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THE UNITED NATIONS World Health Organization

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Committee: World Health Organization (WHO) Topic B: The consequences of the privatization of healthcare in developing nations Written by: Gerardo Medellín, Katia Peña, Estefania Sepulveda, Alexia Hernández and Guillermo Maldonado

I. Committee Background

The World Health Organization (WHO) is the main health authority of the United Nations (UN). This organization was established on April 7, 1948 and its headquarters are located in Geneva, Switzerland. The organization’s main goal is to provide the highest possible level of healthcare to all people regardless of religion, race, sexual orientation, etc. In order to do this, WHO has 150 regional offices staffed by more than 7,000 people around the world. It regularly collaborates with governments and non- governmental organizations (NGOs) to deliver healthcare and react to pressing health issues worldwide. As of 2017, the committee is responsible for promoting healthy choices, supporting the fight against pandemic and epidemic diseases and providing accessible medical treatment in developing and war torn regions (About WHO, WHO, 2017).

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II. Topic information

A) History of Topic

Privatization is defined by the Oxford Dictionary as “the transfer of a business, industry, or service from public to private ownership and control” (Privatization, Oxford Living Dictionaries, 2017). Healthcare is listed as “the organized provision of medical care to individuals or a community” (Healthcare, Oxford Living Dictionaries, 2017). So, with these two definitions, it can be concluded that the privatization of healthcare is to deny a service to the public where only privileged individuals have access to medical assistance.

Millions of people around the world die each year from diseases and infections humankind knows how to cure; these include: malaria, diarrhea, fever, lead exposure and unintentional poisonings. In fact, in 2015, more than 1.2 million children died due to the fact that they did not have access to medical care (Children: Reducing Mortality, WHO, 2016). These deaths are related to the fact that millions of people around the world, especially in developing nations, do not have equal access to medical care. This is in part due to the rise of private health facilities and policies that benefit the wealthy, but marginalize the poor who cannot afford treatment.

The privatization of healthcare has become more prevalent in developing nations because private health facilities offer “better and more flexible access, shorter waiting, greater confidentiality, and greater sensitivity to user needs.” Many world leaders have called for a greater use of private health facilities because they “offer patients greater choice; increase competition in the healthcare market; and remove

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state responsibility for service provision, thereby encouraging its role as regulator and guarantor” (Zwi, Brugha and Smith, The BMJ, 2001). However, academic studies have shown that while private healthcare has its benefits, it is highly disadvantageous to the poor. In a 2001 study conducted by Anthony B Zwi, Ruairi Brugha and Elizabeth Smith, it was found that the poor are either shut out of medical care due to the cost of private facilities or pay substantially more than the wealthy for lower quality healthcare. Many people in the poorest nations end up paying more for lower quality care because they put trust in the provider to “act in their best interests.” Unfortunately, this does not always happen because private healthcare is a business and cost cutting to increase profit is a common occurrence (Zwi, Brugha and Smith, The BMJ, 2001)

The UN has highlighted how privatization has created a system of inequality in developing nations. In its 2008 World Health Report, the organization stated: “In far too many cases, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves” (UN New Centre, 2008). For instance, in South Africa, those who can pay for private healthcare do not receive the same type or quality of care as others. The system is based on an individual's income. Those who earn more receive more benefits than those who earn less. This system of inequality further divides classes and reinforces upper class privilege (Price, Social Science & Medicine, 1988).

Even to this day, many healthcare companies can only be accessed by the privileged. According to the US National Library of Medicine: “Academics and World Bank officials argue that, by reducing out-of-pocket expenditures, expanded private insurance may improve access to needed health services in less developed countries.”

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This means that when removing some of these costs, the private health companies can access a greater population including those from developing countries (Waitzkin, Jasso-Aguilar and Iriart, US National Library of Medicine, 2007). The solution to improve privatization of healthcare in developing countries is there, but it has not been implemented, and many people that are not privileged face the consequences of this unequal system.

B) Current Issues

Guatemala: The healthcare system in Guatemala is divided into three parts: public, private non-profit, and private for profit. The non-profit private zone is composed of non-governmental organizations (NGOs), which currently operate 1,000 medical clinics across the country. The private sector is made up of hospitals, laboratories and clinics. Public healthcare is not completely free and patients need to pay for certain services. However, not a lot of people chose to have public healthcare due to long wait times. More than 40% of people in the country who live in rural regions do not have access to healthcare. Moreover, hospitals in remote areas are usually under-funded and unhygienic (Pacific Prime International, 2017).

Argentina: In Argentina, the healthcare system is divided in three main providers: the public sector, mutuals or social plans, and the private sector. The public sector supplies free clinic care for hospitals and covers 50% of the population. The mutuals or social plans are when employees of a company pay a fixed fee. Over the past decade, this has covered around 45% of the population. The private sector is where patients must pay for the complete cost of the medical care they receive and this covers around 5%

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of the population. Argentina’s government offers free medical care to all of its inhabitants, but the quality of care in public hospitals vary from area to area. This is because funds that go into public hospitals are administered by municipal governments. What is not covered at all levels are prescription . These must be paid for in full by all patients (Angloinfo, 2017).

Brazil: According to Brazil’s constitution, every citizen has the right to healthcare. Healthcare in Brazil is provided by both the government and private institutions. Public hospitals are free and patients do not have to pay doctor fees, lab fees, for surgery or prescription drugs. Around 80% of the nation’s population uses this system regularly. This is because the private system is expensive and is only accessible to the wealthy, so around 20% of the population. It features shorter wait times and up-to-date medical equipment (Living International, 2017).

China: In China, the healthcare system is administered by the federal government. Each year, the nation spends approximately 5.6% of its gross domestic product (GDP) on healthcare. Around 30% of China’s healthcare system is financed by local governments and 36% is publicly financed through , private health insurance or social health donations. Chinese citizens can access healthcare through three different types of plans or insurance. The first two ways are the urban employment-based basic insurance plan and the new cooperative medical scheme, which are financially supported by the government. The other way is through private companies, although this type is usually only available in larger cities and is quite expensive. Therefore, the majority of China’s population use the government funded plans as they are free and well supported (Fang, The Commonwealth Fund, 2017).

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Ghana: The Ghana Health Service was established in 1996 and is responsible for the country’s healthcare system. It is publically funded and supported by the National Health Insurance Scheme. However, this scheme has been criticized for being corrupt and mismanaging funds. Also, in order to run the healthcare system, all Ghanaians must pay 0.66 dollars monthly, which is difficult because a third of all citizens live on less than a dollar a day. Also, most Ghanaians live 15 kilometers from their local health center. This means that the healthcare system they are forced to pay into is not even accessible to them. As a result, many people in Ghana choose to use traditional healers instead of the healthcare system (Our Africa, 2017).

Iran: According to ’s constitution, all citizens are entitled to basic healthcare. There are three sectors in Iran’s healthcare system: public, private and NGOs. The public system is operated by the government, which subsidizes around 90% of all medical costs including prescription drugs and vaccinations. However, the public system has been under a lot of stress due to the country’s rapid population growth over the past two decades. As a result, many Iranians have turned to the private system. The private system is expensive and only accessible to wealthy individuals, but offers shorter wait times and modern facilities. NGOs operate in remote areas of the country and offer limited medical care for free (Healthcare in Iran, Expat Arrivals, 2017).

Mexico: Mexico possesses a complicated medical system which contains a mixture of public and private healthcare facilities. The nation’s public healthcare system, Instituto Mexicano de Seguro Social, is funded by money automatically deducted from all employees who work at a tax paying institution. The healthcare varies drastically depending on the location of the hospital or clinic. More money and resources tend to

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be given to hospitals located within cities, while health centers in rural areas struggle to provide basic services. Since the system is funded by registered workers, individuals who are unemployed are not covered. While Mexico does offer some services to unemployed citizens, this coverage is extremely limited. Private hospitals and clinics are expensive in Mexico, but offer high quality and consistent service (Healthcare in Mexico, Expat Arrivals, 2017).

Haiti: In 2010, Haiti experienced a devastating earthquake which was followed by a massive outbreak of cholera. This left the government unable to support public healthcare across the nation and as a result, hospitals and clinics fell into disrepair. The citizens of Haiti now rely on NGOs such as Médecins sans Frontières (MSF) to meet their medical needs. MSF operates two hospitals in Carrefour and Cité Soleil, that currently serve about 800,000 people. The large need for medical care is a very pressing issue in Haiti because the NGOs are overwhelmed and must turn many people away. For instance, the MSF hospital in Carrefour contains only 275 beds, but sees 400,000 people annually. The NGOs are in desperate need of money and support. In some areas, the NGOs have had to cut back on certain services in order to focus on emergency medical cases (Ekine, New Internationalist, 2013).

C) UN Action

In 1978, the UN adopted the Declaration of Alma-Ata at the International Conference on Primary . This declaration asserted the UN’s belief that universal primary healthcare was the only way to achieve medical equality around the world. It stated that people around the world need to have equal access to quality

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medical coverage because improved health has a direct link to economic and social development. Moreover, the UN has recognized that poor healthcare is connected to populations with low rates of literacy, poor nutrition, substandard housing, contaminated water, and lack of sanitation. As a result, three of the eight Millennium Development Goals (MDGs) were connected to healthcare. Between 2000 and 2007, monetary assistance related to healthcare equality increased from US$ 6.5 billion to more than US$ 21 billion (Chan, UN Chronicle, 2010). Now, with Goal 3 of the Sustainable Development Goals (SDGs), the UN hopes to further promote high quality, accessible and affordable healthcare around the world. It plans on doing this by calling on all nations to increase investment in public healthcare systems, research ways to lower medical costs for basic services and educate citizens about ways to maintain a healthy lifestyle in order to ease the burden on public health systems (SDGs, 2017).

III. Conclusion

The privatization of healthcare can offer benefits to some groups of people, such as the wealthy, but excludes the majority of people in developing nations who cannot afford the high costs associated with it. Unfortunately, this means that many go without life-saving medical care or turn to local healers to alleviate their problems. Through the SDGs, the UN is hoping to increase the amount of people who have access to affordable healthcare and close the gaps between the haves and have nots. Affordable and equal healthcare offers developing nations many benefits such as increased production and development. Therefore, the UN and its member states need to do more to solve this pressing issue.

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IV. Essential Questions

1. Does your country have a private healthcare system? 2. Are public health facilities available in your nation? 3. How many people in your nation do not have access to healthcare? Why is this? 4. What has the United Nations done to insure equal access to healthcare in developing nations? 5. What benefits do private healthcare facilities offer citizens in your nation? 6. What is your nation doing to complete Goal 3 of the Sustainable Development Goals? 7. How does your nation fund healthcare? 8. Does your country work with NGOs to provide healthcare services to individuals in need? If so, which ones?

V. Resources

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"Children: reducing mortality." World Health Organization (WHO). United Nations, Sept. 2016. Web. 31 Jan. 2017. .

Cummings, Elizabeth. "Understanding The U.S. Health Care System." InterExchange. InterExchange, 10 Aug. 2015. Web. 31 Jan. 2017. .

Ekine, Sokari. "Haiti’s struggling healthcare system." New Internationalist. New Internationalist, 25 Feb. 2013. Web. 31 Jan. 2017. .

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ISRMUN 2017 Ave. Real San Agustín No. 4 CP. 66260 Garza García, N.L México. + (52) (81) 8625 1500 [email protected]

“Healthcare in Iran." Expat Arrivals. Expat Arrivals, 2017. Web. 31 Jan. 2017. .

“Healthcare in Mexico." Expat Arrivals. Expat Arrivals, 2017. Web. 31 Jan. 2017. .

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Price, M. "The consequences of health service privatisation for equality and equity in health care in South Africa." Social Science & Medicine. Elsevier, 1988. Web. 27 Jan. 2017. .

"Privatization." Oxford Living Dictionaries. Oxford University Press, 2017. Web. 31 Jan. 2017. .

"Public and Private Healthcare Systems in Argentina." Angloinfo. Angloinfo, 2017. Web. 27 Jan. 2017. .

Scofea, Laura A. "The Development and Growth of Employer-Provided Health Insurance." Monthly Labor Review. U.S. Bureau of Labor Statistics, Mar. 1994. Web. 31 Jan. 2017. .

"Unequal health-care systems are hurting poor worldwide, UN report finds." UN News Centre. United Nations, 14 Oct. 2008. Web. 31 Jan. 2017. .

ISRMUN 2017 Ave. Real San Agustín No. 4 CP. 66260 Garza García, N.L México. + (52) (81) 8625 1500 [email protected]

Waitzkin, H., R. Jasso-Aguilar and C. Iriart. "Privatization of health services in less developed countries: an empirical response to the proposals of the World Bank and Wharton School." International Journal of Health Services: Planning, Administration, Evaluation. U.S. National Library of Medicine, 2007. Web. 03 Mar. 2017. .

Zwi, Anthony B., Ruairi Brugha and Elizabeth Smith. "Private health care in developing countries." The BMJ. BMJ Group, 01 Sept. 2001. Web. 27 Jan. 2017. .