//SOCIAL SUMMIT 2000//DEVELOPMENT: The World’s Poor Still Lack Basic Health Care

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

MEXICO CITY, Jun 22 2000 (IPS) - For a large portion of the wor ld’s poorestimated at over 1 billion peopleaccess to basic health care se rvices still remains a distant dream.

That is the stark message the World Health Organisation (WHO) has for the international community gathering next week in Geneva for the Social Summit Plus Five, a conference expected to advance the global social develop ment agenda that was set at the 1995 World Summit for Social Development i n Copenhagen, Denmark.

This scenario, adds the WHO, reflects how far short countries have fa llen of one of the pledges made at the Copenhagen summit – to achieve univers al access to basic health care services by 2000.

“Efforts to implement the Social Summit’s call for universal access t o basic health care services are not what was hoped for,” the WHO observes in a review of global health systems since 1995.

In its diagnosis, the WHO offered a range of reasons that have contri buted to this global picture of deprivation. Particularly disturbing, it found , was the “profoundly anti-poor” culture prevalent in a number of health system s within countries.

“The distribution of services is highly skewed towards the better- off , and that resource allocation, by default, hurts the poor,” it charges. Such a bias, it adds, is evident when one compares access to health care in the urban regions of countries against what prevails in the rural reaches, where “there are more health personnel in the cities, while most of the poor live in rural areas.”

As a result, poor people are forced to face far longer waiting period s before receiving medical attention.

Such “striking inequities,” the review observes, is true between coun tries, too. In most developed countries, for instance, the WHO found that th ere may be one nurse for every 130 people and a pharmacist for every 2,000 to 3, 000.

Furthermore, a full treatment to cure an illness like pneumonia in th e developed world would cost the patient the equivalent of about two to three hours of wages, and a one-year treatment for the Human Immunodeficien cy Virus (HIV) infection would cost the equivalent of four to six months’ wa ges. What is more, it points out, “the majority of drug costs are reimbursed.”

In the developing world, on the other hand, there may be only one nur se for every 5,000 people and a pharmacist for every million. And regards tr eatment for pneumonia, the required course of antibiotics may cost a full mon th’s wages, while “a full year of HIV treatment would consume the equivale nt of 30 years’ income.”

On top of that, the reviewers say, is another debilitating burden: “T he majority of medicines are paid out-of-pocket.”

The WHO’s assessment is borne out by the profile of the world’s sick and ailing. Children born into absolute poverty, for instance, are five t imes more likely to die before reaching the age of five years and people in abs olute poverty are two-and-a-half times more likely to die between the ages of 15 and 59.

Furthermore, deadly infectious diseases, such as HIV-AIDS (acquired i mmune deficiency syndrome), malaria, tuberculosis and diarrhoeal diseases, “disproportionately affect poor people.”

But what remedy can help change this unhealthy tide?

Greater decentralisation of the health care services is the answer, s ays Alice Merrit, deputy project director of the Centre for Communication Progr ammes at the Baltimore-based Johns Hopkins University. “In a decentralised sys tem, health care money, resources and priorities (including decision makin g) are often transferred to local hands, shifting control away from the cent ral ministry of health.”

According to Merrit, countries that have the most effective health ca re delivery systems have “multi-dimensional approaches.”

Purabi Dutta echoes a similar view, too. Non-governmental organisatio ns (NGOs) can contribute substantially in this regard by being “a major contrib utor” to public health services, says Dutta, director for Health, Nutrition an d Population Programme at the Dhaka-based Bangladesh Rural Advancement Community (BRAC).

Currently, she adds, “a large number of NGOs, including BRAC, have en tered into public health service efforts through community based organisations t o implement national health programmes in Bangladesh.”

Likewise, she also welcomes the role of more private sector involveme nt in the health sector.

Unfortunately, admits the WHO, many governments in the developing wor ld have still not harnessed the potential of such private sector intervention s to secure a better health care system. “A big problem is that government s often ignore the private sector – both their good points as well as their b ad.”

“In order to respond to today’s healthcare crisis in many countries, governments need to develop the ability to set and regulate policies which govern both the private and public sectors in promoting equitable and good quality services for everybody,” the global health body says.

But to ensure that the world’s poor have access to a quality healthca re system, a combination of efforts are needed. And for the Geneva Summit, the W HO will release a position paper spelling out what it has in mind for “renewe d efforts to build health systems that can meet the needs of poor people.”

They include:

n Investing more in aggressively preventing illnesses and protecting health. n n Protecting the poor and the near-poor from impoverishing healthcare costs through pre-payment schemes. n n Directing more resources to improving and maintaining health of hou sehold breadwinners. n — Directing the efforts of private providers towards improved healt h of poor people.

For that, governments will have to inject more funds into their healt h budgets than what prevails, which is often less than 10 percent of the nation al budgets in most developing countries.

To do otherwise, remarks the WHO, will only add to the existing numbe r of people who have not benefited from the recent advances in health, con sequently compelling them to “face shorter lives marked with greater misery.”