Reports of experiences
ALAMES - URUGUAY (group presentation)
ANGÉLICA - COLOMBIA
Global Health Policies
This topic presented and facilitated by David Sanders.
The champagne glass:
20% of population consumes 80% of wealth
Farmers in Japan receive a subsidy of $2600 per year per cow.
Health expenditure per person in Africa is around $500.
Primary health care (Alma-Ata, 1978)
Universal access
Community and individual health
Participation and social control
Addressing the social determinants as well as health care
Soon after the conference in Alma-Ata a new policy model emerged called selective primary care.
The selective PHC model focuses on specific interventions and does not aim to address the social and environmenetal determinants.
The selective approach has dominated global health policy over the last 20 years.
In the early 1990s the World Bank introduced a new variant of selective PHC based on 'cost effective' interventions which are assembled in particular benefit packages: a public health package, a clinical packages for low versus middle income countries.
This approach was based on the DALY and the cost per DALY averted associated with particular interventions.
The package is formulated according to the availability of resources in each country. I
David spoke about new global partnerships for health development
dealing with new products in health, such as AIDS vaccines. There has been a massive increase in funding for programs of
HIV.
What is the impact for those countries? The difficulty is that donors make the agreements among themselves and can change their priorities, which could cause the collapse of some countries' health systems.
The biggest problem is human resources, both in Africa and in Asia
The big problem is health systems in a human resource crisis.
If we had a new way to prepare workers, as in Carmen's presentation, that is not being the exclusive holders of
knowledge (power), the hegemony of model
biomedical, but multipliers?
Mechanisms to fortify Comprehensive Primary Health Care
Decentralization
Professionals do not have skills in public health.
Need to train at all levels
Empowering people at the basic level and communities. Because the deaths occur in most communities.
WHO's global program - IMCI
The administration-level clinic, the scope / coverage is very low.
Therefore, attention should be community, which will a big impact All this has been presented and with evidence.
The debate in the 70's and 80 was whether the health workers in the community should also be stakeholders? What happened was a reduction in staff.
Mitanin Program, in India, in Chhattisgarh, covers a population of 21 million. Program began in 2002 with one of the activists
who started a movement called the Mitanin (means best friend).
More on mitanins in Chhattisgarh: Infochange; Changemakers; Policy Reform Options Database
Community health workers can improve access, but need to be carefully selected and be given adequate training, supervision and logistic support. In Brazil the problem is the outsourcing of / the community workers through cooperatives
Promoters of health. Integration of health. Improving equity: start with the poorest families; integration within the health system with horizontal and vertical linkages, both in
clinic, and community hopital.
Questions
Cost efficiency
Brain drain
Pharmaceutical monopoly a threat. Government regulation is needed in many cases, especially re the price of
drugs. The largest source of income in Ethiopia is the coffee, but
the price of coffee is determined in London not in Ethiopia
nor even in Brazil.
Further reading on health systems policies
Reports from the field
ARGENTINA
1. Save a life
2. Oral health promotion
BOLIVIA
Clotilde
BRAZIL
The Right to Health
This topic presented by Fernando Borgia.
Further reading
- The Right to Health
- Special Rapporteur on the right to health (2008) Protection of all human rights
- Backman, G., P. Hunt, et al. (2008). "Health systems and the right to health: an assessment of 194 countries." The Lancet 372(9655): 2047-2085 (Open Access)
- North South Institute (2007) the Global Right to Health
- The right to the highest attainable standard of health. Comment 14 (2000)
Reports from practice
BRAZIL
CES-the State Board of Health;
GAPA / RS - Support Group for the Prevention of AIDS
CEDEMPA - Center for the Study and Protection of the Black
Brazil;
IACOREQ - Office of the European Advisory Board Remnants of Quilombos;
Maria Mulher- Organization of Black Women; Brazilian Feminist Network of Health;
Nzinga MBANDI;
National Black Women's Forum;
MST - Movement of Landless Rural Workers;
Casa Laudelino - Organization of Black Women;
Candace - National Collective of Black Lesbians Feminists Autonomic
Forum of Black Women of the Amazon Paraense;
Feminist Health Network - Regional Pará;
ABRASBUCO - Brazilian Association of Oral Health
Collective;
ESP / RS - School of Public Health / RS;
Movement for Eradication of hepatitis
Viral / Brazil.
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Revisit Notes Page for Tuesday 16th September
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