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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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Negotiators struggle to find benefits for public health in TTIP

Health concerns raised over EU—US trade deal 

WHO: Fight Ebola Now, Solve Patent Issues Later 

Glaxo Up on Accelerated Ebola Vaccine Development Process 

WHO Health Specialists Meeting To Evaluate Potential Ebola Therapies and Vaccines  

What’s missing in the Ebola fight in West Africa 

Is the Ebola outbreak out of control? Perhaps, but the more important question is, what can we, Africans, already do ourselves to roll back Ebola? 

Mistrust of government spurs Ebola spread 

Who is EU’s new foreign policy chief?  

The true true size of Africa  

Africans’ Land Rights At Risk As New Agricultural Trend Sweeps Continent  

Honest Accounts? The true story of Africa’s billion dollar losses 

How to Wisely Give Humanitarian Aid 

The Post-2015 Development Goals Need to Address Migration—And It Looks Like They Just Might  

What Is the Future of USAID’s Global Development Lab? An Interview with Alex Dehgan  

DFID: New international development funding finder 

Kenya passes law to step up fight against human trafficking 

Higher profile for climate change in new SDGs  

A Climate Change Agreement Is a Global Health Agreement   

Large-scale partnerships with the private sector could undermine Africans’ land rights, drive inequality and damage the environment

Hepatitis C drug daclatasvir approved by European Commission  

Maximising international finance for development in the poorest and most vulnerable countries  

Modi’s industry conference in US to attract pharma, IT players 

India’s IP Policy On Stage As New Leader Heads To US 

HUMAN RIGHTS ACTIVISTS HAVE A COMPROMISE WITH THEIR HOMELAND, ARE MARRIED TO ITS PROBLEMS AND ARE DIVORCED FROM ITS WEALTH. (I. PEREYRA) 

 

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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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WHO, 28 August 2014: Ebola response roadmap

Ebola outbreak: WHO warns that virus could infect 20,000 

The 2014 Ebola outbreak: ethical use of unregistered interventions 

What is Africa’s ODA spent on?

How to Sustain the AfDB’s Progress after Kaberuka  

ADB President Commits to Partnering With India in Reigniting Growth and Reducing Poverty  

Who’s Next as the Top Cop at the Global Fund? 

IFPMA and IFRC: A nontraditional partnership 

Civil society gathers at UN to help shape new vision for global development, prosperity 

United Nations’ “REVIEW OF MANAGEMENT AND ADMINISTRATION IN THE WORLD INTELLECTUAL PROPERTY ORGANIZATION (WIPO)”    

The five biggest myths surrounding overseas aid 

Can China’s New Development Bank Succeed? 

China beats bad image with big aid to Africa 

Taking China’s health professional education into the future 

China enters the global vaccine market

The Global Vaccine Safety Initiative: enhancing vaccine pharmacovigilance capacity at country level 

Médecins Sans Frontières Warns About IP Inclusion In Asian FTA

U.S. $2 a Day Poverty in a Global Context: Five Questions Answered  

Exhibit Of The Month: Income-Related Disparities Associated With Negative Health Outcomes  

Is the world falling apart? 

28 agosto 2014: in vigore la nuova legge sulla cooperazione 

Childhood diarrhoeal deaths in seven low- and middle-income countries  

US weighs international climate action options 

Compulsory Licences Needed For Affordable Hepatitis C Innovative Drug Regimens

Compulsory licences should be issued to roll out generic versions of innovative HCV drugs. Only generic competition can push down the extortionate prices of these lifesaving medicines, while placing equitable access and public interest before monopolistic pharma companies’€™ business strategies

Compulsory Licences Needed For Affordable Hepatitis C Innovative Drug Regimens

by  Daniele Dionisio

Member, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

A leading cause of liver cancer and cirrhosis, infection by hepatitis C virus (HCV) affects at least 185 million people worldwide, 85% of whom live in low (13%)- and middle (72%)-income countries. Around 15% of Egypt’€™s population, for example, is infected -the world’€™s highest prevalence – while it is estimated that 12 million people in India have hepatitis C.

 Nearly 350,000 people are killed by hepatitis C yearly, where  preventive vaccines are lacking.

And this occurs at a time when at least 1.2 million people in Japan and three million Americans suffer from hepatitis C, while the infection is a major European public-health challenge (between 0.4% and 3.5% of the population in different EU Member States) as the most common single cause of liver transplantation.

Up to last year, the success rate of available treatments was poor, with a ribavirin-interferon combination being effective in less than 50% of patients after a year (while being fraught with important side effects), and directly acting newer drugs not exceeding 75% sustained response without fully eliminating the need for ribavirin-interferon therapy.

But in recent months innovative medicines have been approved that can cure most HCV infections and do not require interferon in many cases. By directly blocking essential steps for HCV to replicate, they have shown convincing efficacy, mainly when used in combination (functional cure rates in excess of 90% after 12 week treatment), with a good safety profile. These medicines include Bristol-Myers Squibb daclatasvir(Daklinza®), Gilead sofosbuvir (Sovaldi®), Janssen simeprevir (Olysio®), and Bristol-Myers Squibb asunaprevir (Sunvepra®).

And new entries are expected soon, now that big companies are increasingly engaged in bids and acquisition deals to procure new components for more effective, powerful combination regimens. As an example,  Merck will buy the biotechnology company Idenix Pharmaceuticals for $3.85 billion, aiming, as reported, to add a drug from Idenix to its own combination of two agents and develop a once-a-day pill for all C virus subtypes in as little as four week treatment.

Needless to say, the high prices the companies are paying for such endeavors will eventually be over-rewarded by the billions of dollars in annual sales a successful drug regimen could secure. Purportedly , Sovaldi® already helped Gilead rake in, since its debut last December, about $2.3 billion in the first three months of this year, in compensation of $11 billion the company spent  in 2011 to obtain the rights tosofosbuvir through its acquisition of Pharmasset.

Good news for big pharma profits, these circumstances turn into bad news when it comes to prices the manufacturers apply for a 12-week course of each breakthrough regimen. Nothing less than scandalous,estimated prices, averaging from $133,000 to $200,000 for a two-drug new combination regimen (against trifling production costs!), definitely impair affordability and put these drugs beyond the grasp of most of the 90% of hepatitis C patients in low- and middle-income countries where a 12-week course of treatment should cost no more than $500, as firmly believed by Médecins Sans Frontières.

What’€™s more, following inclusion of these drugs in April 2014 WHO treatment guidelines for hepatitis C virus, the cost issue has become all the more critical for national budgets in the resource-limited and affluent countries as well.

As such, it comes as no surprise that, according to allowances in India’€™s Patent Law as regards lack of real innovation, oppositions  were recently filed with the competent authority in India against granting  Sovaldi®  a patent.

As an effect of the mounting pressure against prices out-of-reach for national health insurances, big pharma has begun negotiating bilateral agreements and voluntary licence (VL) deals with country governments and generic manufacturers. In the Gilead cases with Egypt and India, Sovaldi® has been priced at $900 for a 12-week course, and negotiations are in progress with Indian manufacturers to produce generic sofosbuvir.

Unfortunately, as reported, while the price agreed with Egypt would rank beyond the reach of the domestic health budget, voluntary licence negotiations with India are feared to exclude export to many middle-income countries with high HCV burden.

Likely, this is not happening by chance at a time when international donors are cutting support to middle-income economies and the brand industry is eagerly looking to the fast-growing markets where a number of well-off elites, who can afford out-of-pocket spending (at least 300 million people in India, 800 million in China), now live.

Admittedly, although VLs, as part of the flexibilities laid down in the World Trade Organization TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement, do include permission for export, a number of constraints limit this model basically because the originators actually hold control over the whole manufacturing, distribution and pricing chain of steps: an unbalanced mechanism.

On the contrary, unrestrained competition by compulsory licences (CLs), another flexibility provision in TRIPS, would be a far better mechanism for maximizing the affordability by allowing “…someone else to produce the patented product or use the patented process without the consent of the patent holder”€. 

This would also be the case for an allowance for export agreed upon through a 2003 WTO waiver (the “€œAugust 30th Decision”€) that permits export under CLs to countries unable to manufacture key medicines themselves.

On these grounds, compulsory licences should be issued at once to roll out generic versions of innovative HCV drugs. Only generic competition would be up to pushing down the extortionate prices of these lifesaving medicines, while making equitable access and public interest overcome monopolistic pharma companies’€™ business strategies.

To the point, cheap generic versions of state-of-the-art HCV drugs would reasonably be within reach. Relevantly, published data this year argue that generic-drug makers would be able to roll out these medicines at $100-€“250 for a 12-week course.

Overall, these considerations align with a resolution on hepatitis unanimously adopted by Member States at WHO General Assembly in May.

Among others, the resolution urges Member States …(12) to consider, as necessary, national legislative mechanisms for the use of the flexibilities contained in the Agreement on Trade-Related Aspects of Intellectual Property Rights in order to promote access to specific pharmaceutical products;…

The resolution also requests the Director General  (9) to support Member States with technical assistance in the use of trade-related aspects of intellectual property rights (TRIPS) flexibilities when needed, in accordance with the global strategy and plan of action on public health, innovation and intellectual property;…

  

————————————————————————————

*Article republished from Intellectual Property Watch August 5, 2014 http://www.ip-watch.org/2014/08/05/compulsory-licences-needed-for-affordable-hepatitis-c-innovative-drug-regimens/  

Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. He is an advisor for “€œMedicines for the Developing Countries”€ for the Italian Society for Infectious and Tropical Diseases (SIMIT), and former director of the Infectious Disease Division at the Pistoia City Hospital (Italy). He may be reached at d.dionisio@tiscali.it  https://twitter.com/DanieleDionisio 

 

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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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WHO conference on health and climate 

Call for ‘ecohealth’ approach to tackling climate change 

Desperately seeking scale as ‘pilots to nowhere’ on the rise 

Counting Down to a New Era of Global Health 

UHC and the post-2015 debate: what if we started conceiving health in a society as an emergent property? 

Oxfam: How we fight poverty 

Stopping Disease With A Simple Innovation: New Floors 

Do we really need a new drug or vaccine for Ebola? 

Ebola May Leave 1 Million People In Need Of Food Help 

How to Stop Ebola — and the Next Outbreak   

Ebola in West Africa: Four Questions for the U.S. Response Going Forward   

Opportunities in Africa – Investing Across Sectors 

Great future for U.S.-Africa trade  

Urban Development in Sub-Saharan Africa: Bearer of Goods and Risks

Nutrition: there’s no quick fix for hunger or obesity   

Food security and Rodrik’s trilemma  

DNDi’s  annual report 2013 

10 Big Ideas for Making Energy Efficiency Bankable in India  

Elderly in India  

A Critical New Role for the World Bank 

Briefing: What next for Uganda’s anti-gay law?

Commission moves to tighten customs security 

How the Medicines Patent Pool can help to overcome patent-related constraints on new ARVs to … 

 

 

 

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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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International Regulation of Pharmaceuticals: Codification by Means of Legal Transplantation  

UN declares Ebola outbreak global ‘international public health emergency’ 

Gaza-Israel conflict: Disregard for humanitarian law led to unacceptable toll on civilians  

EU launches new programme to support Africa’s continental integration 

EU to provide new funding to counter organised crime and drug trafficking  

“Unitary patent“ and court system – The oral hearing on Spain’s actions at the CJEU 

EU finalises free trade agreement with Canada 

Analyst: Agriculture remains an obstacle to EU-Mercosur pact 

Eight ways to end Aids within a generation 

The end of AIDS: Possibility or pipe dream? A tale of transitions 

Can innovation drive HIV responses to meet 90:90:90 targets by 2020? 

Is PrEP Cost-Effective?  

PEPFAR Pediatric HIV treatment partnership targets antiretroviral access gap  

Opinion: The US-Africa summit – a missed opportunity

Can the US and China Cooperate on Development in Africa? 

10 Ways the Obama Administration Can Tackle Hunger in Africa 

Public private partnerships key to ensuring food security  

Global Medical Students Call For Shift To Health Over Trade, R&D 

Italy overhauls its development cooperation system in search for a fresh start   

The World Bank Can’t Sacrifice the Poor to Stay in the Game 

World Bank safeguards: Pushing more money out the door at the expense of the poor?  

The solutions to tackle global challenges are within our grasp 

 

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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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Hepatitis C annual report: progress made, but much more to do 

Call to EU Ministers of health and CEOs of Abbvie, BMS, Gilead, Janssen and Merck/MSD regarding universal access to curative hepatitis C treatment in the EU and beyond  

Uganda Anti-Gay Law Struck Down by Court 

Court ruling over anti-gay law ‘fragile gain’ for anti-HIV aid in Uganda 

Sweden resumes aid to Uganda after suspending it over anti-gay law 

Aid agencies request US$ 369 million to meet urgent needs in Gaza and call for safe access  

The 2014 WHO conference on health and climate 

Recycling fuel subsidies as health subsidies

Reframing climate change as a health issue 

Bringing air pollution into the climate change equation 

How to Achieve the Millennium Development Goals 

MAINSTREAMING GENDER IN HIV & AIDS WORK 18-19 September 2014, Protea Hotel O.R. Tambo Airport, Johannesburg 

The Brics have a chance to succeed where the World Bank has failed 

Land Grabbing – A New Political Strategy for Arab Countries   

Family planning and the post-2015 development agenda

Physical growth of children and adolescents in China over the past 35 years 

It’s high time India stands up for its malnourished children 

WHO on Ebola outbreak: We need more health workers   

Ebola  outbreak: US experts to head to West Africa 

Disparities In Access To Palliative Care  

 

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The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries

 

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German NGO says TTIP will undermine global food security 

TTIP bad for health says civil society 

European Patent Reform Forum September 11, 2014 

EU development committee tackles 2015 priorities 

Editing ODA: What to Omit and Add in the Definition of Aid 

The strange relationship between global warming denial and… speaking English  

Developing sustainable environments despite budget constraints 

Leaked World Bank lending policies ‘environmentally disastrous’ 

Abundance Of Latin American Candidates For Senior WIPO Post

From food aid to nutritious, locally produced food: A look at fortifying flour in Ethiopia 

Report: Italy ‘overzealous’ in reporting EU farm fraud cases 

Ottawa tells Oxfam to stop trying to prevent poverty 

The BRICS move forward 

Narendra Modi government now wants a SAARC bank 

India IP Policy Misrepresented By US Trade Representative, Indian Pharma Says 

The E15 Initiative Strengthening the Global Trade System 

Competition Analyses of Licensing Agreements. Considerations for Developing Countries under TRIPS

Rapporto sull’attuazione della Piattaforma d’Azione di Pechino Rilevazione quinquennale: 2009-2014. Cosa veramente è stato fatto in Italia  

AIDS 2014: Financing the new global HIV treatment vision – advocacy and economics  

Economic interventions for HIV prevention 

Building social capital to improve health and reduce HIV risk 

Systematically excluded: young women’s experiences of accessing child support grants 

New Medicines Patent Pool-Gilead Agreement For New HIV Drug In 112 Countries   

GSK seeks approval for world’s first malaria vaccine 

Health Policy Briefs Update

The Political Determinants of Health

The root causes of health inequities are to be found in weaknesses in political domains at the supranational level. These include: democratic deficit, weak accountability, institutional stickiness, missing institutions and restricted policy space for health. Achieving health equity is not just a matter of coming up with technical solutions and providing the means to finance them.  We have to consider the political landscape and rectify the dysfunctions in global governance that undermine health

The Political Determinants of Health

by Ole Petter Ottersen*

and Desmond McNeill**

University of Oslo

 

 

The Millennium Development Goals report 2014 was launched in early July. The report shows that in the course of 22 years, annual number of under 5 deaths fell from 12 to 6.6 million while the global maternal mortality ratio was nearly halved, from 380 to 210 maternal deaths per 100 000 livebirths. Causes of progress are manifold, but setting clear goals has inspired, so much so that many talk of removing health inequities in a generation. Bill Gates, for one, articulates ambitions of this scale, as does the WHO Commission on the Social Determinants of Health.

It is tempting to make the assumption that the positive development will continue unabated, provided that due efforts are made to sustain or even increase funding of targeted initiatives such as those embedded in the Millennium Development Goals.  However, in a changing world, extrapolations are fraught with difficulties. We have seen it in Syria, where polio was near eradication but now develops into a major health emergency. We have seen it in Greece, where health suffers in the wake of the austerity measures. And we saw it in the many countries that experienced a wave of hunger and malnutrition due to the food price volatility in 2008-€2009. Recent history is replete with setbacks, and we need to pause and reflect on why.

Such an exercise reveals that root causes of health inequities are to be found in political domains outside of the health sector.  We are talking about dysfunctions in global governance that negatively impact health.  These dysfunctions were put under scrutiny by the Lancet-University of Oslo Commission that released its report in February this year. Based on the analysis of a number of cases the commission concludes that health is impacted by five major dysfunctions in governance at the supranational level: democratic deficit, weak accountability, institutional stickiness, missing institutions and restricted policy space for health.  These weaknesses hamper or undermine the efforts of the global health system and constitute what we call the political origins of health inequity.

Let’s take the last point as an example: restricted policy space for health. An increasing number of decisions are taken at the supranational level, and many of these decisions constrain the policy space of nations. A primary obligation of a nation state is to safeguard the health of their population, but its ability to do so is easily thwarted when health is subordinated to other goals, primarily economic ones. Austerity measures have been mentioned.   But trade agreements may similarly diminish policy space for health if they are put together without due consideration of the short or long term consequences for the health sector. Once signed, a trade agreement proves difficult if not impossible to change, even when inadvertent health effects come to the fore. The Commission used the TRIPS agreement (Agreement on Trade-Related Aspects of Intellectual Property Rights) as a case in point and as an example of “€institutional stickiness”€.

Trade agreements and foreign investment treaties also serve to illustrate other major dysfunctions of global governance that negatively impact health. Agreements and treaties that will ultimately affect large populations are often drafted without due transparency. There is a democratic deficit and weak accountability. Further, the Commission points out that institutions that could hold transnational corporations responsible for activities that interfere with health, are nascent or missing. There are powerful forces beyond the health sector that determine health, and there are substantial voids in global governance that leave these forces unchecked.

It is this political dimension of health that the Lancet-University of Oslo commission brings to the fore.

The commission argues that for ambitions to be realized, we have to ensure that there is global governance for health -€ i.e., that we have a global governance system that is conducive to the efforts of the health sector and of the numerous private-public initiatives that target specific health challenges.  Achieving health equity is not just a matter of coming up with technical solutions and providing the means to finance them.  We have to consider the political landscape and rectify the dysfunctions that undermine health.

To trace the political origins of health inequities the commission identified and discussed seven different cases, derived from political arenas outside of the health sector: foreign investment treaties, transnational corporate activity, immigration policies, violent conflict, food security and agriculture, intellectual property rights, economic crises and responses. When each arena is considered individually, it comes as no surprise that decisions taken therein significantly influence health.  It is when these seven arenas are seen in context that a pattern emerges and an awareness is instilled about the cross-sectoral nature of the global governance dysfunctions impacting health.  Only by taking a broad view across sectors was it possible for the Commission to recognize the five dysfunctions referred to above. These are dysfunctions that cut through the global governance system at large.

The value of narrowing down common denominators is obvious: we should be better able to find appropriate remedies in order to rectify what now stands as a defective global governance system for health. For the next move, timing is of the essence. The preparations for the post-2015 Sustainable Development Goals (SDG) are well under way, and it is of paramount importance that these goals are formulated with due attention to the shortcomings of global governance.  For improvements to occur, there will be a need for concrete and quantifiable milestones. We will need to identify parameters and indicators by which we can measure progress when it comes to democratic involvement, accountability, institutional flexibility and policy space for health – i.e., across the dimensions identified above. This will not be an easy task. But it is a task from which we cannot shy away.

The Commission came up with a number of recommendations, the most essential of which is the establishment of an Academic Monitoring Panel. As we now see it, this panel should take responsibility for making the next move and help ensure that the political root causes of health inequities are duly taken into account when new policies are being worked out.

The panel should be mandated with the following tasks:

1. Revisit the political arenas analyzed by the commission, with the aim of providing concrete and proactive measures to safeguard health;

2. Carry out, solicit, or inspire high quality research, so as to deepen our understanding of the scale and nature of the global governance dysfunctions that impact health;

3. In order to avoid repetition or overlap, these tasks should be based on a comprehensive review of the efforts and initiatives that are currently being made to coordinate governance for health across political arenas outside of the health sector.

Point #1 acknowledges the complexity of the issues at hand and the need for much more research to truly understand how decision making at the supranational level affects health. Point #2 is based on the belief that high quality research should inform political choices. Point #3 is important, as the Panel should seek to fill a void rather than be seen as a body competing with existing initiatives or with WHO or other institutions in the health sector. Trade agreements and foreign investment treaties could be the first cases for the panel to revisit.  By assessing health impacts of trade agreements in nascendi, the panel could help decision makers strike a balance between narrow economic goals and the need to safeguard and provide policy space for health.

It is important to note that the Panel should be truly independent and genuinely academic.  As such, it should not be normative and assume an activist role, but rather inspire to action through high quality research and analyses.  When confronted with hard evidence of health impact, it will prove difficult for decision makers to solely pursue restricted economic goals. And when confronted with hard evidence of the cross-sectoral nature of health, it will prove difficult for the architects of the SDG to avoid bringing global governance in as an important element. Health is biology, and technology has much to contribute to its improvement, but health is also inextricably coupled to politics on the grand scale. These are two views of health that today stand as utterly disconnected. The post-2015 agenda must be where the twain should meet and productively interact.

 

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*Ole Petter Ottersen, Professor MD, PhD, President of the University of Oslo and Chair of the Lancet-University of Oslo Commission on Global Governance for Health

**Desmond McNeill, Professor PhD, Centre for Development and the Environment, University of Oslo, Commissioner, University of Oslo Commission on Global Governance for Health

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War on drugs: collateral damage  

UNAIDS: The Gap Report

What to Expect at This Year’s International AIDS Conference 

Medicines Patent Pool Signs 7 New Sub-Licences For Generic HIV Drugs  

HIV 2014: Science, Community and Policy for Key Vulnerable Populations  

Global Fund Results Show Strong Gains 

The right to privacy in the digital age: Report of the Office of the United Nations High Commissioner for Human Rights

MAKING HUMAN RIGHTS RADICAL AGAIN: THE ROLE OF SCIENCE, PASSION AND COMMITMENT (PART 2 OF 3) 

TPP: Still a Terrible Deal for Poor People’s Health 

4 ways agricultural development groups can invest in land rights

With 51 Ratifications, Nagoya Protocol To Enter Into Force In October  

Codex Alimentarius Commission – Geneva 14-18 July 2014 

Building food security in Ethiopia 

What China’s shift away from self-sufficiency means for African agriculture  

Climate policy in focus ahead of UN September summit 

BRICS Countries Launch New Development Bank 

BRICS Forges Ahead With Two New Power Drivers – India and China 

Building the whole picture of China’s growing ODA 

5 things you need to know about the New Development Bank

The new BRICS Bank should offer a new vision for development, not more of the same  

MSF calls on BRICS countries to prioritize health and access to medical innovation  

How to make the EU-West Africa trade partnership work

5 Things You Can Do Today to Empower Women in Poverty   

Diritti civili e HIV: il caso dell’Uganda 

Oltre gli sbarchi. Per un Piano nazionale dell’accoglienza 

 

 

Philippines: European Development Cooperation Should Not Support Commercialisation of Health Care Exacerbating Inequality

The current privatization policies of the Philippine government do not provide an answer to the enormous health needs. Despite the name of the Philippine "€œUniversal Health Care"€ program that claims to "€œbring equity and access to critical health services to poor Philippinos"€, commercialisation of health services will do exactly the opposite. Unfortunately, the European Commission is supportive of these policies and formerly approved a contribution of  € 33 million in support of the Health Sector Reform Agenda of the Philippine government

Philippines: European Development Cooperation Should Not Support Commercialisation of Health Care Exacerbating Inequality

 by Natalie Van Gijsel*

Campaign and Policy Officer at Medecine Pour le Tiers Monde (M3M)

Today, in the Philippines, 28 women out of 100 do not enjoy skilled attendance during delivery, a situation showing a glaring lack of access to healthcare. While in Belgium each year 8 mothers die of pregnancy-related causes, in the Philippines 8 mothers die every day. Every day 194 children under five years die in the Philippines, compared to one child per day in Belgium. Especially the poorest of the poor die without ever having seen a doctor.

Philippine civil society criticizes Public Private Partnership approach

The Aquino government claims that “public-private partnerships (PPP)”1 are the only alternative to meet the health needs and the continuing population growth in the Philippines. By outsourcing public hospitals to the commercial sector2, as announced by Health Minister Enrique Ona, one wants to save on government spending, while progressing in public health outcomes. All 72 public hospitals in the Philippines would be eligible for privatization.

However, according to local organisations – IBON, Gabriela, Council for Health and Development (CHD) and Advocates for Community Health -€“ the current privatization policies of the Philippine government do not provide an answer to the enormous health needs. Despite the name of the Philippine “€œUniversal Health Care”€ program that claims to “€œbring equity and access to critical health services to poor Philippinos”€, commercialisation of health services will do exactly the opposite and leave the poor behind.

What is the role of the European Union?

The European Commission (EC), being a big donor in Overseas Development Assistance to the Philippines, is supportive of the current health sector reforms in the Philippines and formerly approved a contribution of € 33 million in support of the Health Sector Reform Agenda of the Philippine government. The latest published Philippine-EU Strategy Paper (2007-2013) stated that “€œfurther privatisation is critical and urgent”€ (p.18).

The “€œAgenda For Change€ of the European Union’s Development Cooperation (Directorate General Devco) -in line with the 1993 World Bank Report ‘Investing in Health’– is pushing for more involvement of the private sector. In the document it is written how “€œthe EU should develop new ways of engaging with the private sector, notably with a view to leveraging private sector activity and resources for delivering public goods”€, including health care provision. According to the Agenda For Change, the EU should “€œcatalyse public-private partnerships and private investment”€. References are made to imposing stricter conditionalities on the development aid provided, “€œthrough a range of aid instruments, notably ‘€˜sector reform contracts'”€. In a recent press release Andris Piebalgs, the European Commissioner for Development, confirmed the urge for “€œA Stronger Role of the Private Sector in Achieving Inclusive and Sustainable Growth in Developing Countries”, stating that “€œThe private sector has a crucial role to play in helping people to lift themselves out of poverty (…), ensuring that businesses find an enabling environment to invest more, and more responsibly, in developing countries to help everyone enjoy the economic opportunities which the private sector can bring”€.

Commercialization increases inequalities in access to health care

The most disadvantaged populations in the Philippines live in slums in the cities. People migrate to the city in search for work opportunities and a better life. But what they find is poverty, a life in unsanitary conditions and exposure to pollution. Although slum dwellers are the most vulnerable to diseases, they have the least access to health care.

The commercial sector in the Philippines invests mostly in specialized hospitals in the cities. Rural areas, where the majority of the population lives, and preventive primary health care are being overlooked by the private-for-profit sector. In addition, one has to pay high fees for health care by private for-profit providers, while user fees have been proven to result in low utilisation of and exclusion from health care and further  impoverishment. The rural and urban poor are then pushed to rely on the underfunded public health sector or poorly regulated informal providers.

The outsourcing of healthcare to commercial investors goes at the expense of the public sector; it is diverting resources away from the public sector. First of all, the private-for-profit sector entices health workers away from the public sector by offering better working conditions and higher salaries3.The Philippines also train health workers en masse for export. So there is a net surplus of health workers, but through the “brain drain” the poor in urban and rural areas are left behind with a shortage of doctors and nurses. Secondly, increasing commercial sector involvement replaces Philippine public expenditure for health care. For reasons of diversion of resources away from the public sector, public health care provision is often of poor quality. A two-tier health system with commercial facilities for the better off and underfunded public services for the poor raises concerns of equity and social justice in health care access. Considering that the health system, being an important social determinant of health equity, can increase or reduce  inequities in health outcomes.

Does the private-for-profit sector provide better quality health care? 

If assumed that “quality care” is understood as “offering the best treatment according to the diagnosis, based on evidence and international treatment guidelines”, then this is not necessarily the case. Indeed, research in developing countries shows that, more often than their public counterparts, doctors in the private-for-profit sector do not respect international treatment guidelines.

In Peru and Chile higher rates of potentially unnecessary procedures, particularly ceasarian sections, were reported in private-for-profit settings after privatization of  obstetric services. Studies in Mexico suggested that fee-for-service payment structures (which are more heavily present in private than in public care delivery settings) incentivized increased C-sections, while ceasarian sections should only be performed on medical indication because they entail more health risks for the mother.

Recent studies also suggest that in several developing countries, private-for-profit practitioners had a significantly worse knowledge of correct diagnosis and treatment. In Sub-Saharan Africa doctors serving in the for-profit sector have shown to be more likely to prescribe unnecessary antibiotics to children with diarrhea, instead of the recommended oral rehydration salts. Irrational prescribing practices could lead to antibiotic resistance, which poses the world population at risk.

Is the private sector more efficient than the public sector?

We understand “€œefficiency”€ as “€œproducing the best possible results with the available budget”€. According to the 2009 Oxfam report “€œBlind optimism“€, commercialization of health care increases public spending, while health outcomes deteriorate. Lebanon has one of the most privatized health systems in the developing world. The country spends two times more on health care than Sri Lanka, a country far lower on the development index of the United Nations. Despite the high public spending, the infant and maternal mortality rates are 2.5 and 3 times higher, respectively. Outsourcing healthcare to the commercial sector in China- still remembered for its former “€œbarefoot doctors”€- has led to a decline of less-profitable preventative health care; immunisation coverage dropped by half in the following five years. Likewise, following extensive privatization reforms in Colombia in 1993, population vaccine coverage declined and more cases of tuberculosis occurred.

EU should refrain from promoting privatization policies

Economic development is seen as the panacea in creating health and wealth. However, opening up the health sector for increased private-for-profit investments is creating inequalities in access to health care and thus inequities in health outcomes, which raises serious concerns of sociale justice. Therefore, the European Union should refrain from development policies that support or push privatization efforts in the health sector.

References

1-IBON Facts and Figures. PPP in Health. Vol. 34. N° 7 & 8, 15 & 30 April 2011

2- IBON Facts and Figures. Aquino’s Universal Health Care. Vol 34, N° 17, 15 september, 2012

3-Haddad, S., Baris, E., & Narayana, D. (2008). Safeguarding the health sector in times of macroeconomic instability: policy lessons for low- and middle-income countries. Ottawa: Africa World Press: International development research centre

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*Natalie Van Gijsel is Campaign and Policy Officer at Medecine pour le Tiers Monde in Belgium. Being a midwife she worked in Belgium and for some years in Sierra Leone. She is a master-student in Global Health Policy at the London School Of Hygiene and Tropical Medicine