Covid-19” Holidays (Or So We Hope)

IHP news 579 : Going on “Covid-19” holidays (or so we hope) ( 3 July 2020) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, Starting from this evening, IHP will take a few weeks of (hopefully also Covid-19 ) holidays. We trust you’ll get your Covid-19 related and other global health (policy) updates from our colleagues from Global Health Now, KFF, FT Health, Cidrap News, Stat News, Devex … in the coming weeks. Earlier this week, Dr. Tedros described the world’s “new normal” like this: “The critical question that all countries will face in the coming months is how to live with this virus”, he said. “That is the new normal.” We can’t wait. In quite a few countries, meanwhile, Covid-19’s equivalent of Shakespeare’s “To be or not to be, (that’s the question)” turns out to be, “Is it a second wave, of rather the second peak of a first wave?” Anyway. Last weekend I wrote a short blog on why I think “global health”, instead of seizing the corona moment, might be wasting it. I don’t want to get stuck here in endless discussions on ‘global health’, my blog clearly targeted some of the well-connected health experts in the North (who have the ear of at least some key decision makers and politicians) and what they could do (better) in this respect. Even if they’re, arguably, only one small part of the broader ‘global health’ community. The background of this blog: it’s my deep conviction that far more people would support multilateralism and global solidarity (and more sustainably so), if they had faith in the fairness of their tax systems, so that the strongest shoulders contribute the most (including to Global Public Goods). As long as we don't get that right, things will only get uglier, I’m afraid. Including, very much, the global populist picture. Obviously, populism has a number of causes, but for sure, populists around the world also thrive on this (widely felt & mostly correct) deep sense of tax injustice - evidence of betrayed social contracts in many countries. While I’m all for #STAX and other vital taxes on Global Public Bads (already more than difficult enough to get implemented in their own right, unfortunately), I think ‘fair tax systems’ for the 21st century require more, especially asking ( a lot) more from the people with the deepest pockets, as well as MNCs (not the least including Big Pharma), and visibly so. In short, I think the time has never been more appropriate for global health to team up with the movement for global tax justice. The link with UHC has been a no brainer for a while, and the planetary emergency makes it even more urgent. And the current OECD- led process on global tax reform can use all extra advocacy, given how things are going. 1 From that point of view, it’s clear that “ Global Citizen’s” top priority should be: fair tax systems, all over the world. We can surely forget about a critical mass of “Global Citizens” if our social contracts of the 21st century fail to include fair tax systems. So let Bezos, Ma, Branson and other Ambanis show they’re ‘Global Citizens’ too by pushing governments, all over the world to raise fair taxes (and make sure they’re collected too). As dr. Tedros likes to say, “Solidarity”! And it’s not just Global Citizen, the “Global health” community should also make this case at every high-level occasion and venue, instead of settling for financing mechanisms that, in my opinion, at best date from the ‘Third Way’ MDG era (replenishments, fundraising events with stars, …). I’m also not convinced the WHO Foundation is major progress, by the way. (“We need less foundations in the SDG era, and more taxation ” – now here’s a nice slogan for Global Citizen! ). Or another one: “It’s time global health joins #BuildingBackBetter – as compared to #BuildingmoreoftheSame .” We cannot just rely on civil society to make this case, no, it’s more than time to team up with them, and put massive pressure on global health (and other) power, not just in scientific papers or Comments, but through a collective campaign of Op-eds along these lines in globally read pieces, like the Guardian, NYT, FT, Project Syndicate, … And yes, some of the people I mention in my blog, have a special responsibility in this respect, I feel, as they have ‘access’ to these global media platforms. Also, in the current increasingly authoritarian world, Europeans and Americans have a special duty to do so – you can’t expect this from our Chinese or Russian colleagues, and India and Brazil are not far behind, sadly. By linking global health explicitly with global tax justice, these global health opinion leaders could push many others in this direction, creating many new “global citizens” in the process. Conversely, by failing to do so, we should probably also stop whining about “vaccine nationalism”, gross Big Pharma profiting and implosion of multilateralism. I’m exaggerating a bit, but you get the point. This is a cataclysmic moment, it surely should also be one for global and planetary health. I have to say, my former colleague Gorik Ooms is sorely missed, these days. He famously quipped that perhaps first a “WW III” would be necessary to make a quantum leap forward on global health, global social protection and global justice in general. The Covid-19 pandemic is no world war, fortunately, but we urgently need people like him, daring to dream big these days. If not, we will indeed have wasted this moment. Enjoy your reading. Kristof Decoster 2 Featured Article WGH India Dialogue Series: Amplifying the engagement of Female Frontline Health Workers in India’s COVID-19 Response. WGH India (Preethi John, Deepika Saluja, Sapna Kedia and Sumegha Asthana wrote this on behalf of WGH India) India’s response to COVID-19 relies heavily on the female Frontline Health Workers (FLWs), also known as Community Health Workers (CHWs). FLWs include Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and Anganwadi Workers (AWWs). From the beginning of the pandemic, they have been involved in surveillance, home visits, awareness generation about COVID-19 transmission and prevention, and facilitating access to COVID testing and treatment services along with their usual responsibilities as an FLW. While there is wide recognition of the role of scientists and doctors in the COVID-19 response, contributions of ASHAs and AWWs continue to be unrecognized. National and State Governments have issued guidelines to engage FLWs in the pandemic response, among others on the provisioning of additional financial incentives, Personal Protection Equipment (PPE), health insurance and other added benefits. Despite these measures, these workers continue to experience stigma, violence, delayed and insufficient payments, and lack of proper and adequate PPE while performing their tasks. Moreover, in a number of cases, FLWs who tested COVID-positive did not receive adequate support and care. These challenges not only hamper their performance but also have wider implications in the form of a delayed and ineffective health systems response to control COVID-19. Concerns of these workers have been raised in presentations by worker’s trade unions, through journalistic writing and independent research studies. However, a more systematic approach to connect the voices of workers with policymakers and the public is still lacking. To address this gap, Women in Global Health India (WGHI), the national arm of the global WGH movement organized a series of dialogues to make the COVID-19 related contributions and concerns of the ASHAs and AWWs better known. The series was designed to gain perspectives from stakeholders located at different levels of health systems including community, state, and national levels. It comprised three virtual dialogues in the second week of June. Discussants included health workers, workers representatives, trade union representatives, civil society members, researchers, state and national level policymakers, and international development partners. Around 393 participants from India and abroad affiliated with civil society, academia, advocacy groups, and development partners, interested in the issues of FLWs, health systems, gender, women empowerment, registered for the dialogue series. Each level of the health system was taken up in a separate dialogue and emergent issues from each level were then fed into the next level of the health system discussed in the series. The primary objective of the series was to create a common platform for various stakeholders to discuss issues 3 concerning the effective engagement of ASHAs and AWWs in the COVID-19 response and recommend broad policy responses for improving their engagement. Based on the discussions, an effective policy response for addressing key challenges of these workers requires : ● Recognition of FLWs’ work by the government and their communities (through financial and non-financial incentives) ● Structured mechanisms for feeding FLWs’ experiences, needs, and gender, class, and caste realities in policymaking ● Development and dissemination of timely, clear and concise guidelines for FLWs ● Establishment of capacity building and supportive supervision initiatives developed in consultation with FLWs ● Developing support systems for ensuring the physical and mental well-being of FLWs ● Initiating broader health system reforms for FLWs including strengthening policies for fair recruitment, retention, financial protection, leave management, protection against sexual harassment, physical protection, and stigma prevention with clear accountability at all levels. As WGH India concluded this series, it received interest for hosting more such dialogues from associations and networks working on the issues of women health workers. Consequently, WGH India will expand the series (in collaboration with other networks) and host similar dialogues on ANMs, female nurses, female doctors, women collectives, and women leaders in the health sector.

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