation itself such as health effects of climate change and trade policies.3 Youde’s book deals precisely with these issues and how global mechanisms for dealing with this have been coping.

An Overview

Global Health Governance by Youde begins with an overview of the historical evolution of international health governance efforts and then moves to discuss how some of the key actors like the World Health Organisation (WHO), World Bank, Global Fund, Gates Foundation, Treatment Action Campaign, among others have played their roles to reign in various global health challenges, and finally, discusses some key issues like infectious disease surveillance, health security and access to pharmaceutical as examples of the struggle to address global health governance challenges.

While the book does justice to documenting the evolution of global health governance and some of the key events which shaped its form, functioning and influence, it fails to adequately capture the political-economy context under which such governance efforts developed or rather failed to sustain. Historically WHO (emerging from its precursor the Health Organisation of the League of Nations) was mandated by nation states to engage with global health governance issues with a clearly defined constitution to direct it, but the character of the global political economy prevented it from achieving its goals. The profit-first nature of global capitalism, exemplified by the global pharmaceutical industry, and the cold war did not permit WHO to exercise its authority in right earnest. Due to these political-economy factors the evolution of global health governance assumed a direction in which a fragmented and selective approach developed leading to the spawning of a number of other players like the Global Fund and UNAIDS – the United Nations Programme on HIV/AIDS – on one hand, and private players like the Bill & Melinda Gates Foundation and the Clinton Foundation on the other.

Youde recognises the problems of these developments, but does not attribute the failure of WHO to these developments. Rather, Youde mentions that the failure of WHO was responsible for emergence of these mechanisms. This may appear to be true when we view it from the evolutionary perspective, but if we recognise the political economy context, then the story is very different. Let me summarise Youde’s trajectory of arguments.

Evolutionary History

Youde begins with identifying four key attributes of effective global health governance – it must focus on factors that cross and ignore geographical boundaries, it must employ multisectoral and multidisciplinary approaches to craft effective interventions, it should give voice to a wide range of actors and it needs to rely on transparent and accountable systems. No disagreement with this. But for governance to be effective two other factors are critical. First an adequate budget to deal with its mandate, and second a political backing to make it work. Later in the book Youde does identify these factors while discussing why WHO failed, but if Youde had recognised these upfront, then the trajectory of arguments could have developed differently.

The evolutionary history of global health governance is very well-documented by Youde from the international sanitary conferences of 19th century to the role of the Rockefeller Foundation post-first world war and right through to today. But there is one factual issue that needs to be addressed. There seems to be an assumption that the cross-border spread of disease was an east to west phenomena. While many diseases emerged in Asia and Africa, the west also contributed through syphilis, typhus, tuberculosis, etc, which spread to the east through trade.

The earliest response to contain epidemics was quarantine and this was done on country borders and entry points, but traders did not like it as it affected movement of goods, and consequently, their profits. Soon international conventions emerged like the International Sanitary Bureau in Americas, International Office of Public Hygiene in Europe and ultimately culminating into the Health Organisation of the League of Nations and post-second world war, WHO.

Key Players of Global Health

In the next section Youde discusses the key players like WHO, World Bank, Global Fund and a few non-state actors who are presently part of the global health governance mechanism. Again each organisation that Youde discusses is done quite thoroughly and here Youde does factor in the influence of the political economy context, especially in the discussion of the WHO. Youde tells us that over time WHO does evolve into a strong organisation and the Alma Ata Declaration forms a key watershed of its strength as a global organisation addressing global health challenges as well as supporting public health issues within countries, especially the developing world. It reaches its peak under the leadership of Halfdan Mahler with Health for All as the epitome of its success – what Youde calls the activist orientation phase of WHO which promoted health equity.

This phase of WHO demonstrated that global health governance is feasible – there was a political leadership under Mahler and its finances were quite robust. Youde acknowledges this but does not go far enough to say that this in itself posed a threat to global capitalism which in the health sector operates primarily through the pharmaceutical industry. After Mahler, the next director general of WHO, Hiroshi Nakajima, was indeed, a pharmaceutical man (who had earlier worked for Roche in Japan), who changed the trajectory of WHO setting it on a path of destruction. This changed political economy destroyed WHO and opened up the arena for new players in the global health governance arena led by the World Bank.

WHO under Nakajima

The fact that the World Bank entered the scenario, not only undermined WHO, which under the two terms of Nakajima’s leadership (incidentally Nakajima died recently on 26 January 2013 and the world over obituaries focused on how under his leadership WHO became fragmented and deteriorated as an organisation) was considerably weakened through under-financing of the core budget – a clear shift of resources of WHO from the dominance of its regular budget that member countries contribute to a dominance of programme – and project-based budgets that donors contribute and then dictate the agenda.

Youde has captured this quite well. This budget shift also began the process of fragmentation of WHO’s strategy into dealing with global health challenges as vertical programmes. The latter was already happening with public health programmes across most developing countries and this clearly moved the agenda from Health for All, a universal access approach, to a selective and fragmented approach to deal vertically with specific diseases and health issues like polio, malaria, immunisation, tobacco control, and later HIV/AIDS and reproductive and child health (RCH). This shift has been largely under the leadership of the World Bank,4 Global Fund and various private players like Gates, Ford and Clinton Foundations, among others, as also various bilaterals like the United States Agency for International Development (USAID) and Department for International Development (DFID).

Fragmenting Global Health

Youde has again documented very well the roles of the World Bank, UNAIDS, the Global Fund and the Clinton and Gates Foundations in supporting this new trajectory in global health governance where the control shifted from nation state controlled-WHO to these other so-called “non-political” players. It is precisely the change in politics of health that changed the lead players in global health governance and Youde acknowledges this by quoting Nuruzzaman5 – the World Bank’s strategy as a change from understanding health as a fundamental right to a conception of health as a private market-based good. This, in turn, changed the political economy of global health governance. User fees, public-private partnerships, privatisation, outsourcing, health insurance, etc, are some of the strategic changes that the structural adjustment policies of the World Bank brought to global health governance. WHO, unfortunately now follows this along with most other key players in global health, and primarily because WHO’s budget is predominated by donor contributions who call the shots.

Youde explains that UNAIDS actually emerged out of a conflict situation within the WHO, whose Global Program on AIDS (GPA) was headed by Jonathan Mann, who was a great fundraiser and helped raise the profile of HIV/AIDS globally that attracted huge funding and this created strong jealousies and disagreements with the leadership of WHO under Nakajima forcing Mann to quit, and subsequently, the GPA was transformed into an independent agency of the United Nations (UN) christened as UNAIDS under the leadership of Mann’s assistant Peter Piot. Since UNAIDS focused on providing technical and informational support, another agency to play the funding support role called the Global Fund to Fight AIDS, tuberculosis and malaria was created. This maintained the continuum of fragmenting global health governance and reducing the importance and strength of the WHO.

Youde describes all this very illustratively. One question comes to mind when reading Youde’s discussion of these institutions: What was the underlying reason of setting up these institutions and moving it out of WHO’s control? Was it the new patents regime and the need to facilitate pharmaceutical industry’s profit-making by keeping the control of governance of global health outside the nation state-controlled WHO? And a related question – despite having strong oversight mechanisms in the Global Fund, why has there never been an audit of pharmaceutical purchases by the Global Fund?

The private actors discussed by Youde, Gates and Clinton Foundations, basically fell in line with the World Bank strategy and supported the need to raise substantially the involvement of non-state actors in global health governance. Both these institutions also helped raise further the HIV/AIDS profile globally with more resources being committed to it and also advocated for a more market-oriented approach, for instance, in the procurement of antiretroviral (ARV) medicines. In reality what they were doing is trying to address market failures in health so that the larger health system can be made more market-oriented.

Conclusions

The chapter on civil society organisations (CSOs) focuses on the role that CSOs have played in global health, primarily representing the interests of the common people, as Youde puts it – as voices for the voiceless. Youde illustrates this with the examples of OXFAM International and the Treatment Action Campaign from South Africa.

In the last section Youde goes back to the key issues around which he has built his discussion on global health governance – surveillance of infectious diseases, framing health security and access to pharmaceuticals, mainly ARVs. The first two issues revolve around global regulation of communicable diseases and the response of the international community and how the global health governance mechanisms discussed above have at best been able to engage in firefighting. In the case of access to pharmaceuticals, the access to ARV campaign is viewed as one that could possibly lay the basis for a larger campaign for access to free medicines – regarding medicines and public goods. The Twelfth Five-Year Plan in India, based on the experiences of Tamil Nadu and Rajasthan, is promising access to free medicines in all public health institutions. Will this become a stepping stone towards universal access to healthcare and take us back to the Health for All intiative?

Youde concludes by saying that global health governance has evolved from being a technical issue addressing mechanism until the 1970s to a more rights- and equity-based phase during the 1970s and 1980s, when WHO was in control and since then has entered its neo-liberal phase under the tutelage of the World Bank and various non-state actors, though in recent years, there is a clear effort with pressure from civil society to bring back the Health for All agenda under universal access to healthcare. But this would cost money, conservatively at least 5% of gross domestic product (GDP). Is there the political will of the G-8 or G-20 or other G’s to muster these resources by putting the burden on capitalism by imposing the Tobin tax or financial transaction tax, for instance, which can rein in huge resources in this era of finance capital, and of course, we do not want to forget the old Rio commitment of developed nations to contribute their 0.72% GDP for the global development agenda. The shaping of the post-2015 development agenda goals needs to emphasise this very strongly.

To conclude, Youde’s book is a very good documentation of how global health governance has evolved in the last 150 years or so but it is limited in its conclusions because Youde opted to use the lens of communicable diseases. Today, as Youde acknowledges in his conclusions, non-communicable diseases are much larger global health challenges, but governance issues for these would be very different from what he has discussed in the present book. To deal with these we will have to steep much deeper into issues governing global political economy.

Notes

1 Kumar (2005) 38-53 also see website http: //indiagovernance.gov. in Rao (2013).

2 See for example: Demmers et al (2004); see alsohttp://www.ohchr.org/EN/Issues/Development/GoodGovernance/Pages/Good-Gov… accessed 25 March 2013.

3 Julio Frenk and Suerie Moon, “Governance Challenges in Global Health”, NEJM, 368: 10, 7  March 2013, pp 936-42.

4 See the 1993 World Development Report – Investing in Health, OUP, New York, which became the Bible of this new approach to healthcare.

5 Quoted by Youde from Nuruzzaman, Mohammad (2007).

References

Demmers, Jolle, Alex E Fernández Jilberto and Barbara Hogenboom, ed. (2004): Good Governance in the Era of Global Neoliberalism: Conflict and Depolitisation in Latin AmericaEastern Europe, Asia and Africa (London: Routledge).

Frenk, Julio and Suerie Moon (2013): “Governance Challenges in Global Health”, The NewEngland Journal of Medicine(NEJM), 368: 10, 7 March, pp 936-42.

Kumar, G Narendra (2005): “An Institutional Framework for Good Governance in India”, ASCI, Journal of Management,34(1&2), Administrative Staff College of India, Hyderabad, available at http://journal.asci.org.in/Vol 34 (2005)/04.% 20G N.%20Kumar.pdf accessed on 25 March 2013.

Nuruzzaman, Mohammad (2007): “The World Bank, Health Policy Reforms and the Poor”, Journal of Contemporary Asia, 37(1), pp 59-72.

Rao, N Bhaskara Rao (2013): Good Governance – Delivering Corruption-free Public Services, (New Delhi: Sage).

 

Archives

Kractivism-Gonaimate Videos

Protest to Arrest

Faking Democracy- Free Irom Sharmila Now

Faking Democracy- Repression Anti- Nuke activists

JAPA- MUSICAL ACTIVISM

Kamayaninumerouno – Youtube Channel

UID-UNIQUE ?

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 6,228 other followers

Top Rated

Blog Stats

  • 1,839,209 hits

Archives

April 2021
M T W T F S S
 1234
567891011
12131415161718
19202122232425
2627282930  
%d bloggers like this: