PEOPLE OVER PROFIT: END POLICIES THAT UNDERMINE HEALTH FOR ALL
Volume 2 Issue 1 2019 IN THIS ISSUE EDITORIAL
People Over Profit: End Policies That Undermine Health for All 3
INTERNATIONAL
IMF conditionalities promote unhealthy conditions - EURODAD report 5 The impacts of austerity on health 7 PSI participates in 144th Executive Board Session of the WHO 10 United Nations adopts Two Landmark Global Compacts on Migrants and on Refugees 12 WHO, ILO and OECD Launch the International Platform on Health Worker Mobility 14 Liberia: Trade union actions on decent work for people with disabilities 16
AFRICA & ARAB COUNTRIES
Government set to reform Kenya’s health system 18 Reality of Right to Health in Niger - Political Commitment Needed 20 Unions, Social Inequalities and the Senegalese Health System 21 25 Years After Apartheid: Health Inequities Persist in South Africa 22
ASIA AND PACIFIC
KHMU Campaigns Against For-Profit Hospitals 24 New legislation on Universal healthcare and maternity leave in the Philippines 26 Community Health Workers in Pakistan – A Struggle for Union Registration 28 2019 India federal budget pushes private insurance in health 30
EUROPE
EPSU 50th Standing Committee on Health and Social Services 33 The Long Term Plan for the NHS in England 34 Let’s talk about staffing again 35 Bulgarian Federation of Trade Unions - Health Services Continues to Defend Workers and Public Health 36
INTER-AMERICAS
Canadian Unions Campaign for Universal Access to Prescription Drugs 38 FENPRUSS updates its “Another Health System Is Possible” proposals 40 Costa Rica government’s new objective: abolish the right to strike 42 Argentina: 30,000 Health professionals strike 44
© Cover photo maisa_nyc/CC
Right to Health is an electronic newsletter published by Public Services International (PSI), in further- ance of the PSI Human Right to Health Global Campaign. For more information on the campaign and to subscribe to Right to Health, visit our webpage: http://www.world-psi.org/PublicHealth4All. You can also send us stories, or make further enquiries. To contact us, Tel: +33(0)450406464; Email: [email protected]. www.world-psi.org.
2 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 3 PEOPLE OVER PROFIT: END POLICIES THAT UNDERMINE HEALTH FOR ALL EDITIORIAL am happy to welcome you to this new volume of the Right to Health. As the PSI newsletter for our global Right to Health campaign, over Ithe past two years it has brought you news of the work PSI and its affiliates are doing across the world, to ensure every woman, man and child can access quality public health. We intend to do this even better.
PSI’s vision is one of a better future, based on social and economic justice, and efficient, accessible public services around the world. Campaigns to influence policy internationally and nationally is thus central to our work. The Right to Health Quarterly serves as our voice to advance the goal of universal public healthcare.
The human right to health1 means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions and a clean environment. This right is protected in several international conventions, and reflected in the constitutions2 of at least 115 countries.
It is however clear that most people, particularly in low- and middle- income countries, are denied this fundamental right in practice. To ensure “the enjoyment of the highest attainable standard of health” becomes a universal reality, governments and international institutions
2 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 3 need to promote and implement policies which put People Over Profit. PSI’s vision is one of a In this edition, we look at how policies such as austerity measures and better future, based on international financial institutions’ conditionalities undermine the right to social and economic health, and call for an end to such neoliberal policies. It is impossible to attain the targets or to “ensure healthy lives and promote wellbeing for justice, and efficient, all at all ages3” by 2030 within the neoliberal policy framework. accessible public services PSI represents over 14 million health and social care workers in 270 around the world. unions across 152 countries and territories. Our members bear the Campaigns to influence burden of cuts in the funding of healthcare and the marketisation of health services as workers and as members of their communities. policy internationally and nationally is thus central But we are not mere passive onlookers. We are actively organising to change the situation for the better. As you will see in several stories from to our work. The Right to all the regions, we are at the forefront of the struggle to realise the right Health Quarterly serves as to health.
our voice to advance the We are not doing this alone. We continue to build alliances and forge goal of universal public coalitions with communities, civil society organisations and well- meaning decision-makers, including legislators. And one of the lessons healthcare. to be learnt from many of these stories is that when we are united and determined, we can win.
Ending all policies that undermine health for all will be a well-deserved victory for billions of people who today cannot access quality health, or who face catastrophic health expenditure. EDITIORIAL
Rosa Pavanelli PSI General Secretary
1. https://www.nesri.org/programs/what-is-the-human-right-to-health-and-health-care 2. http://www.world-psi.org/sites/default/files/en_concept_note_draft_2.pdf 3. https://www.who.int/sdg/targets/en/
4 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 5 EURODAD REPORT
IMF CONDITIONALITIES PROMOTE UNHEALTHY
CONDITIONS ©EURODAD
A report by EURODAD investigates the IMF policy of attaching policy conditions to its loans. Not only do these conditionalities undermine the sovereignty of countries that receive IMF loans, they also promote austerity measures to detriment of public services. INTERNATIONAL
The focus of this EURODAD re- considerations of macro-critical PSI has consistently argued search was the International resilience, conditions for loans that international financial institu- Monetary Fund (IMF) practice of and reviews of loans have been on tions (IFIs) contribute to under- attaching policy conditions to its the increase. The 26 programmes mining the realisation of the right loans, particularly for crisis-hit together had 227 quantitative con- to health, particularly in low- and countries. It investigated the con- ditions (i.e. an average of 8.7 per middle-income countries. A report ditions attached to IMF loans for programme) and 466 structural titled Unhealthy conditions: IMF 26 country programmes that were conditions (i.e. an average of 17.9 loan conditionality and its impact approved in 2016 and 2017. Its per programme). Meanwhile, the on health financing1, issued at the findings were compared to those average number of conditions per end of last year by the European of a previous study of the Network loan in between 2011 and 2013 was Network on Debt and Development covering IMF programmes ap- 19.5. (EURODAD) confirms this perspec- proved in 2011 to 2013. tive, and draws global attention to Quantitative conditions for IMF the fact that such bad practice Contrary to the IMF’s stated com- loans, otherwise described by the might be getting worse. mitment to streamlining its con- institution as quantitative perfor- ditionalities and limiting these to mance criteria (QPCs) “relate to
4 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 5 macroeconomic variables2 under terms with little explicit account The IMF’s debt sustainability as- the control of the authorities, such taken of the link between debt and sessments should thus be comple- as monetary and credit aggre- the achievement of social devel- mented with independent Human gates, international reserves, fiscal opment goals. Rights Impact Assessments (HRIA). balances, and external borrowing”. This will help ascertain the implica- Structural conditions, or Structural Reviewing the impact of IMF pro- tions of debt burdens and ensure Benchmarks (SBs) as they are grammes in 21 countries over two they are restructured to ensure called, involve economic reforms3 decades, researchers demon- countries can meet the targets of that require legislation and critical strated in 2008 that IMF program- the Sustainable Development Goals policy changes. meconditionalities are associated and fulfil their human rights obliga- with worsening health outcomes. tions to the people. q These conditionalities undermine And in 2015, it was established the sovereignty of countries which that decades of prioritising debt receive IMF facilities. They tend to payments over investment contrib- promote austerity measures, with uted significantly to the devastat- cuts in the funding of public ser- ing extent of the Ebola outbreak’s vices, such as healthcare delivery. impact in Guinea, Liberia and Sierra Leone. Health services had been The EURODAD report further points starved of investment4, including out that: vital public health infrastructure, undermining crisis preparedness “There are many pathways in what were already fragile health through which IMF conditional- systems. Not less than 11,315 lives ities impact on health systems were lost as a result. and access to health services – in particular, debt service pay- The continued promotion of un- ments, fiscal deficit reduction healthy loan conditionalities by the and limitations to public sector IMF cannot be allowed to continue. employment.” A fundamental change in approach is required. PSI shares the policy INTERNATIONAL Much needed funds for health ser- recommendations of EURODAD: vices get committed to debt ser- expansion of fiscal space through vice payments. And to meet fiscal debt restructuring as a first op- deficit targets set as quantitative tion, and demonstrable respect for conditionalities, governments are states’ democratic ownership of constrained to constrict public their policy instruments. health expenditure. Indeed, in 23 out of the 26 country programmes, IMF loans are meant to help mem- “financial consolidation” (auphe- ber countries tackle balance of mism for austerity measures) is payments problems5, stabilize clearly spelt out in the programme their economies, and restore sus- objectives, policies and strategies. tainable economic growth. Thus, countries turn to the IFIs when The continued neoliberal thrust they have economic problems. 1. https://eurodad.org/unhealthy-conditions of IMF loan facilities undermines Addressing economic challenges 2. https://www.imf.org/external/np/exr/ the possibility of achieving the must, however, not be at the cost facts/pdf/conditio.pdf Sustainable Development Goals. of social wellbeing. A better future 3. https://eurodad.org/files/pdf/1546182- Health is a fundamental poverty-re- is impossible without health being conditionally-yours-an-analysis-of-the- lated sector which is particularly realized as a fundamental human policy-conditions-attached-to-imf-loans. vulnerable to decreased spending. right. People and not profit must pdf Debts incurred by less developed be at the heart of development for 4. http://www.cadtm.org/spip. countries is generally considered this to be sustainable and humane. php?page=imprimer&id_article=11217 by the IMF in macroeconomic 5. https://www.imf.org/external/about/ lending.htm
6 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 7 THE IMPACTS
OF AUSTERITY Health sector workers are affected in different ways by austerity measures. ON HEALTH ©Per Flakstad
by Carolina Dantas
usterity is a policy used “solution” presented is a contrac- IMF, enforced it. In Latin America, by governments to save tion of public expenditure, associ- the Bretton Woods Institutions Amoney, either as an overall ated with labour, health and pen- (IMF and World Bank) seem to be reduction in government spend- sion reforms. recovering their influence to rec- ing as a percentage of GPD (Gross ommend fiscal adjustment. An Domestic Product), or specific re- International Financial Institutions analysis of 27 European and Non- INTERNATIONAL ductions in government spending. (IFIs) hold a major role in rec- European countries, part of OECD, However it is defined, austerity ommending austerity measures; between 1995 and 2011 showed causes specific losses to specif- in Europe, the triumvirate, also that the increase in public debt ic people. It has become an issue known as the Troika, composed with IFIs, apart from its volume, especially in recent years, mainly by the European Central Bank, the is associated with higher cuts in in Southern Europe after the 2008 European Commission and the health. (REEVES, 2014). global economic crisis and in Latin America after the end of the com- modity boom in 2012. Health reform Measures by Region, 2010-15 (number of countries) Governments justify austerity with a discourse saying it is necessary East Asia and Pacific 2 to promote “fiscal consolidation”, Eastern Europe/Central Asia 9 “fiscal sustainability” or “rational- Latin America/Caribbean 2 ize the public expenditure”, which in layman’s terms means to solve Middle East and North Africa 3 the fiscal deficit in a short term pe- South Asia 0 riod, reduce the pressure of the ex- Sub-Saharan Africa 6 ternal debt over the public budget, All countries 56 and by the fallacious financial un- sustainability of social policies cre- Source: Authors’ analysis of 616 IMF country reports published from February 2010 ated by previous left-wing admin- to February 2015 istrations. As a consequence, the
6 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 7 • The ILO, in joint research with disproportionally more affected wage and social assistance, and of the University of Columbia, than men, and when when the the reimbursement of medical ex- launched a paper reviewing state does not provide welfare ser- penses from health insurance. 616 IMF country reports in 183 vices it is usually the women who countries, published between take charge of the care of elderly, Countries such as Spain and February 2010 and February sick people and children, through Portugal, which implemented 2015. The result shows that, unpaid domestic work2. austerity policies, faced similar following IMF prescription, problems, while Iceland, where reforms to the health sector Other uneven effects of austeri- austerity was rejected by popu- are being considered by 56 ty measures are associated with lar vote, increased investments governments in 22 developing weakened mental health, depres- in health, producing a different and 34 high-income countries. sion, anxiety, increased substance result5. According to Vieira, who abuse, such as alcoholism and did a broad revision of the im- • Health sector workers are af- tobacco use, and higher suicide pacts of economic crisis and fiscal fected in different ways by rates3. The European Centre for austerity: austerity measures. These in- Disease Control warned that seri- clude: by adjustments in the ous health hazards are emerging 1. the economic crisis can aggra- wage bill to achieve cost-sav- because of fiscal consolidation vate the social problems and ings - under consideration by measures introduced since 2008. increase social inequalities; 130 governments across the 2. the economic crisis can wors- globe – including non-adjust- One systematic review of the Greek en the health status of the ment of salaries in line with economic crisis between 2009 population; local inflation; by reductions and 2013 observed the follow- 3. the fiscal austerity measures, in investment in public health ing impacts on the health system which establish the reduction care, that may lead to dismiss- of the country: reduction in pub- of social protection expenditure als - reductions in medical lic health expenditure in both the aggravate the effects of the cri- personnel - and overload; by provision of services; reduction of sis over the health, particularly privatizations. And in many the workforce in health, reduction the social conditions; and cases, they are even blamed of working hours, as well as wage 4. the preservation of social pro- for the existence of the crisis. and pension losses; reduction in tection programs is an important the offer of health services, in- measure to protect the health of Austerity measures may include cluding the services provided by the population and to recover introduction or increase of user fees university hospitals; fluctuation of the economic growth in a short- for health services, discontinuation the pharmaceutical market, with er period6. of allowances and increased an increase in consumption dur- copayments for pharmaceuticals. ing the period observed – mainly The health and social protection These lead to increased out-of- medication for the treatment of policies are a factor that mitigates INTERNATIONAL pocket expenditure for health. psychiatric illnesses– followed by the effects of unemployment and/ Meanwhile, a lower quality of the decrease in the consumption, or reduction of work income. The health service provision leads which led to the closure of some countries which maintained or re- to worse health outcomes1. The pharmaceutical factories in the inforced social protection policies, effects are especially intense in country; reduction in the financing including cash transfer, during the fragile health systems, worsening for biomedical research4. periods of crisis, as a countercycli- health inequities between as well cal measure, presented best eco- as within countries. Consequently, the quality of health nomic and social performance, as services in Greece was affected, well as less incidence of mental Public health workers are not both by the restriction in service health and suicides. the only ones affected by cuts in provision, as well as by the dispo- health expenditure, service us- sition of health staff, whose per- An essential point in this discus- ers also suffer. The hardest hit are formance was jeopardized by the sion, for Latin Americans and other those with low incomes, who can- situation of stress in their private developing countries, is to learn not afford to pay for the services and professional lives. Nikolaos from recent European experience and so are excluded from or re- Grigorakis et al also call attention the best ways to present solid ceive less critical assistance when to the increase in out-of-pocket and convincing results about the their needs are greatest. expenses to the Greek population, harmful effects of austerity on the thanks to the obstacles prevent- health of the population, which is There is also a displacement of ing normal access to public health useful for collective bargaining . the effects of the crisis from the services. This is further intensified public sphere to households, by the reduction of household in- PSI advocates for public, univer- which is commonly not seen in come as a consequence of high sal, rights-based, people-cen- economic analyses. Women are unemployment, reductions in tred, and good quality health care.
8 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 9 Investment in health and social current fiscal deficit that do not 1. See Karanikolos et al., 2013; welfare is essential and is not a include cuts in public expenditure, Mladovsky et al., 2012 burden on public finances. On the but that include more progressive 2. Bruff And Wöhl, 2015 contrary, health, social and med- taxation and control over tax eva- 3. See WHO, 2011; Stuckler and Basu, ical-social activities are genuine sion and avoidance. Governments 2013Simou & Koutsogeorgou 2014 creators of wealth and are afforda- should sustain their commitments 4. Karanikolos, 2013 ble, even in the poorest countries. to public health, pensions and so- 5. Schramm, Paes-Sousa & Pereira cial services during the periods of Mendes, 2018 The focus of the debate should crisis and introduce new schemes 6. Fernandez et al., 2015; Karanikolos et always be on the people, not only to extend health and social protec- al., 2013; Kentikelenis et al., 2014; on the expenditure. There are tion for all. q 7. Labonté E Stuckler, 2016 other alternatives to address the 8. Barreto, 2018
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BARRETO, M. L. Austerity comes to Latin America: Lessons researchgate.net/publication/282361067_The_rise_of_ne- from the recent European experience on studying its ef- oliberalism_How_bad_economics_imperils_health_and_ fects on health. Debate. Salud Colectiva. 14(4):681-684. what_to_do_about_it 2018. Available in: https://www.researchgate.net/publi- Mladovsky, P.; Drivastava, D.; Cylus, J.; Karanikolos, M.; cation/329703731_Austerity_comes_to_Latin_America_ Evetovits, T.; Thomson, S.; McKee, M. 2012. Health policy Lessons_from_the_recent_European_experience_on_ responses to the financial crisis in Europe (Copenhagen, studying_its_effects_on_health WHO). Available in: http://www.euro.who.int/__data/assets/ pdf_file/0009/170865/e96643.pdf Bruff, I.; Wöhl, S. Constitutionalizing Austerity, Disciplining the household: Masculine Norms of Competitiveness and REEVES, A. et al. The political economy of austerity and the Crisis of Social Reproduction in the Eurozone. In: Hozic, healthcare: cross-national analysis of expenditure changes Aida A. and True, Jacqui (eds.): Scandalous Economics: in 27 European nations 1995-2011. Health Policy (Amsterdam, Gender and the Politics of Financial Crises, Oxford: Oxford Netherlands), v. 115, n. 1, p. 1–8, mar. 2014. Available in: University Press, 92-108. http://researchonline.lshtm.ac.uk/1386879/1/1-s2.0- S0168851013003059-main.pdf FERNANDEZ, A. et al. Effects of the economic crisis and social support on health-related quality of life: first wave of Schramm JMA, Sousa RP, Villarinho L. Políticas de austeri- a longitudinal study in Spain. The British Journal of General dade e seus impactos na saúde: um debate em tempos de Practice: The Journal of the Royal College of General crises. Rio de Janeiro: Centro de Estudos Estratégicos da Practitioners, v. 65, n. 632, p. e198–203, mar. 2015. https:// Fiocruz, Fiocruz; 2018. Available in: http://www.cee.fiocruz. INTERNATIONAL bjgp.org/content/65/632/e198 br/sites/default/files/1_Joyce%20M-R%C3%B4mulo%20 P-Luiz%20V_austeridade_1.pdf ILO: The Decade of Adjustment: A Review of Austerity Trends 2010-2020 in 187 Countries. ESS Working Paper SIMOU, E.; KOUTSOGEORGOU, E. Effects of the eco- No. 53. Columbia University and the The South Centre, nomic crisis on health and healthcare in Greece in the 2015. Available in: https://www.social-protection.org/gimi/ literature from 2009 to 2013: a systematic review. Health RessourcePDF.action?ressource.ressourceId=53192 Policy (Amsterdam, Netherlands), v. 115, n. 2-3, p. 111– 119, abr. 2014. Available in: https://www.sciencedirect. KARANIKOLOS, M. et al. Financial crisis, austerity, and health com/science/article/pii/S0168851014000475/pdfft?m- in Europe. Lancet (London, England), v. 381, n. 9874, p. d5=86e37425eee9a50b2ef85e03a9e6e887&pid=1-s2.0-S 1323–1331, 13 abr. 2013. Available in: https://www.thelancet. 0168851014000475-main.pdf com/journals/lancet/article/PIIS0140-6736(13)60102-6/ fulltext Stuckler, D.; Basu, S. 2013. The body economic: Why aus- terity kills (New York, NY, Basic Books). KENTIKELENIS, A. et al. Greece’s health crisis: from austerity The World Health Organization (WHO). 2010. Health systems to denialism. Lancet (London, England), v. 383, n. 9918, p. financing: The path to universal coverage, World Health 748–753, 22 fev. 2014. Available in: https://www.thelancet. Report 2010 (Geneva). Available in: https://www.who.int/ com/journals/lancet/article/PIIS0140-6736(13)62291-6/ whr/2010/whr10_en.pdf?ua=1 fulltext VIEIRA, F. S. Crise econômica, austeridade fiscal e saúde: LABONTÉ, R.; STUCKLER, D. The rise of neoliberalism: que lições podem ser aprendidas?. Brasília: Instituto de how bad economics imperils health and what to do about pesquisa econômica aplicada, 2016. Available in: http://re- it. Journal of Epidemiology and Community Health, v. positorio.ipea.gov.br/handle/11058/7266. 70, n. 3, p. 312–318, mar. 2016. Available in: https://www.
8 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 9 A seven-person delegation from Public Services Genevieve Gencianos, International (PSI) took part PSI, spoke at the WHO in the 144th session of the Executive Board meeting. World Health Organization (WHO) Executive Board which took place in Geneva from 24 January to 1 February.
PSI PARTICIPATES IN 144TH EXECUTIVE BOARD SESSION OF THE WHO INTERNATIONAL In his report to the Executive Development”, “Primary health 1 PSI was accorded official Board , the WHO Director-General, care towards universal health cov- relations as a non-State actor with Dr. Tedros Adhanom Ghebreyesus erage”, “Health, environment and the WHO by the 142nd Executive declared that the mission of the climate change”, “Human resourc- Board in January last year. This al- WHO under his leadership is “to es for health”, and “Promoting the lows us to participate in the gov- promote health, keep the world health of refugees and migrants”. erning bodies of WHO such as safe, and serve the vulnerable”. the Executive Board sessions, The first step towards this is the On the implementation of the the World Health Assembly and 13th WHO General Programme of 2030 Agenda for Sustainable 2 meetings of the WHO Regional Work (2019-2023). The ambitious Development , PSI pointed out Committees. targets at the heart of this plan of that, while some progress had work are: “1 billion more people been made towards meeting The WHO Executive Board has 34 benefitting from universal health the targets of the Sustainable technically qualified members who coverage; 1 billion more people Development Goals, “much more represent WHO Member States better protected from health progress will be made with a re- and are elected for three-year emergencies; and 1 billion more form of the global economic ar- terms. Other Member States can people enjoying better health and chitecture”. As far back as 1978, join the Board’s deliberations, and well-being.” Member States of the WHO called non-state actors in official relations for a New International Economic with the WHO, like PSI, are invited The PSI delegation intervened Order at the historic Alma-Ata to submit written statements on on five crucial items on the Conference, as a necessary step agenda items. agenda: “Implementation of the towards achieving “health for all by 2030 Agenda for Sustainable 2000”.
10 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 11 Two decades after the year 2000 Calls for funding of action on en- PSI will be building on these argu- target set at Alma Ata3, health for vironmental health and climate ments at the World Health Assembly all is yet to be achieved. The en- change must take into considera- on 20-28 May 2019. It will also be trenchment of a neoliberal world tion inequalities in wealth across an opportunity to deepen rela- order which puts profit before regions. Countries and companies tions with civil society organisa- people has resulted in the com- contributing to global warming tions and coalitions committed to modification of health. We must must pay their fair share for our col- the struggle for universal public now curtail global health compa- lective action to mitigate climate health care such as the People’s nies’ influence on international change, in line with the principles Health Movement9 (PHM) and the health. We need to establish a new of social and generational justice. Geneva Global Health Hub10(G2H2) order which puts people over prof- in the series of CSOs meetings it and allows the right to health for In our intervention on Human that precede WHO Governing Body all to become reality. Resources for health (HRH), PSI meetings. q welcomed the launching of the On primary health care (PHC) to- International Platform on Health wards universal health coverage Worker Mobility6 (IPHWM) in 1. http://apps.who.int/gb/ebwha/pdf_files/ (UHC), PSI welcomed the WHO’s October last year. The Platform was EB144/B144_2-en.pdf renewed spirit “to deal effectively developed through dialogue and 2. https://sustainabledevelopment.un.org/ with current and future health chal- cooperation among WHO Member post2015/transformingourworld lenges” and its people-centred States, international agencies and 3. https://www.who.int/publications/almaa- approach with “emphasis on tack- stakeholders, such as employ- ta_declaration_en.pdf ling the determinants of health”. ers, professional associations 4. http://apps.who.int/iris/bitstream/hand and trade unions. It is also part of le/10665/275474/9789241550369-eng. We added that this reinvigorated the collaboration between WHO, pdf?ua=1&ua=1 vision of the WHO should encour- the Organisation for Economic 5. https://www.ipcc.ch/sr15/ 6. https://www.who.int/hrh/migration/ age fiscal justice. To enhance do- Cooperation and Development int-platform-hw-mobility/en/ mestic resource mobilisation for (OECD) and the ILO to implement 7. https://www.unhcr.org/towards-a-glob- PHC, multinational corporations the resolutions of the 2016 United al-compact-on-refugees.html have to pay their fair share of tax, Nations High-Level Commission on 8. https://www.iom.int/global-compact-mi- while low- and middle-income Health Employment and Economic gration INTERNATIONAL countries should be spared the Growth. 9. https://phmovement.org/ burden of international financial 10. http://g2h2.org/ institutions’ “fiscal consolidation” Finally, PSI intervened on pro- conditionalities. moting the health of refugees and migrants. We welcomed the PSI also supported the WHO alignment of the WHO Draft Global Guideline on Health Policy and Action Plan 2019-2023 (EB144/27) System Support to Optimize with the UN Global Compact on Community Health Worker Refugees7 and the UN Global Programmes4, launched in October Compact for Migration8. 2018, as a global policy frame- work for government. Community We further highlighted three key Health Workers have a major role points: the need to ground the in providing universal access to Draft Global Action Plan on interna- healthcare. tional human rights law; ensuring Speaking on health, environment access of migrants and refugees and climate change, PSI called for to well-funded quality public health urgent action in the light of findings services, and safety and decent of the Intergovernmental Panel on work for health workers, including Climate Change (IPCC) recent spe- frontline workers in conflict zones. cial report on “Global Warming of 1.5°C5”
10 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 11 2018 was a milestone year in international cooperation on the issue of migration and refugee protection, with the adoption by the UN General Assembly of two landmark global compacts, namely, the Global Compact for Migration and the Global Compact on Refugees.
UNITED NATIONS ADOPTS TWO LANDMARK GLOBAL COMPACTS ON MIGRANTS AND ON REFUGEES
by Genevieve Gencianos
he World Health Organization international community will under- WHO DEVELOPS FIVE-YEAR is building on this momen- take in order to ease pressure on GLOBAL ACTION PLAN ON tum, with the 144th WHO host countries, enhance refugee T THE HEALTH OF MIGRANTS Executive Board preparing a Global self-reliance, expand access to Action Plan (2019-2023) on Health third-country solutions and sup- AND REFUGEES
INTERNATIONAL of Refugees and Migrants. port conditions for safe and digni- fied returns of refugees. The WHO Director General, Dr In December 2018, the United Tedros Ghebreyesus, presented Nations General Assembly adopt- Both Compacts affirm the human a draft Global Action Plan (2019- ed the UN Global Compact for right to health for migrants and ref- 2023) on Promoting the Health Migration and the UN Global ugees and encourage stakehold- of Refugees and Migrants to the Compact on Refugees. The com- ers, including trade unions and civil 144th WHO Executive Board meet- pacts were adopted after two years society, to cooperate with govern- ing in January. The Global Action of intensive consultations and ne- ments and international agencies Plan is an elaboration of the WHO gotiations. PSI actively engaged to realise this right, through a Framework on Priorities and in advocacy and lobbying during whole-of-society approach. PSI’s Guiding Principles to Promote the these processes and welcomed Right to Health Campaign pro- Health of Refugees and Migrants their adoption1. vides the vital tools with which we as mandated by the World Health can promote the right to health Assembly resolution WHA70.15 of The UN Global Compact for in the Global Compacts. At the 2017. Migration is a robust framework same time, our continued engage- of international cooperation to ment in the implementation of the The goal of the Action Plan is address the multi-dimensional as- Compacts will provide the oppor- to assert health as an essential pects of migration. tunity to enhance PSI’s Right to component of refugee protection Health Campaign in the context of and assistance, and of migration The UN Global Compact on migrant and refugee rights. governance. The plan aims to ad- Refugees is a comprehensive ref- dress the health and well-being of ugee response framework that the refugees and migrants in an inclu- sive, comprehensive and holistic
12 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 13 Health workers caring for refugees INTERNATIONAL
manner that takes into account the • Reduce mortality and morbidity • Strengthen health monitoring health of the overall population. among refugees and migrants and health information systems. through short and long-term It recognizes that, in order to pre- public health interventions. The WHO Executive Board vent inequities and inefficiencies, • Promote continuity and qual- endorsed the Global Action Plan public health considerations of ity of care, while developing, and submits it for adoption by the refugees and migrants are insepa- reinforcing and implementing World Health Assembly in May occupational health and safety rable from those of the host popu- 20192. q lation. Given that migration is a nat- measures. ural human feature, exacerbated • Advocate mainstreaming of ref- by unprecedented levels of forced ugee and migrant health in the displacement arising from con- global, regional and country 1. See: http://www.world-psi.org/en/psi- flicts and climate change, the plan agendas. welcomes-adoption-un-global-compact- migration & http://www.world-psi.org/ reflects the urgent need for the • Enhance capacity to tackle the en/psi-joins-civil-society-welcoming-un- health sector to deal more effec- social determinants of health and accelerate progress to- global-compact-refugees tively with the impact of migration 2. Read the full text of the Draft Global wards achieving the Sustainable and displacement on health. Action Plan on Health of Refugees and Development Goals, including Migrants: http://apps.who.int/gb/ebwha/ The Action Plan outlines key priori- universal health coverage. pdf_files/EB144/B144_27-en.pdf and read ties and options for action: • Support measures to improve the PSI statement to the WHO Executive communication and counter Board in January 2019 in response to the xenophobia, and draft Global Action Plan here.
12 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 13 The World Health Organization (WHO), International Labour Organization (ILO) and the Organisation for Economic Cooperation and Development (OECD) jointly launched the International Platform on Health Worker Mobility, in a first meeting held on 13-14 September 2019 at the WHO Headquarters in Geneva.
INTERNATIONAL PLATFORM ON HEALTH WORKER MOBILITY INTERNATIONAL Participants at the launch of the international platform on Health Worker Mobility
by Genevieve Gencianos PSI participated in the meet- The aim of the meeting was to ing, which was attended by 79 discuss existing policy measures participants representing national and to identify strategic actions governments, civil society, trade to strengthen the management unions, employers’ associations, and governance of health work- national regulatory bodies, inter- er mobility. The Platform is one national credential verificationof the recommendations from organisations, and international the report of the United Nations Genevieve Gencianos is the Migration Programme agencies. The PSI representatives High Level Commission on Health Coordinator of PSI. to the meeting included Baba Aye, Employment and Economic Growth PSI Health and Social Services (UNComHEEG), where the PSI Officer, Genevieve Gencianos, PSI General Secretary Rosa Pavanelli is Migration Programme Coordinator one of the Commissioners. and Herbert Beck, who was Genevieve Gencianos presented also representing the European the perspective of PSI on the is- Federation of Public Services sue of Global Skills Partnerships Unions (EPSU). (GSP), which is a new form of skills
14 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 15 To read PSI’s Analysis of the Global Skills Partnerships in the Health Sector:
http://world-psi.org/sites/de- fault/files/attachment/news/ web_2018_mig_report_mar- rakesh.pdf
mobility being promoted in the strengthened information and context of the recently adopted knowledge exchange at the global United Nations Global Compact on level, capacity-building around Migration. PSI is critically examin- bilateral agreements, review of the ing the concept of GSPs, particu- WHO list of countries with critical larly in the health sector, where health shortages, enhanced policy demographic trends and health and multi-sectoral dialogues at the
worker shortage will be driving national level and the development INTERNATIONAL health worker migration in the of knowledge repositories in areas coming years. In her presentation, relevant to health worker mobility Gencianos highlighted core ele- (see full IPHWM Meeting Notes ments that should constitute any here: consideration of global skills part- nerships, namely: tripartism and https://www.who.int/hrh/migration/ social dialogue, equity, sustaina- platform-meeting-h-w-mobility/en/). bility and human rights, and the application of international norms This meeting is only the first among and standards, including those the activities of the IPHWM. PSI contained in the WHO Global Code will continue to play an active role of Practice on the International in the platform, bringing its con- Recruitment of Health Personnel, crete best practice example from and the UN and ILO Conventions the Germany-Philippines Bilateral on Migrant Workers. Labour Agreement on Nurses, its pioneering analysis of the GSPs, Throughout the two days of panel and its broader global policy ad- discussions and break-out groups, vocacy in the context of the UN meeting participants identifiedGlobal Compact on Migration. q strategic actions which included
14 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 15 LIBERIA: TRADE UNION ACTIONS ON DECENT WORK FOR PEOPLE WITH DISABILITIES
While the international average number of persons with a disability (PWD) is 10%, in Liberia the number reaches 16%. The causes range from congenital conditions and birth trauma to accidents and sickness. The two civil wars in Liberia between 1999 and 2003 also caused an increase in the numbers of PWD. The Liberian Government is calling for actions to promote the cause and interests of PWD, including access to social protection and decent work.
by Faustina Van Aperen, ILO-Actrav
INTERNATIONAL ccording to Morgan that there is no way to provide However, effective implementation Ashenfelter (Handicap evidence or identify their attack- of these international labour norms International), in his 2013 ers, said Ambassador Daintowon has still to become reality. A 1 article Changing Liberian Attitudes Domah Paybayee - an Advocate Toward the Disabled, “People for the Missing Voices “Persons African Heads of State adopted a with Disabilities have it tough in with Disabilities especially Protocol to the African Charter on Liberia: Educational facilities do Women, Youth and Children” and Human and People’s Rights on the not cater to their needs, employ- Coordinator of African Youth with Rights of Persons with Disabilities ment is difficult to find, sidewalks Disabilities Network in Liberia. in Africa on 31 January 2018. It has barely exist in the city and most four strong provisions on peo- businesses and government build- On a positive note, Liberia estab- ple with disabilities’ rights: arti- ings do not even have a ramp... In lished the National Commission cle 17 is Right to Work, article 14 addition, some disabilities, such on Disabilities in November 2005, is Right to Education, article 13 is as post-traumatic stress disorder and adopted the National Decent Accessibility and Article 7 is Right or missing limbs, are stigmatized, Work Act. At the international level, to Life. as they are associated negatively Liberia has ratified 25 International with the war”. Labour Conventions (only 14 are in The Liberia Labor Congress held a still in force) including six out of the joint workshop with the ILO Bureau There have been cases of fami- eight ILO Fundamental Labour con- for Workers’ Activities (ACTRAV) lies who abandon their disabled ventions (the exceptions are C100 and the ILO Abuja office to sup- child, of rape cases of PWDs who and C138). In 2012, Liberia ratified port its members’ contribution to are blind, deaf and dumb where the United Nations Convention on decent work for persons with dis- the court of justice considers rights of People with disabilities. abilities on 3-6 December 2018 in
16 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 17 Daintowon Domah Paybayee, Advocate for persons with disabilities in Liberia
Monrovia. The LLC invites its mem- decent work for all and social line ministries (especially the bers to engage national social inclusion. ministries of Education, Health, partners on the issue of decent Labour, Gender and Justice) to work for persons with disabilities, The workshop reached the fol- ensure people with disabilities especially their access to social lowing decisions for action: are fully included and are not protection and employment. discriminated against in terms • Develop National Awareness of education, employment and The workshop was attended by Raising on decent work for and social protection. 35 participants, 20 guests from with people with disabilities. the Liberia Labour Congress and • Hold partners meetings and In conclusion, People with the groups representing People engagements with line minis- Disabilities deserve a good health with Disability in Liberia. The tries, international partners and delivery system, education facil- opening session was attended by relevant social partners and ities, legal protection, a nation- the Minister of Labour of Liberia, groupings/institutions. al social security coverage, and Honorable Moses Kollie. • Demand the government rat- equal employment opportunities ifies and implements ILOwith equal protection under the The members of Liberia Labour Conventions C138 and C100, law. Congress recognized that since with regulations that promote the 14 years of civil war which accessible employment within As children with disability and INTERNATIONAL ended in 2003, the nation the private and public sectors their mothers are the most has made significant progress for PWDs without discrimina- vulnerable, they should be towards decent work for all2. tion, and ensure a legal frame- considered a national priority in But at the same time, they work and public services to the implementation of the national expressed their concerns about support the implementation of social protection system. Liberia the lack of effective protection ILO Conventions that have been Labour Congress calls on the for people against social risks in ratified in relation to PWD. Government and the Liberian their country (lack of assistance to • Ensure the Liberia Labor Chamber of Commerce to join children living with disability, aging, Congress engages relevant efforts in the building of a national accidents, job loss, inadequate stakeholders and conducts a social protection of children and pensions...). Labour Force Survey with full their mothers, as an integral part of inclusion of the people with dis- actions for decent work for all. q This situation means that persons abilities; to lobby government to with disability continue to be sub- ensure the establishment of a 1. Ambassador Daintowon Domah Pay- ject to social, economic and cul- desk for people with disabilities bayee, resource person at the LLC tural injustice. The nation also de- at the Ministry of Labour to be seminar 3-6 Dec 2018 prives itself of the benefit of the headed by person with disabil- 2. http://www.lr.undp.org/content/ 16% PWDs’ labour contributions. ities; engage employment insti- liberia/en/home/presscenter/press- The lack of an effective social pro- tutions both in the private and releases/2018/persons-with-disabil- tection system keeps the majority public sectors to ensure decent ities-want-inclusion-.html of PWD in a vulnerable condition, work for PWD through social dia- preventing them from enjoying logue; work in collaboration with
16 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 17 AFRICA AND ARAB COUNTRIES
GOVERNMENT SET TO REFORM KENYA’S HEALTH SYSTEM
Sicily Kariuk, Cabinet Secretary for Health and James Wambugu, Chair of the panel of experts. ©: Kenyan Ministry of Health
The Kenyan government has called on an independent panel of experts to help transform and reposition the National Health Insurance Fund (NHIF). Mr James Wambugu, a former insurance company manager, is leading the panel of experts. They have 90 days from 26 February to present a report, which will guide the AFRICA AND ARAB COUNTRIES country’s progression to universal health coverage (UHC).
he NHIF is in dire need of Members of Parliament recently In addition, most private health reform and the govern- pointed out that “small private facilities are far smaller than the ment’s commitment to UHC hospitals are the biggest bene- public hospitals, so the difference T 1 is commendable. But, building ficiaries of the NHIF millions.” in funding per patient is even a strong public health system greater. Not even the prestigious must be at the heart of any Between July 2018 and 25 public tertiary health institutions transformation process to realise February 2019, about 1,266 private are spared. quality health for all in Kenya. and faith-based health facilities claimed 2 billion Kenyan Shillings The National West Hospital, which The high administrative costs (US$19,848,300) from the is the eighth largest private hospital of running the Fund is the Fund. But, 5,751 public hospitals in the country, was allocated KSh first challenge to overcome. It claimed just KSh789,002,629 147,362,358 (US$ 1,462,440). But represents 22% of the funding (US$7,830,170). between them the two leading available for NHIF against an ave- public health institutions in the rage of 2,7% for social insurance On average, a private provider drew country were allocated only KSh funds globally. US$15,678 from the fund while a 155,933,682 (US$1,547,510). public hospital drew just US$1,361: These are the Kenyatta National Even more worrying is the fact barely 9% of the average amount Hospital, which is Kenya’s oldest that private health providers are obtained from the fund by a private and largest hospital and the benefitting the most. Kenyan health provider. teaching hospital of the University
18 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 19 of Nairobi, and the 113-year old Moi A well-funded public health system independent panel of experts to Teaching and Referral Hospital. is the cornerstone of health for assist. The objective is for the all. And the public must have country to progress to universal Thus, we agree with Mr Wambugu the opportunity to be active in health coverage. The main issue that “the government has to governance of the public health must be the building of a strong come in2” to ensure provision system to ensure transparency and public health system, putting
of universal health coverage, democratic accountability. people over profit. q AFRICA AND ARAB COUNTRIES because “it is their responsibility”. Improved public funding of health We welcome the words of Ms is a pressing need. For example, Sicily Kariuki, Cabinet Secretary for 1. https://www.the-star.co.ke/ despite a gradual increment in Health, who said when inaugurating news/2019/03/01/alarm-as-private- budgetary commitment to health- the panel that government will health-providers-file-huge-claims_ care delivery over the years, “ensure that the reform process c1901731 elbowing out major public the Kenyan national and county attains highest possible level of health facilities.” 2. https://businesstoday.co.ke/ governments have spent an public participation”. PSI affiliates in 3 insurance-captain-drive-nhif-overhaul/ average of just 7.1% on health . Kenya will engage with the process 3. https://pesacheck.org/how-much-of-ken- This is less than half of the 15% and in line with the objectives of yas-budget-is-going-towards-the-health- budgetary allocation commitment the Campaign for Public Health sector-5ee2040b1f5 made by African Heads of States for All in East Africa launched last and Governments in the 2001 May in Nairobi. They will call for “a Abuja Declaration. Human Rights Based Approach (HRBA) to the pursuit of Universal It is equally important to stop Health Coverage,” putting people enriching for-profit interests such over profit in reforming the NHIF in as insurance companies and particular and the Kenyan national private health establishments health system in general. with public financing of health, especially while the immense Kenya’s National Health Insurance majority of the population use only Fund is undergoing reform, and public health facilities. the government has called on an
18 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 19 REALITY OF RIGHT TO HEALTH IN NIGER
Political Commitment Needed
by Nouhou Mamadou Badjé
Nouhou Mamadou Badje SGa2 / BEN / SUSAS / Niger
uaranteeing the health of health centres have been built, The trade unions, with PSI affiliates the Nigerien population is they are crucially lacking in quali- at the fore, and civil society or- Ga constitutional obligation fied personnel. 90% of health and ganisations continue to call on the which is supposed to be bind- social workers are contract staff or government of Niger to be more ing on the government. The right volunteers. Patients are crammed concerned about revamping the to health is a fundamental human into treatment rooms and ambula- health sector in reality more than right enshrined in the constitution. tory services are almost non-exist- in rhetoric. But this has been to no As stated in Article 12, "Everyone ent. All these have resulted in loss avail. has the right to life, to health, to of confidence of the populations physical and moral integrity, to a in the health centres Several international organisations healthy and sufficient food, ..." But and partners2 including the World the reality thus far is quite different To make matters worse, the state Health Organization have also giv- from the provision of the law. is disengaging more and more en the government advice such from the provision of health ser- as pointing out the importance Poor resources and inadequate vices. Private sector provision of of committing not less than 15% priority for health by government, health care is fast increasing. But it of the national and 8% of local even with the resources availa- is impossible for most of the pop- authorities’ budgets to health. ble, has made life ever more diffi- ulation, who are poor, to pay their Government has failed to respond
AFRICA AND ARAB COUNTRIES cult for 20 million people that live charges. A lot of people thus have positively to these suggestions. in our landlocked country in the no option but self-medication or to The public health system thus West African sub-region. The share turn to traditional healers with all continues to sink into the abyss of the health sector in the annual the attendant dangers that go with because of insufficiency of materi- budget has never been up to 10%. these approaches. al, human and financial resources. The result of this is that we have a very fragile public health system The situation is notably worse in Beyond empty proclamations of the rural areas. And these are the progress being made, the Nigerien Recently, the Nigerian state adopt- places where most Nigeriens live. authorities must accord the health ed a five-year Health Development Many women bleed to death1 dur- sector the paramount priority it Policy (PNS). This encompass- ing or after giving birth in these deserves, to ensure citizens actu- es several programs, plans and areas because they cannot reach ally enjoy their legitimate right to projects which are meant to im- the health services health. prove the health status of the populations. There are a few medical proce- Health is priceless but has a cost! dures that are supposed to be free, q The state and health authorities particularly for women and child have recorded some achieve- care. But this makes no meaning ments in the provision of health in the absence of basic medical infrastructure. But these are gross- equipment and medicines. As a 1. https://reliefweb.int/report/niger/reduc- ly inadequate. And working condi- result, some of the gains in health ing-health-care-inequality-adequate-pri- tions in the health sector remain outcomes that were made earlier in mary-care-rural-communities-niger terrible despite the much-vaunted the decade, such as reduction of 2. http://uhcpartnership.net/towards-a- achievements. While a few new child mortality, are being reversed. new-national-health-policy-in-niger/
20 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 21 UNIONS, SOCIAL INEQUALITIES AND THE SENEGALESE HEALTH SYSTEM
Dr. Mbaye Kamara, by Dr. Mbaye Kamara a pharmacist and health economist, is Secretary General of the C.H.N.E.A.R. (Albert rom the 1980s, the Royer National Children’s Senegalese health system Hospital) of the SAT- has evolved from a relatively Santé / CSA; member F of the Federation of modern and efficient system into Independent Trade a two-tiered system of privatised Unions (FSA) affiliated and commercialised healthcare with the PSI. delivery. Private provision has be- come increasingly widespread, For example, 68% of the poorest The roots of health inequities lie while user fees and pharmaceu- people cannot use maternal and in social conditions outside the tical charges finance a significant child health services for economic health system’s direct control4. part of the public health sector1. reasons2. Therefore, there is need for re- newed struggle against the pre- This situation started with eco- The government must therefore carious nature of the existence nomic crises, the rise of unemploy- carry out systemic health care re- poor working people, in gener- ment and increase in demand. It forms which put the people at the al. Related directly to the health was worsened with reorganisation heart of the reform process and sector, the unions have to call for of the health system in 1998. This thus facilitates improvement of the improved funding of public health was largely in the form of hospital quality of health services for the care and the de-marketisation of reform. It brought about chang- entire population, including the hospital services. es in hospital policy and rules, most vulnerable groups, econom- including the modes of financing ically and socially. Such reforms The UHC programme is a good op- and operation of public health fa- must emerge from public discus- portunity to reduce social inequal- cilities. They began to operate as sions including the trade unions, ities, but it must rest on the bed- semi-private institutions creating civil society organisations and rock of availability of quality public financial barriers for a large part of communities. health care for all, because health the Senegalese population, lead- AFRICA AND ARAB COUNTRIES is a fundamental human right. Now ing to inequality of accessibility. Shortly after his election in 2012, more than ever, Senegalese trade President Macky Sall promised unions must be at the forefront of Access to Public Health Esta- to end inequitable access to campaigns for the realisation of blishments (PHEs) is a fundamen- health by 2022 by introducing a this right, and for government to tal human right. And the right to Universal Health Coverage (CMU) take concrete steps to address the health is recognised and protect- programme. The Strategic Plan social, economic and environmen- ed by the Senegalese constitution for Developing Universal Health and by international declarations, tal determinants of health. q Coverage in Senegal 2013-2017 such as the African Charter of was designed to help achieve this Human Rights. However, because goal3. But, the strategic plan has 1. Foley, Ellen E. “No money, no care: women of systemic weaknesses in hospi- not been quite successful. Thus, and health sector reform in Senegal.” tal reform, access to health care less than three years to the set Urban Anthropology And Studies Of remains unaffordable for the poor target, it seems unlikely that uni- Cultural Systems And World Economic and rural populations. This leads to versal access will be achieved by Development 30, no. i (2001): 1-50 a sense of injustice. 2. https://www.jica.go.jp/english/our_work/ 2022, except if drastic steps are evaluation/oda_loan/economic_coop- taken now. The labour movement The Senegalese state is respon- eration/c8h0vm000001rdjt-att/sene- and particularly health unions in sible for poor health outcomes gal_161115_01.pdf Senegal have a key role to play to resulting from its reforms. Most of 3. https://www.r4d.org/projects/lay- ensure progress is actually made ing-groundwork-universal-health-cover- the population does not use formal and not just rhetoric. age-senegal-sustainable-financing/ health services when ill, because 4. http://www.aho.afro.who.int/ they lack the money to pay health profiles_information/index.php/ expenses, even in public hospitals. Senegal:Universal_coverage?lang=en
20 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 21 25 YEARS AFTER APARTHEID: HEALTH INEQUITIES PERSIST IN SOUTH AFRICA
Young workers at the PSI People’s National Health Insurance Conference.
On 27 April 1994, history was made in South Africa. That day, now known as Freedom Day in the country, the apartheid regime was buried as South Africans voted in the first multi-racial elections in the country’s history, marking a significant democratic transition.
AFRICA AND ARAB COUNTRIES n 1996, South Africa’s final This reflects a human rights- • 8,000 babies die each year Constitution was enacted based approach to health which during or shortly after birth due Ias one of the most socially recognises the importance of to preventable causes linked to inclusive and democratic in the social and economic determinants health system failures; world. Reflecting the spirit of the of health. Post-apartheid govern- • 30% of children are people’s struggle that ended the ments have made significant malnourished and obesity in regime of racial segregation, it efforts to improve access to health adolescence and adulthood included a Bill of Rights. In the care services over the last two and is prevalent due to paths of constitution, it is explicitly stated a half decades and progress has deprivation cut by childhood that been made from the aftermath of hunger; apartheid. • There is an exploding cancer “Everyone has the right of epidemic, with people dying access to – But such progress remains because cancer medicines inadequate. South Africa remains cost so much and there are 1. Health care services, including an “ailing nation” as Mark Heywood extremely few oncologists in reproductive health care, noted in an article1 which draws the public health system; 2. Sufficient food and water, and attention to a “health crisis” • There are 270,000 new HIV 3. Social security, including, if rocking the country. He pointed infections and 89,000 AIDS- they are unable to support out that: related deaths annually; themselves and their • There is pervasive corruption dependents, appropriate • There are an estimated in the procurement of health social assistance.” 300,000 cases of Tuberculosis equipment and medical and 80,000 TB-related deaths supplies; annually; • Large numbers of publicly-
22 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 23 trained doctors and nurses are industry, commerce and through Rather, the NHI should serve leaving the public health system neopatrimonial ties to the state5. as a pivotal instrument within a – migrating or practicing in the mix of government policies and private sector; The dynamics of health inequities programmes that strengthen the can thus be best grasped by public health system, with active Heywood correctly noted that this understanding the disparity bet- participation of the people. worrisome state is symptomatic of ween the quality of care available the inequality inherited from South to almost 50 million South Africans This is an important step in rolling Africa’s past. But at the same time, (with a large number in the rural back the persistence of health as he added, there is much that areas) who can access health inequities in South Africa. The next could have been done to improve services only from the under- step is ensuring people over profit the situation. funded public health system, and in fashioning out macroeconomic the just over 8 million (mainly and social policies in general. “Studies have shown that social urbanised people) on “medical aid The guarantee for lasting health inequalities in health is widening coverage” who can access well- equity lies in addressing the social, across social groups and races resourced private sector health economic and environmental in South Africa as a result of the care delivery subsidized by the determinants of health. q apartheid legacy”2. For example, state. “(i)n 1987, the number of white dentists for each person in the For example, while one doctor 1. https://www.spotlightnsp. white population was 1: 2 000, sees 2,457 people6 in the public co.za/2019/02/07/ail- while for black people, it was 1: 2 health facilities, the estimated ing-nation-the-things-so- 000 000” and in 1990, the ratio ratio of doctors to people on the na-wont-say-about-the-health-crisis/?fb- clid=IwAR13ACdcsFefw55hQ2EoPGf7npQ- of doctors to patients in (largely medical aid scheme is however 1 falB--nMImU0uinslXCSoWPLC1IfT2qc white-dominated) urban areas to 429. These divergent figures, 2. Obuaku-Igwe, C. C. (2015). Health was 1: 900, but in the (black- scary enough as they are, are just inequality in South Africa: a systematic dominated) rural areas it was 1: 4 the tip of the iceberg. The private review. African Sociological Review/Revue AFRICA AND ARAB COUNTRIES 1003. health facilities have more up-to- Africaine de Sociologie, 19(2), 96-131, date equipment, adequate medical pp: 98 But subsequent to the transition to supplies and are more conducive 3. Heywood, M. (2007). A background to a democratic South Africa, “macro- to delivering care. health law and human rights in South economic policies, fostering Africa. Health and Democracy: A Guide to Human Rights, Health Law and Policy in growth rather than redistribution, South Africa might once again be Post-apartheid South Africa, 2-29, pp: 12 contributed to the persistence on the cusp of history with the 4. Coovadia, H., Jewkes, R., Barron, P., of economic disparities between newly-drafted National Health Sanders, D., & McIntyre, D. (2009). The races” and this has contributed Insurance (NHI). health and health system of South Africa: significantly to the severe public historical roots of current public health health challenges which the PSI affiliates and civil society challenges. The Lancet, 374(9692), 817- country is confronted with today4. organisations are campaigning for 834. a People’s NHI7, unlinked from the 5. Lodge, T. (2014). Neo-patrimonial politics Race remains an important social Medical Aid Schemes. Publicly in the ANC. African Affairs, 113(450), 1-23. determinant of inequality, in what funded health must be for the 6. http://www.hst.org.za/publications/ is probably the most unequal people and not used to subsidise South%20African%20Health%20Reviews/ country in the world. Racialised private insurance firms and health HST%20SAHR%202017%20Web%20Ver- social inequality in South Africa providers. Private healthcare has sion.pdf#page=323 must however be understood demonstrated its incompetence 7. http://www.world-psi.org/en/fight- along with sharp class divisions and how steeped in corruption it ing-peoples-national-health-insur- as an increasing number of black is, with R22 bn (US$1.57m) lost to ance-south-africa middle class and upper class fraud and waste8 annually. 8. https://allafrica.com/sto- now benefit from the system, in ries/201903010069.html
22 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 23 ASIA AND PACIFIC
KHMU CAMPAIGNS AGAINST FOR-PROFIT HOSPITALS
The Korean Health and Medical Union (KHMU) will organise a series of campaigns this year to defend the right to quality public healthcare and for workers’ rights in the sector. At its 21st anniversary ceremony and regular congress1 which took place on 27-28 February, the union decided to include all-out mobilisation against the expansion of for-profit hospitals and against precarious work.
n its mobilisation to stop the ex- people. The demonstration includ-
ASIA AND PACIFIC pansion of for-profit hospitals, ed 280 union leaders from across IKHMU intensified its struggle at the country and over 500 rank the end of 2018. In Jeju Province, and file workers and civil society the provincial government had giv- activists. en permission for the construction of a for-profit hospital, the Jeju KHMU President Na Sun-ja said Greenland International Hospital. the union is “committed to pre- KHMU immediately set up a venting even a single for-profit Taskforce Team against the hospi- hospital from opening”. She add- tal and held a ‘Candlelight Cultural ed that protest against licensing Performance against For-Profitof Greenland International Hospital Hospital in Jeju’ on 15 December. “has since spread out nationwide, The union also initiated a signature showing the reserved strength of campaign against licensing Jeju the KHMU”. Greenland International Hospital. Health workers in Korea have On 3 January 2019, a mass ral- fought against privatisation of ly was held at the Jeju Provincial health since 2014, when KHMU led Government Building which urged three general strikes and collect- Governor Won Hee-ryong of the ed around two million signatures Jeju province to retract approval in collaboration with civil society for the for-profit hospital and step allies. The central government still down as governor for putting profit went ahead to amend the medi- over the welfare and well-being of cal service law, allowing for-profit
24 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 25 KHMU members protest against the for-profit hospital in Jeju. © KHMU
hospitals to be established. But be built on 5 December. Now, the The action against marketisation
KHMU won a partial victory, with union demands withdrawal of the and commodification of health is ASIA AND PACIFIC the amended law allowing such plan and license for Greenland a democratic one. Unions must private hospitals to be run only in International Medical Centre and forge alliances with the civil soci- free economic zones like the Jeju for it to become a public hospital. ety movement and communities. It province. KHMU is committed to blocking is a struggle for a better future for the opening of more for-profit hos- all, with universal access to quality Public hospitals represent only pitals and for strengthening the public healthcare. 10% of the entire medical institu- public nature of medical services. tions in the country. South Koreans This also requires improved staff- Realisation of the right to health re- want more public health coverage ing levels and decent work in pub- quires our unity and determination, and not more for-profit health ser- lic health facilities. Thus, the union as the KHMU shows. With these, vices, as demonstrated in Jeju. is equally campaigning for enact- victory is assured. q Governor Won organised a public ment of a new Medical Personnel opinion survey between March Law. It also wants to kick out pre- and October 2018 after the loud carious work, unpaid labour and outcry against any attempt to grant all forms of violence (verbal or be- an operating license to Greenland havioural) at the workplace. Jeju Healthcare Town Ltd. KHMU is not alone in this fight. The poll showed 58.9% of resi- According to President Na, the dents were against the for-profit union works closely with the civ- venture in health. But Governor il society movement taking the Won still issued the license, per- struggle “beyond Jeju to Seoul 1. http://bogun.nodong.org/english/ mitting the for-profit hospital to and to every corner of the nation”.
24 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 25 NEW LEGISLATION UNIVERSAL HEALTHCARE AND MATERNITY LEAVE IN THE PHILIPPINES
Filipino President Rodrigo Duterte made history on 20 February 2019 when he signed several bills the government had enacted into law, including the Universal Health Care (UHC) Act and the Expanded Maternity Leave (EML) Act. Both are part of the PSI Philippines campaign under the Health Project supported by Finnish PSI affiliates and SASK.
THE UNIVERSAL HEALTH CARE ACT “Now we need to make sure that the en- According to the World Health forcement of the new legislation does Organization: not turn into a gift for private insurance companies, nor create a double system, “The new UHC Act is a critical step to- one for the poor and the other for rich ASIA AND PACIFIC wards health for all Filipinos as it will people,” she added. facilitate major reforms to consolidate existing yet fragmented financial flows, This requires adequate funding of pub- increase the fiscal space for benefit licly delivered health services to all, delivery, improve the governance and and enhanced participation of the peo- performance of devolved local health ple in the health policy process. The systems, and institutionalize support Philippines’ first step towards health mechanisms such as health technolo- for all was taken fifty years ago with the gy assessment and health promotion”. enactment of the Philippine Medical Care Act. And in 1995, the National Speaking on this landmark develop- Health Insurance Act was passed, set- ment, the PSI General Secretary Rosa ting up the Philippine Health Insurance Pavanelli said: Corporation (PhilHealth). It had the aim of implementing universal health “This success shows how international coverage. solidarity can really make a difference for public service workers and citizens. The impact of the earlier legislation was It is even more important as it contrib- undermined by inequities in access utes to ensure the fundamental right to to health services and health status. health to the Philippines people. It is an Instead of health being free for at point achievement of the Filipinos and for the of delivery for all, citizens considered PSI global campaign on the human right to be indigent were merely subsidised. to health.” They still had to make out of pocket
26 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 27 PSI affiliates in the Philippines campaigned intensely in favour of the new laws.
payments (which they could hard- THE EXPANDED MATERNITY Implementation of the EML will go ASIA AND PACIFIC ly afford) to access care in pri- LEAVE ACT a long way in promoting women’s vate health facilities. Due to this, rights as human rights in the world poor communities have suffered The Expanded Maternity Leave of work, as well as improving ma- a higher burden of disease, de- Act is equally a very progressive ternal and child health outcomes. spite PhilHealth’s claim of achiev- legislation. It was first approved in Gender equality is an important ing “universal” health coverage for the Senate two years ago. It has part of PSI’s work, so we welcome 86% of the population in 2010. extended paid maternity leave the new law. from 60 days to 105 days. Seven The new UHC Act opens additional of these 105 days are transferable We share the view of Senator Risa sources of funding for PhilHealth, to the father, at the discretion of Hontiveros, a friend of PSI who has through taxes, which will enable the female worker entitled to ma- been at the fore of advocacy for universal access to free diagnos- ternity leave benefits. There is also the passage of the bill over the last tic services, consultation fees and an option of extending the leave few years, that: medical tests. by 30 more days without pay. And employees who are single parents “The signing into law of the As the Philippine Department of will enjoy 15 additional days of fully Expanded Maternity Leave Act Health (DOH) and PhilHealth draft paid maternity leave. is a moment mothers, families, the implementing rules and regula- and children will not only remem- tions (IRR) for the Act, we assure The law further ensures that ma- ber, but a victory generations of them of our support and urge them ternity leave shall be granted to fe- Filipinos will reap the benefits of to ensure quality health for all re- male workers in every instance of for the rest of their lives.” q mains the cornerstone of this his- pregnancy or miscarriage regard- toric legislation. less of frequency.
26 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 27 The Community Health Workers programme in Pakistan, commonly known as Lady Health Workers, LHWs programme, was started in 1994 with a staff of nearly 30,000 women. Over the years, the programme has expanded to more than 125,000 employees deployed in all districts of the country. They serve as the cadre that links first-level care facilities to communities.
COMMUNITY HEALTH WORKERS IN PAKISTAN – A STRUGGLE FOR UNION REGISTRATION
by Mir Zulfiqar Ali, Executive Director of Workers’ Education and Research Organisation (WERO), based in Karachi, Pakistan
he programme’s objective is in 2009, the All Pakistan Lady of proper security during polio to provide essential primary Health Workers Association vaccination campaigns, denial of Tmaternal, neonatal and (APLHWA). They started a national maternity leave and broken-down child healthcare services, family movement for the regularisation medical facilities. planning, and integrating health of their jobs as public servants. promotion programmes. Almost 60 They organised protest rallies, Considering the denial of LHWs’ percent of Pakistan’s population is press conferences, sit-ins and legal rights in the Province of covered by the programme. It was nationwide media campaigns, and Sindh, they organised themselves cited as a game changer in the filed a petition in the Supreme as the All Sindh Lady Health country as it played a key role in Court of Pakistan. In 2012, when Workers Association (ASLHWA) in improving health outcomes in rural APLHWA organised a large protest 2013, with the aim of collectively areas It also revitalised the public in front of the Supreme Court of fighting for the rights of LHWs healthcare system and reduced Pakistan with the participation of in Sindh. ASLHWA fights against ASIA AND PACIFIC the gendered division of public LHWs from all over the country, the injustice and unites around 25,000 and private spaces, which has Chief Justice of Pakistan ordered workers and employees of the been a major obstacle in women’s the regularisation of all staff under Lady Health Workers’ Programme. access to basic services including the programme, namely LHWs, education and employment. The Lady Health Supervisors (LHSs), In 2016, with the support of PSI programme is one of the few drivers, account supervisors and and the Workers’ Education and non-agricultural, formal sector programme management unit staff. Research Organisation (WERO), employment opportunities for a labour support group, ASLHWA women in rural areas. However, because of a series of launched a Campaign against administrative delays it took more Stolen Wages to highlight the However, despite these achieve- than four years for the regularisation impacts of delayed wages and ments, LHWs face many chal- to be adopted by each of the four demand fair remuneration and lenges. Initially not considered provinces of Pakistan. decent working conditions for employees of the public health LHWs. care system, they were not entitled Since then, LHWs continue to face to wages and labour rights. many issues, especially concerning ASLHWEA organised district-level payment of their wagesThere meetings to strengthen the union Faced with extremely poor working are delays, arrears are not paid, through increasing outreach, lobby conditions without wages, long fuel and vehicle maintenance meetings to engage government hours, no clear job description, allowance are denied, and officials, parliamentarians and uncertainty of tenure and lack of salaries do not correspond with leadership of mainstream political safety while on the field or any seniority and qualifications. Other parties. It organised conventions legal rights recognised by the issues include the lack of service and conducted research on key state, LHWs formed an association structure, sexual harassment, lack issues.
28 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 29 After three years of campaigning, the union successfully resolved some major issues on payment of wages. Regularization letters were issued to LHWs, wage costs of LHWs were included in the budget proposal of 2017 and the union made sure the requirements for bio-metric verification of employees at districts level com- plied with. These actions were led to the payment of wages directly to the workers through the treasury. In addition, ASLHEWA successfully campaigned for the payment of arrears and payment of pending fuel and maintenance dues.
STRUGGLE FOR THE REGISTRATION OF ASLHWEU
Despite these extraordinary achie- vements, ASLHWEA was not an officially registered trade union.
The process to register All Samina, one of Pakistan’s Lady Health Workers. Sindh Lady Health Workers and ©Jamshyd Masud Employees Union (ASLHWEU) started in April 2017, when the union department. The union held fifteen by the labour department. The MPs submitted documents to the regis- meetings to moblise members on assured that the issue would be tration authority. Under article 9 of district and tehsil (local) levels taken up at parliament and raised the Sindh Industrial Relations Act across the Sindh and organised in party meetings. (SIRA) 2013, the registrar is bound two demonstrations in front of to issue the registration certificate labour departments of Hyderabad In the meantime, ASLHWEU also within 15 days after submission and Sukkur. At a sit-in in the city of met with the legal advisor of the of the application. However, the Hyderabad, around 3000 LHWs labour department and provided application went through several blocked the roads for two hours, him with relevant jurisprudence ASIA AND PACIFIC administrative delays. chanting slogans against the regarding the formation of unions labour department. These actions by government servants. The legal In July 2018, with help from PSI, were widely covered by the media. advisor confirmed that LHWs are the union developed a three- entitled to form a union. After stage strategy to pressurize the In the 2nd stage, ASLHWEU leader- almost two years of struggle, the government for registration. They ship along with members and other labour department confirmed decided that this would include trade unionists, met with the labour the registration of ASLHWEU in educating the membership on the director to demand approval of the October 2018. Since ASLHWEU is importance of union registration union’s application for registration. the sole registered union of LHWs, and holding protests in front of They also warned him that more it is now applying for a ‘collective labour departments of different than 24,000 members would be on bargaining agent’ certificate. regions in Sindh. They also agreed the streets if their demand was not to lobby parliamentarians and met. He was further informed that ASLHWEU organised a convention political parties, with support the matter would be taken up with in Hyderabad on 28 December from like-minded senior trade the ILO Committee for Freedom of 2018 to celebrate this big win and unionists, lawyers and civil society Association. invited its allies to thank them for organisations as well as with their unconditional support to win international labour organisations. In the 3rd stage ASLHWEU organised the right of association for LHWs. lobby meetings with the newly Special thanks were given to PSI st In the 1 stage, ASLHWEU mobi- appointed health minister and and WERO for their full support lised its membership at the women Members of Parliament to at all stages and in anticipation of district level to prepare them for draw their attention to the violation their support in the future. q street protests against the labour of the constitutional right of LHWs
28 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 29 Every year, around 55 million Indians are pushed into poverty due to catastrophic healthcare expenditures. And this is only one of the symptoms of a broken system that is also entrenched in ethical issues over inappropriate treatment in private facilities, overcrowded and underfunded public facilities and deteriorating work conditions.
2019 INDIA FEDERAL BUDGET PUSHES PRIVATE INSURANCE IN HEALTH
by Susana Barria, PSI Trade Justice Campaigner in the South Asia sub-region ASIA AND PACIFIC
n the last issue of Right to THE INTERIM BUDGET Health, we published a critique IS BIASED AGAINST of the Indian Governments I STRENGTHENING PUBLIC proposed ‘Modicare’ health insu- rance scheme, raising concerns HEALTH SERVICES about its adequacy in resolving the issues people in India face in In the budget, government accessing healthcare. systematically neglected compo- nents that are essential to As India prepares federal strengthening public healthcare. elections in May 2019, the current For instance, capital expenditure government presented its last used to build infrastructure and budget in January. What emerges procure equipment has been from the Interim Budget 2019-2020 reduced by 43% in the interim is the consolidation of two trends budget 2019–20 over the actual – allowing public health services to expenditure in 2017–18. Resources collapse, while strengthening the towards establishing new medical role of the private sector through colleges and upgrading district one of the world’s largest public– hospitals have declined by nearly private partnerships in healthcare. 40% over the expenditure in 2017– 18. Schemes to strengthen district
30 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 31 Enrolling for National Health Insurance in India. ©ILO ASIA AND PACIFIC
hospitals and medical colleges Primary Healthcare Centres (PHCs) 8.8 billion), an increase of INR 70 with more human resources face was strengthened. This led to an billion compared to the previous reduction in real terms too. As for improvement of health outcomes year. INR 64 billion is devoted to the the frontline workers, the budget by bringing people back to public Pradhan Mantri Jan Aarogya Yojana speech offers a risible increase sector facilities in rural India. (PMJAY), with an impressive 167% in the honorarium of community However, the budget allocation for increase over the previous year. health workers (known as NHM is lower than the expenditure accredited social health activists of the previous year. The share WHAT IS THE AYUSHMAN or ASHAs) from the current INR of NHM in the total allocation on BHARAT SCHEME? 2,000 per month to INR 3,000 health has gone down from 61% (US$ 28 to 42), which is far less in 2014–15 to 49% in the 2019–20 The Ayushman Bharat Scheme than the long-standing demand budget. is a national health initiative that for a monthly wage of INR 18,000 was announced in early 2018, with (US$ 253) (JSA Statement). Yet, the overall health budget has two components. The National seen an increase, more than half Health Protection Mission or The National Health Mission (NHM) of which is dedicated to a single Pradhan Mantri Jan Aarogya Yojana launched in 2005 had increased scheme, the insurance component (PMJAY) is the insurance scheme budgetary allocation to public of the Ayushman Bharat Scheme. for hospitalisation in empanelled primary care facilities especially The Ministry of Health and Family private or public hospitals. PMJAY in rural areas. It is under this Welfare (MOHFW) has received an is expected to cover around 100 programme that the network of allocation of INR 633 billion (US$ million families (close to 40%
30 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 31 of Indian population) when fully GDP or the WHO recommended not only through this assured operationalised. 5% of GDP. market share, but with subsidies as well, such as facilitated access This is an expansion of an existing Private players have welcomed the to land and viability gap funding, as scheme called RSBY, under which move towards a consolidation of was announced in a recent press India’s poorer families were insured insurance-based health provision release. by the government to the tune of and are also proposing their own INR 150,000 (US$ 2,100). Under estimates. Private providers are Not surprisingly, the government PMJAY the insurance coverage demanding that the allocation for push for PMJAY has been is increased from INR 150,000 to PMJAY be increased to INR 2,500- criticised by health networks 500,000. The second component 3,000 billion if the government such as Jan Swasthya Abhiyan is the expansion of existing sub wants it to be sustainable for the (JSA). “The Interim Union Budget health centres, under the name private sector to be meaningfully 2019–20 reflects a definite push of Health and Wellness Centres involved. This would mean that for an insurance-based model of (HWC) to provide free primary care while the government does multi- healthcare, which comes at huge in rural areas. ply its budget from the current and disastrous costs of the public 1% of GDP to the recommended provisioning of health. […] When PMJAY: SINKING PUBLIC 5% of GDP, it fully sinks public insurance is scaled up in a context funding for healthcare into mostly where there is a huge inadequacy RESOURCES FOR PRIVATE private provided hospitalisation and inequity in access, and an PROFITS? for 40% of the population through almost complete absence of PMJAY, with little resources for regulation, it would result largely While PMJAY has received the primary care provision. Further in the transfer of public funds highest increase in this budget and this would also mean that 60% into private hands without any represents close to 10% of the total of the population will either have matching health outcomes or MOHFW budget, the allocation to pay on their own for healthcare financial protection.” remains highly inadequate for what services in the private sector, or it proposes to do. The current rely on a further neglected public The Statement published by the allocation (INR 64 billion) is lower health system. nation-wide health coalition which than the government’s planning is affiliated to the People’s Health body Niti Ayog’s own calculations ASIA AND PACIFIC Movement (PHM) calls on the FLAWED PUBLIC–PRIVATE that at least INR 100 billion is government to strengthen public required, just to pay premiums. PARTNERSHIPS IN provisioning of healthcare, ensure HEALTHCARE adequate supply of free medicines Yet, health economist Indranil and diagnostics, work towards Mukhopadhyay shows that even Experiments with the earlier avatar upgrading of primary health centres this calculation corresponds to a of PMJAY, the RSBY, have shown and community health centres, grossly underestimated premium that where the public healthcare improve working conditions of the payment of INR 250 per person sector is weak, the scheme gives health workforce and ensure com- per year. This would be largely a boost to the private sector. munity accountability of public insufficient to ensure adequate Data from 2016 shows that 80% health services. Unions of health hospital treatment of the covered of reimbursements under the workers in particular, and public population. He suggests that the scheme were made to private services workers in general will numbers should be in the range enterprises, though in smaller be an essential ally in exposing of an allocation of above INR 600 hospitals. Big players in healthcare the impacts of the current flawed billion to be adequate – a figure hospitals (the so called luxury direction of health policy. Clearly, closer to the total health budget of hospital sector) have welcome with this budget, the challenge for the MOHFW. the increase coverage as 40% of a just and equitable health system India’s population would become with quality public provision of This points to the inadequacy of potential buyers of the treatment healthcare at its core has gotten the health budget, which stands at rates they offer. harder for the right to health around 1% of GDP (union and state movement. q budgets combined), instead of the PMJAY essentially incentivises long-standing promise of 2.5% of private investment in healthcare,
32 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 33 EUROPE
EPSU 50th Standing Committee
ON HEALTH AND SOCIAL SERVICES
Jan Willem Goudriaan, General Secretary, EPSU The European Federation of Public Service Unions Standing Committee on Health and Social Services (EPSU SC HSS) held its 50th statutory meeting on 27 February at the International Trade Union House, Brussels. Speaking during the course of the meeting, the EPSU General Secretary, Jan Willem Goudriaan noted that this marks a milestone in the history of EPSU.
he EPSU SC HSS meets collaboration between EPSU and Baba Aye, the PSI Health and Social twice a year to deliberate the European Trade Union Institute Sector Officer updated the Steering Ton issues of concern to (ETUI). Committee on implementation of EUROPE health and social sector unions the PSI Programme of Action 2018- across Europe. It also serves to With the EPSU Congress coming 2022 in the sector and recent promote social dialogue within the up on 4-7 June at Dublin, updates HSS-related activities in general. European Union mechanism and on the draft Programme of Action with the European Hospital and and congress preparation was an He spoke on engagement with Healthcare Employers’ Association important item on the agenda. The the Global Skills Partnership (GSP) (HOSPEEM). first exchange on thematic priori- in relation to international health ties for the health and social ser- worker migration, the PSI Right to The meeting deliberated on a vices sector for 2019-2024 was a Health global campaign; proposed wide range of issues, including first step to formulate the Standing research work for 2019, and items of sectoral social dialogue Committee’s Work Programme for enhancing participation of affiliates in the hospital sector such the next five-year period. in World Health Organization and as joint priorities and action OECD Health Committee meetings. points for EPSU in the field of Exchanging information on staf- He also urged more European musculoskeletal disorders (MSD) fing levels and taking action to en- affiliates to contribute articles to and psychosocial risks and stress sure safe and effective staffing for the PSI Right to Health Quarterly. at work (PSRS@W). Concepts and health will be an important part of reforms concerning skills mixes and the work in the coming period, ac- The meeting ended in high spirits, task shifting were also discussed. cording to the EPSU Policy Officer with 8 October fixed as the date for And affiliates shared information on for the sector, Mathias Maucher. A the next meeting of the Steering initiatives to address the impacts web portal will be established as a Committee. q of digitalisation in health and repository of good practice. social care, in line with an ongoing
32 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 33 UNISON will ensure that the voice of healthcare staff is heard in the way the Plan is implemented. ©Number 10
THE LONG TERM PLAN FOR THE NHS IN ENGLAND
by Guy Collis, health policy officer of UNISON
he UK National Health through legislation at this time, does, it remains hard to see how Service has just published given that the UK Parliament the NHS will be able to implement Tits latest plan for how remains deeply divided and many of the worthwhile ambitions the NHS in England should be dominated by Brexit. contained within the Plan. organised over the next five years and beyond. Another positive aspect of the Beyond this, the continued failure report is a focus on improving by the government to publish its The 136-page document1 repre- mental health services and an un- proposals for social care, along sents a vision of a future health derstanding of the need to halt the with ongoing cuts to public health service that is based more on fragmentation of England’s am- services, threaten to undermine treating patients outside of hos- bulance and emergency services. the goal of a more cohesive health pitals, with a larger role for new and care service for England.
EUROPE digital technology and, in theory at But there are less positive aspects least, a much smaller role for mar- too, such as the continuing desire There is of course further uncer- ket competition. Overall, the plan to drag yet more “efficiency sav- tainty stemming from the UK’s im- represents a mixed bag of laudable ings” from administrative budgets, pending exit from the European intentions and daunting challenges despite the fact that most hospi- Union and the lingering fear that for a system that remains beset by tals have already been cut to the the extra funding the government financial problems and a staffing bone. has committed to the NHS, while crisis. welcome, will only be enough And, as waiting times for treatment to keep services from collaps- From a trade union point of view, continue to grow, there is a ing rather than allowing the sys- there are some clear positives, renewed drive to offer private tem to make the much-needed including the potential for legisla- sector treatment to patients if they improvements. tive change to remove the worst have been waiting too long for elements of the NHS market in care. UNISON will be working hard in England that were established by the coming months to keep up the abhorrent Health and Social Perhaps most important of all, the pressure for a meaningful Care Act of 20122. however, is what is missing from workforce strategy and to ensure the Plan, most tellingly the rela- that the voice of healthcare staff It should, however, be noted that tively meagre commitments for the is heard in the way the Plan is such plans are only suggestions workforce. implemented. q from the NHS itself rather than clear commitments from government. It An accompanying strategy for the remains to be seen how realistic future health and care workforce 1. https://www.longtermplan.nhs.uk/ it is to expect politicians to push has still not surfaced and until it 2. http://www.legislation.gov.uk/ukp- ga/2012/7/contents/enacted
34 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 35 FRANCE LET’S TALK ABOUT STAFFING AGAIN
The survey on staffing involves paramedics and healthcare staff in France. ©Gaetan Zarforoushan by Eve Rescanières
he French union CFDT done work is the predominant It is with this mindset that we Santé Sociaux (health and factor. wanted to give space to non- Tsocial services) decided academic feedback to build our to continue with the survey As in September 2017, employee investigation. on staffing for paramedics and testimonials add a personal touch healthcare staff it initiated in 2017. to the statistics, diagrams and Once upon a time there was the This annual barometer is part of the percentages, which are certainly aging of the European population. roadmap that our federation has essential to build a database to Once upon a time, there was set itself in terms of investment in present an opposing motion to the budgetary discipline with its share European bodies and international employers, but not sufficient on of deregulation, flexibility and trade union involvement. their own. precariousness for employees. EUROPE The initiative is connected to “What is important is not the Once upon a time, there was a CFDT’s work with the European number of patients, but the needs network of European health and Federation of Public Service Union of each patient” is the response social services unions, pioneers of (EPSU). In Brussels, a question of of employees when asked for their social justice. concern to the various European opinion on good practice. unions in the health and social And in this network, once upon sector is; should we advocate for To be able to act and have a time, the CFDT Santé Sociaux minimum staffing level legislation? influence in European dialogue, was and still eager to contribute CFDT Santé Sociaux thinks it is vital to building a social Europe which We think that the important thing to reconnect with the workplace. guarantees high protection for is not to provide a ready-made workers in the health, social and and definitive answer, but to ask Slowly but surely, our method medico-social sector. the right questions, and to ask the is proving effective. On issues main stakeholders. as diverse as activity and skills To do this, we are giving you benchmark and the competence an appointment in September Thus, our questionnaire, which of care assistants, or the setting 2019 to continue to refine our employees had access to between up of territorial social dialogue vision of the working conditions 25 June and 1 July 2018, is the same conferences, our main concern is of healthcare professionals and as in 2017. And as in September those who do, not those who give paramedics through the prism of 2017, the respondents spoke of the orders to do. And sometimes, the workforce. q conflicts of workplace values management ends up adopting that go against their professional what we have built with the ethics. Dissatisfaction with poorly employees.
34 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 35 Ivan Kokalov, President of Federation of Trade Unions – Health Services, BULGARIAN Bulgaria. FEDERATION OF TRADE UNIONS
HEALTH SERVICES CONTINUES TO DEFEND WORKERS AND PUBLIC HEALTH
he Federation of Trade the Bulgarian health sector. Since Unions – Health Services then, the federation has continued T(FTU-HS-CITUB) was foun- to consistently promote the cause ded 30 years ago and is Bulgaria’s of workers in the health sector, largest trade union federation in with adroit use of the collective the healthcare sector. Throughout bargaining mechanism.
EUROPE its existence, the federation has successfully overcome many chal- Its most recent collective bar- lenges and has become an active gaining agreement (CBA) was in partner whose voice is heard by 2018. This included an increase governments, employers and NGOs of 45-50% for initial salaries in alike. FTU-HS continues to defend the medical sector (1,500BGN for the social and labour rights and in- doctors, 950BGN for nurses*), terests of all healthcare sector em- together with occupational health ployees – be they medical special- and safety provisions, specific ists (doctors, nurses, midwives) social acquisitions and quali- or administrative and assistance fication brackets, with the aim personnel. The federation works of providing a better sense of with regional councils around the security at work, leading to better country to ensure health sector quality healthcare. workers all over Bulgaria benefit from labour protection, guarantees The CBA also includes provisions on the right to work, decent wages for preventing all forms of and better quality of life and social discrimination and of physical status. or psycho-social violence in the workplace and as well guarantees The first collective bargaining in the working conditions to agreement was signed in 1991 after prevent chronic stress and physical FTU-HS-CITUB helped develop the or psychological injuries at work. collective bargaining process in
36 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 37 Bulgarian Federation of Health Workers organised a joint protest in 2018 with the Nurses’ Association against nurses’ low wages, their working conditions, increasing migration of nurses and the consequent lack of qualified nurses in hospitals, all of which have a detrimental effect on the quality of health services. The action was successful and resulted in the signature of new collective bargaining agreements and wage rises. EUROPE
The federation has applied the in Western Europe, makes health It is the Bulgarian State - and collective bargaining agreement as workers wonder if the govern- not the patient - that ought to a principal tool to defend healthcare ment aims to align the Bulgarian be indebted to the medical pro- workers’ interests and labour rights health service with countries with fessionals. We must, therefore, when faced with difficult and well-functioning healthcare sys- demand rules and conditions of controversial healthcare reform. tems or whether it is following the government that are designed to Over the years, FTU-HS has dictates of a “global market in so- retain our medical specialists here constantly insisted on the need cial services”. in the country. Through their active for reform in the healthcare sector work, FTU-HS and its members and for noticeable improvements Answering that question poses provide a counterpart to market in public healthcare provision in a serious challenge to Bulgarian pressures in the name of solidarity Bulgaria. As an active member of society as a whole and to the and the health and well-being of the sectoral legislative committee political class in particular. Despite the Bulgarian people. in Parliament, the federation the complex political and financial frequently introduces initiatives environment in the healthcare * Note: 1 BGN = 1,955 EUR q and amendments. sector, FTU-HS-CITUB strives to preserve the moral dignity of the However, the ongoing health- medical profession and to foster care reform in Bulgaria, especially trust in the health workers’ daily when compared with develop- battle against disease. ment trends of healthcare systems
36 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 37 INTER-AMERICAS
CANADIAN UNIONS CAMPAIGN FOR UNIVERSAL ACCESS TO PRESCRIPTION DRUGS
ccording to the Wellesley The costs of this overbearing Lack of universal access to pre- Institute1, Canada is the influence of big pharma is not only scription medications has increas- Aonly developed country in dollars and cents. It includes ingly undermined the benefits of with a universal healthcare the loss of lives and has adverse Canada’s universal healthcare pro- programme which does not include impact on people’s wellbeing. gramme. In an article published in access to prescription drugs. Thus, An expert research report3 the Canadian Medical Association while Canadians don’t need to pay commissioned by Canada’s nurses Journal5 in 2012, Michael R. Law et to see their doctor, prescription last year found that at least 640 al showed a 10% cost-related non- drugs are not covered by the people die prematurely every year adherence to prescription in the universal healthcare programme. from one disease alone because population. And they are some of the highest of unaffordable medications. It priced in the world, with patients’ also documented the avoidable By 2015, members of almost one in out-of-pocket expenditure on deterioration of the health status four families were not adhering to prescribed drugs amounting to of some 70,000 older Canadians prescriptions because they could $3.6bn annually. annually due to the high cost of not afford the price of medication, medications. according to a national poll6.
INTER-AMERICAS Big pharmaceutical corporations make huge profits from the A national poll commissioned An additional 36% of Canadians marketization of prescription by the Canadian Federation responded that pharmaceutical drugs. And they have great of Nurses Unions (CFNU) and expenditures were causing policy influence on the federal conducted by Environics Research them financial hardship. 91% of and provincial governments. between 9 and 21 January reveals respondents declared support for The National Union of Public and that Canadians want universal a national pharmacare programme Government Employees (NUPGE) pharmacare. This was stated in a that would ensure universal observed that “for large insurance media release4 issued by CFNU on access. companies or drug manufacturers, 19 February. the current situation is very CFNU organised an issue-based profitable. They would prefer The poll confirmed that: campaign to place healthcare not to see a national pharmacare • 88% agree it is better to issues at the front burner of programme.”2 have a simple cost-effective debates during the 2015 elections; prescription drug coverage #Vote4Care7. The campaign cal- Similarly, Linda Silas, CFNU program that covers everyone led for expanding medicare into president said, “big pharma and in the country than the existing new areas, including pharmacare. the insurance industry profit from patchwork programme. Public concern on the need for a our current system, and Canadians • 85% agree that it is worth national pharmacare programme don’t trust them to look out for investing public money for which puts people over profit our interests or think they should prescription drug coverage. heightened after the elections. influence our public health care • 84% think that prescription policy”. drugs should be included in our For over a year, the federal health public health care system. committee heard from more than
38 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 39 ©: Government of Prince Edward Island
100 experts after which it8 called of British Columbia/NUPGE12 to universal pharmacare plan. There for the expansion of the Canadian the Advisory Council on the Imple- are lessons to be learnt from the Health Act (CHA) to include phar- mentation of National Pharmacare. experience of the province since macare in April 2018. Two months The submissions stressed the the introduction of an insurance- later, Prime Minister Justin Trudeau need for Canada’s national based drug coverage in 199717. constituted a seven-member na- pharmacare to be “governed by tional advisory council led by Dr a public authority on a non-profit The most important of these, as Eric Hoskins, former Ontario health basis to ensure accountability Fédération Interprofessionnelle minister, to come up with a national exclusively to the public interest de La Santé du Québec has pharmacare strategy. and democratic institutions”. consistently pointed out, is that The final report of the advisory such public-private systems of In September, more than 709 council will be released in June. insurance do not work18 and 100% national, provincial and territorial However, an interim report13 was public pharmacare programme is organisations, including NUPGE issued at the beginning of March. necessary. and CFNU, came up with the best While presenting the report, Dr INTER-AMERICAS model for national pharmacare, Hoskins said “the current system Activists across Canada will thus as part of the policy formulation of prescription drug coverage in continue to campaign for universal process, national dialogue initiated Canada is inadequate, unsustaina- access to prescription drugs as an with the constitution of the ble and leaves too many Canadians essential element of the struggle advisory council. behind”. His council has called for for full realisation of the right the establishment of a national to health. This includes urging This is based on Consensus drug agency to address the issue. the advisory council to include Principles for National Phar- a recommendation for national macare10, which has now been The interim report fails to pharmacare to be governed by the adopted by over 80 organisations, address a universal, single-payer principles of the Canada Health viz: pharmacare14 programme. But, Act (CHA) in its final report. q as Larry Brown, NUPGE President • Universality points out, it “clearly states • Public, Single-Payer the urgent need for national Administration phamacare”15. The campaigns of • Accessibility the labour movement and civil • Comprehensiveness society organisations in Canada • Portable Coverage has thus yielded fruit.
These principles constitute the A united front16 of trade unions backbone of the 28 September and civil society organisations 2018 submissions of CFNU11 and in Quebec has demanded the the Health Sciences Association implementation of a national public,
38 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 39 1. http://www.wellesleyinstitute.com/ 7. Giasson, T., & Marland, A. J. (Eds.). 13. https://www.canada.ca/content/ health/whats-next-for-prescription- (2015). Canadian Election Analysis, dam/hc-sc/documents/corporate/ drug-coverage-in-canada-2/ 2015: Communication, Strategy, and about-health-canada/public-en- 2. https://nupge.ca/content/let-feder- Democracy. UBC Press. gagement/external-advisory-bodies/ al-government-know-we-need-afforda- 8. issued a report https://nupge.ca/ implementation-national-pharmacare/ ble-universal-and-public-pharmacare content/federal-health-committee-re- interim-report/interim-report.pdf 3. https://nursesunions.ca/wp-content/ leases-report-recommending-phar- 14. https://www.cbc.ca/news/politics/phar- uploads/2018/05/2018.04-Body-Count- macare-now-%E2%80%93-nup- macare-drug-agency-council-1.5044673 Final-web.pdf ge-calls-federal 15. https://nupge.ca/content/adviso- 4. https://nursesunions.ca/canadi- 9. https://nursesunions.ca/phar- ry-councils-interim-pharmacare-re- ans-overwhelmingly-support-univer- macare-consensus-announced/ port-positive-momentum-building sal-pharmacare-new-poll/ 10. http://www.healthcoalition.ca/wp-con- 16. https://www.newswire.ca/news-releas- 5. Law, M. R., Cheng, L., Dhalla, I. A., tent/uploads/2018/10/2018.10.26-Con- es/a-united-quebec-front-demands- Heard, D., & Morgan, S. G. (2012). The sensus-Principles.pdf that-ottawa-implement-a-public-univer- effect of cost on adherence to pre- 11. https://nursesunions.ca/wp-con- sal-pharmacare-plan-809171913.html scription medications in Canada. Cmaj, tent/uploads/2018/02/Adviso- 17. http://www.spph.ubc.ca/a-lesson-for- 184(3), 297-302. ry-Council-on-Pharmacare-Submis- canada-quebec-pharmacare-system-cre- 6. https://www.theglobeandmail.com/ sion_2018-09-28_FINAL-web.pdf ates-winners-and-losers/ news/national/national-pharmacare- 12. https://hsabc.org/system/files/ 18. http://www.world-psi.org/en/striv- has-large-support-across-canada-says- HSABC%20Pharmacare%20Submission. ing-towards-100-public-medication-in- poll/article25509989/ pdf surance-
CHILE FENPRUSS UPDATES ITS “ANOTHER HEALTH SYSTEM IS POSSIBLE” PROPOSALS
he National Confederation such as the constitutional right to meeting, so that the final docu- INTER-AMERICAS of Health Service health, strengthening the public ment produced with the help of TProfessionals (FENPRUSS) health system and its operation, contributions by academics and has enthusiastically begun work funding and human resources. specialists on the issue of health on updating its proposals for can reflect the thoughts of all strengthening and defending the “We have decided to take this FENPRUSS members. public health system in Chile. This important step because we important work is taking place with must contribute to the discus- Matías Goyenechea, adviser to the the valuable support of Matías sion on the health reforms that union, said that the work aims to Goyenechea and his team from Chile needs. We already know be participatory and to contribute the Creando Salud Foundation1, a lot about the situation and to the discussion on health re- who will be calling on a range of this task represents one of our form in the country. He said that academics to contribute ideas on union’s key areas of work. We it builds on work already done by the four components that we hope have pressed for a bigger and FENPRUSS in its booklet Salud will complement the work that has better public health system. que Soñamos es Posible. “We already been completed by the We have defended the system want to analyse the difficulties and organisation. through our proposals, ideas inequalities in the system and we and actions in the street in the hope we can achieve this by up- This work will build on materi- 23 years since FENPRUSS was dating the union’s proposals for al included in the document La founded”, said Aldo Santibáñez, the health system”. q Reforma del Bicentenario de la national president of FENPRUSS. Fenpruss2 and the booklet La Santibáñez explained that the re- 3 Salud que Soñamos es Posible sults will be validated in the same 1. http://creandosalud.org/ (Another health system is pos- way as before, that is, at a national 2. FENPRUSS Bicentenary Reform sible) and will deal with issues 3. Another Health System Is Possible
40 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 41 “We want it to be a participatory process that takes on board the aspirations of all those who believe in a strong and high- quality public health system able to make progress towards providing timely and supportive health care for all Chileans”, said the FENPRUSS national president. FENPRUSS members display the booklet “Another Health System is Possible.” Photo: FENPRUSS
Thanks to the generations trained in the middle of the 20th century, Chile has played a leadership role in the field of public health. Despite the brutal reverses inflicted by the dictatorship, it has health indicators that place it in the vanguard in Latin America and the world. For example, life expectancy is longer than in the United States, even though there are less resources. This success has been built on the commitment of health professionals. Comparing Chile with other OECD countries, the country has 2 hospital beds per 1,000 inhabitants (OECD average is 4.9); 3.2 medical appointments (OECD average 6.4); and 9,936 hospital INTER-AMERICAS discharges (OECD average 15,508). This clearly shows that Chile allo- cates less resources to health, as does data showing health expenditure per inhabitant: health expenditure in the United States is US$ 8,233 per year per inhabitant, the OECD average is US$ 3,265 and Chile is US$ 1,202, including both the public and private sectors.
The situation is even more dramatic if we take into account that the av- erage figure of US$ 1,202 per person disguises the fact that the public health system provides healthcare for most of that part of the population that has a smaller percentage of income. In this context, FENPRUSS will steadfastly continue to defend the public health system and oppose the growing transfer of resources to the private sector, whether that takes place through granting hospital concessions or the procurement of ser- vices. FENPRUSS will continue to campaign for decent work and quality jobs, denounce the shortfall in human resources, demand training and adequate working conditions and reject any abuses, in the knowledge that the ultimate aim is to deliver quality health care to service users.
40 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 41 COSTA RICA : GOVERNMENT THREAT TO THE RIGHT TO STRIKE
By María Esther Hernández Solís
The National Association of Nursing Professionals (ANPE)1 in Chile is fighting new legislation which aims to abolish the right to strike. The action started when the union exposed that big business was receiving fiscal advantages while public services struggle. Now they are fighting against four bills removing the right to strike.
bill on “Legal Security Court forced the finance ministry Regarding Strikes and to present a list of companies that AAssociated Procedures” submitted tax returns indicating
INTER-AMERICAS is before the Costa Rican legis- zero profit and therefore no tax lative assembly. The government liability. aims to abolish the right to strike, if it is passed into law. The bill is The list was made public and backed by a president who has showed that one in four big com- demonstrated his contempt for panies claimed zero profit even the people and a legislative as- though these companies had a sembly ready to remove hard-won turnover of 8.1 billion colons2 dur- labour rights, including the right to ing the period of 2010-2016 and protest. their assets were valued at 15.5 billion colons3. The background is a strike that began on 10 September and last- It was equally alarming to find out ed 90 days. The strike was called that, in the period 2010-2014, the against government proposals for tax authorities did not examine the fiscal consolidation and reducing accounts of 76% of the big com- the fiscal deficit. The only ones to panies that declared net losses in lose out were public service work- two or more consecutive financial ers, while big companies continue years. Despite these figures, the to evade and avoid their responsi- government is threatening the pay bility to pay tax. and working conditions of public service workers, who have their This bias towards big business was taxes deducted at source and thus unmasked when the Constitutional no tax liabilities.
42 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 43 Rodrigo López and María Esther Hernández Solís, ANPE. María Esther Hernández ©Aaron Sequeira. Solís is a leading member of the National Association of Nursing Professionals (ANPE)
In the current legislative session, contrary to the country’s con- of negligence. Workers have four bills under consideration all ar- stitution and violates inter- taken action on behalf of pa- gue that protests should not affect national instruments. It goes tients rather than to win bene-
the general public and all of them against decisions made by fits for themselves.” INTER-AMERICAS remove the right to strike. The bills the Committee on Freedom arbitrarily classify a range of ser- of Association and the The government should respect vices as essential and are drafted Committee of Experts on the the social dialogue mechanism in such a way as to make workers Application of Conventions and and promote decent work to curtail afraid to go on strike. They even go Recommendations. It is there- industrial conflict instead of resort- so far as to threaten the dissolution fore a regressive measure. ing to strategies that undermine of individual unions. workers and trade union rights, As for what is an essential even if this is with laws. Such a Our union was called on to re- public service, the authorities law, if passed, is unjust. Our union spond at the legislative assembly’s should specify what exactly is therefore ready to defend pub- Economic Affairs Committee. Dr is essential about the servic- lic service workers’ right to strike, Rodrigo López García, our gen- es in question and define the including health workers in Costa eral secretary, and Dr Ma. Esther concept in relation to those Rica. q Hernández Solís, a member of our particular services. The CCSS4 executive committee, emphatically provides an essential service expressed their opposition: but it is the administration’s negligence and not strikes that “We do not agree with this bill. have paralysed the provision of specialist services, causing 1. http://anpe.co.cr/ It removes the right to strike, delays in operations and long 2. 13,900.000$US which is a basic right for work- waiting lists and forcing insured 3. 25,240.000$US ers who feel under threat at parties to make claims against 4. Costa Rican Social Security Fund. any particular moment. It is the institution on the grounds
42 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 43 ARGENTINA: 30,000 HEALTH PROFESSIONALS STRIKE
The Trade Union Federation of Health Professionals of Argentina (FeSProSa) organised a two-day strike on 6-7 March “against adjustment and dismissals”. Nearly 30,000 doctors, nurses, pharmacists and other professionals downed tools in over 600 health facilities across the country.
n a press statement, the union The health workers’ strike repre- INTER-AMERICAS said, “We are committed to sents resistance to attacks on the Ifighting for dignified health public health system and the public for the most vulnerable sectors sector in general. Neoliberal poli- of society, a fight that goes hand cies of the government, under the in hand with decent wages and direction of international financial infrastructure conditions.” institutions like the International Monetary Fund (IMF) pose grave The government’s refusal to enter danger to the people of Argentina. a collective bargaining agreement FeSProSa’s struggle, in conjunc- that would improve working tion with a broad array of unions conditions for health and social and civil society organisations, workers is only part of its renewed draws the attention of the world to attacks on working conditions this danger. and the labour movement. And to rub salt on an open wound, the Public health funding has witnessed government dismissed workers a series of sharp cuts over the last at the largest health facility in the year2, while military expenditure country, the Posadas Hospital in continued to soar3. This bad Buenos Aires. This is in line with situation became worse with the its programme of downsizing the government’s austerity budget4 public sector workforce, since for 2019, which slashes social 2016. Such layoffs (and pay cuts) spending by 35%5. Immediately have been more aggressive1 in the this was adopted by the Senate in last few months. November 2018, unions and civil
44 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 45 ARGENTINA: 30,000 HEALTH PROFESSIONALS STRIKE
Health professionals in Argentina demonstrate against budget cuts in the health service.
society organisations organised benefit from public health as it is 1. https://www.efe.com/efe/english/world/ demonstrations against austerity for members of the union. argentine-public-employees-go-on-strike- INTER-AMERICAS measures. But these were to no to-protest-layoffs/50000262-3525450 avail. PSI has consistently argued against 2. https://www.telesurenglish.net/news/ Argentines-Protest-Changes-Cuts-to- how IMF conditionalities constrict Health-Ministry-in-Govt-Austerity- IMF conditionalities for a $57.1 social funding, to the detriment Package-20180906-0012.html 6 billion credit facility in total are of the people. We condemn the 3. https://www.telesurenglish.net/news/ at the root of the ongoing social regime of fiscal consolidation Argentina-Announces-Ministry-Cuts-But- crisis. The budget of austerity is the IMF has foisted on Argentina. More-Military-Spending-20180911-0017. designed for an IMF deal7. Two There is also the need for the html months before the budget was Argentine government to get its 4. https://www.france24.com/en/20181115- signed, global health activists took priorities right. Health and social argentinas-senate-approves-austerity- to the streets in Washington, DC to services, not the military, deserve budget adopted by the Argentine government highlight the looming health crisis primacy of government funding, 5. https://www.aljazeera.com/ facing the people of Argentina, if the people are actually at the news/2018/11/argentina-senate-passes- with the strict targets set by the centre of development and the austerity-budget-181115184759290.html IMF in its conditionalities. political system is democratic. q 6. https://www.imf.org/en/News/ Articles/2018/09/26/pr18362-argentina- The impact of austerity measures, imf-and-argentina-authorities-reach-staff- including salary “adjustments” and level-agreement layoffs of staff, on the Argentine 7. https://www.voanews.com/a/argentine- health system is severe and will senate-approves-austerity-budget-for- imf-deal/4660517.html be long-lasting. The struggle of FeSProSa is as much for the millions of Argentinians who
44 PUBLIC SERVICES INTERNATIONAL RIGHT TO HEALTH - VOLUME 2 ISSUE 1 2019 45
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