Health Care Skewed Against the Poor
By Marwaan Macan-Markar
(IPS World Desk) - A "profoundly anti-poor" culture in the health care systems of many countries was largely responsible the poor quality of care available to the poor, according to a diagnosis by the World Health Organisation (WHO).
"The distribution of services is highly skewed towards the better-off , and that resource allocation, by default, hurts the poor," WHO charges in a new report.. Such a bias 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."
This scenario, adds the WHO, reflects how far short countries have fallen of one of the pledges made at the Copenhagen summit - to achieve universal 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.
WHO reported "striking inequities," in health care between countries, evidenced by comparative costs.
The treatment to cure an illness like pneumonia in the developed world would cost the patient the equivalent of about two to three hours of wages, and a one-year treatment for the Human Immunodeficiency Virus (HIV) infection would cost the equivalent of four to six months' wages. What is more, it points out, "the majority of drug costs are reimbursed."
In the developing world, on the other hand, antibiotics to treat pneumonia may cost a full month's wages, while "a full year of HIV treatment would consume the equivalent of 30
years' income." On top of that, "the 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 times more likely to die before reaching the age of five years and people in absolute 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 immune 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, says Alice Merrit, deputy project director of the Centre for Communication Programmes at the Baltimore-based Johns Hopkins University. "In a decentralised system, health care money, resources and priorities (including decision making) are often transferred to local hands, shifting control away from the central ministry of health."
According to Merrit, countries that have the most effective health care delivery systems have "multi-dimensional approaches."
Purabi Dutta echoes a similar view, too. Non-governmental organisations (NGOs) can contribute substantially in this regard by being "a major contributor" to public health services, says Dutta, director for Health, Nutrition and Population Programme at the Dhaka-based Bangladesh Rural Advancement Community (BRAC).
Currently, she adds, "a large number of NGOs, including BRAC, have entered into
public health service efforts through community based organisations to implement national health programmes in Bangladesh."
Likewise, she also welcomes the role of more private sector involvement in the
health sector. "A big problem is that government s often ignore the private sector - both their good points as well as their bad."
"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 healthcare system, a combination of efforts are needed. And for the Geneva Summit, the WHO will release a position paper spelling out what it has in mind for "renewed efforts to build health sytems that can meet the needs of poor people."
They include:
Investing more in aggressively preventing illnesses and protecting health.
Protecting the poor and the near-poor from impoverishing healthcare costs through pre-payment schemes.
Directing more resources to improving and maintaining health of household
breadwinners.
Directing the efforts of private providers towards improved health of poor people.
For that, governments will have to inject more funds into their health budgets than what prevails, which is often less than 10 percent of the national budgets in most developing countries.
To do otherwise, remarks the WHO, will only add to the existing number of people who have not benefited from the recent advances in health, consequently compelling them to "face shorter lives marked with greater misery."
(END)
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