TIME for QUALITY REVOLUTION in HEALTH CARE ISSUE 5 - November/December 2018 in THIS ISSUE

TIME FOR QUALITY REVOLUTION IN HEALTH CARE ISSUE 5 - November/December 2018 IN THIS ISSUE

▪▪EDITORIAL Quality Revolution in Health 3 ▪▪INTERNATIONAL Quality Public Health for All: Time for Action 5 4th People’s Health Assembly held in Bangladesh 6 Salute to Amit Sengupta! 8 Astana Conference: 40 Years after Alma-Ata 9 For Decent Care Work: Time to Act 10 Financing Social Protection 12 Eliminating workplace violence in the health sector 14 ▪▪AFRICA & ARAB COUNTRIES Healthcare in South Africa - #NoToXenophobia 16

Environmental Health and Universal Health Care in Nigeria 17

Collaborating for quality health in Mauritius 19

Fighting for a People’s National Health Insurance in South Africa 20 ▪▪ASIA AND PACIFIC India: is “Modicare” the answer? 22

Unions defend aged care in Australia 23

From challenge to success – Organising hospitals in the Philippines 25

Fiji nurse questions the World Bank about privatisation 27 ▪▪EUROPE CFDT fights for quality residential elderly care 28

Turkey: Health workers charged for rendering humanitarian services 30

Dismissed care workers reinstated in Germany 32 ▪▪INTER-AMERICAS PSI warns: transnational companies are bad for your health! 33

Health care staffing levels: an election issue in Quebec 34

Americans want better healthcare for all 35

Right to Health is a bi-monthly electronic newsletter published by Public Services International (PSI), in furtherance 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 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 EDITORIAL

Time for Quality Revolution in Healthcare

major focus of this edition is the need to go beyond the tokenism which favours profit-making for health companies of different sorts over the provision of quality health Afor all, presented as “universal health coverage”. A position the PSI has held for several years is that quality health for all is what we need, and this is possible only when it is publicly delivered.

The report of the Lancet Global Health Commission on High Quality Health Systems in the SDG era (HQSS), which was released in September, reinforces our point. It shows quite clearly that the universal health coverage strategy is not sufficient to improve health in low-income and middle-income countries (LMICs). Provision of good quality health care is essential for the attainment of sustained improvement in health outcomes and the full realisation of the human right to health.

The report, entitled “Time for a Quality Revolution” highlights the importance of strong health systems and the need for governments to invest in designing and building people-centred health systems that deliver safe, effective and quality care.

This perspective buttresses some of the views jointly expressed by the World Health Organization (WHO), World Bank (WB) and Organisation for Economic Cooperation and Development (OECD) earlier in July. In the document “Delivering quality health services A global imperative for universal health coverage,” the three international organisations observed that “better access to care without attention to its quality will not lead to desired population health outcomes.”

They further agreed “that high quality, safe, people-centred health care is a public good that should be secured for all citizens,” emphasising the fact that quality of care is the foundation of people-centred healthcare.

These are positions that Public Services International and its affiliates across the world have upheld over the years, in the face of reforms driven by international financial institutions that undermine the capacities of already fragile health systems. We have always advocated universal access to quality health services. PSI has also continually stressed the obvious: this is possible only as universal public healthcare.

Thoroughgoing reform must be implemented by governments to carry out a quality revolution in healthcare. On this, there is a consensus by all stakeholders in the health and social sector, including PSI. But when it is argued, as in the Bellagio Declaration on high quality

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health systems, that “these reforms will not succeed without including the private health sector and other sectors,” a seeming truth acquires ominous undertones.

The question is not so much about involving the private sector, it is about how this is to be done. PSI has affiliates in the private sector which it represents. It might not be realistic to wish away some level of private sector involvement in healthcare delivery, but such involvement must take due cognisance of health as a fundamental right of all persons in truth and in deed. Consequently, it must be appreciated that health care is not a commodity, even when delivered through private providers. The marketization of health services must be curtailed, to make quality health universally accessible.

Starting from the 1980s as Private Finance Initiatives (PFI), and later through other forms of Public-Private Partnerships (PPPs), private sector involvement in public health, including through contracting out of services and staff, contributed to the crisis of quality we face today.

Pharmaceutical corporations and health insurance companies, which are giants of the private sector such as global health and social care companies, have also skimmed off billions of dol- lars that could have been invested into providing quality public health services, as rents – well beyond what could legitimately be considered as profits. Quite a few multinational health companies have equally been involved in tax evasion.

Besides, quality healthcare delivery by private providers is priced beyond the reach of the vast majority of the population, particularly in low-income and middle-income countries. The only way these people could have access to quality healthcare is with governments being firmly in the saddle of driving the process.

As I said at the time of the launch of the report:

“Health is a fundamental human right. The responsibility to ensure that every woman, man and child has quality health rests squarely on the shoulders of governments. It is worrisome, as the Lancet Global Health Commission observed, that we lose not less than 8 million people every year due to poor quality of care. We thus need to go beyond the dominant perspective of universal health coverage.

The challenge before governments all over the world is to put people over profit. Ordinarily this should not be a challenge, because governments are supposed to serve the people and not big business. But, the questionable influence of multinational corporations over governments and multilateral international organisations’ decision-making processes has become so pervasive in re-defining otherwise lofty goals. “Universal health coverage” for example, has not meant universal access to quality health.

Governments must invest adequately in the public health system, and promote concerted tripartite social dialogue in the sector, as agreed upon in the Working for Health: Five-Year Action Plan. They must also make sure that the private health care providers uphold quality standards in terms of service delivery and the working conditions of health workers”.

Public Services International and its affiliates will continue advocacy for universal quality public healthcare. We will work with governments, international organisations and civil society organisations to make sure the future of health is genuinely people-centred. Thus, we will lay the foundations for a healthier, better world, as envisioned in the sustainable development goals.

Rosa Pavanelli

PSI General Secretary

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governments as recognised in the United Nations General Assembly Quality Public Health for All: resolution A/RES/67/81.

In the third quarter of the twenti- Time for Action eth century, major advances were made towards the attainment of health for all. This informed the Alma-Ata Conference’s vision of “Health for All by the year 2000”, forty years ago. At the heart of this tendency towards achieving uni- ast year the UN General "The enjoyment of the highest at- versal healthcare was the gener- Assembly officially estab- tainable standard of health" is a alisation of a strong, well-funded lished 12 December as fundamental human right. But half and people-centred public health L system. It was cut short with the an international day, making of the world’s people have no ac- 12 December 2018 the first cess to basic health services and turn towards neoliberal globalisa- International Universal Health about 100 million people globally tion, accompanied by funding of Coverage Day. For PSI, it are pushed below the pov- health and social services, privati- provides an opportu- erty line as a result of sation and marketization. nity to reflect on healthcare expendi- Over the last four decades, private the unacceptable ture every year. for-profit interests have expanded health inequities in healthcare delivery. They in- between and The immense clude multinational corporations within coun- majority of and national conglomerates in the tries across these are in pharmaceutical industry, health the world. low- and mid- insurance, hospital services and Considering dle-income social care. For them, health and the abundant countries, with social care is nothing but another wealth availa- women and economic sector; and a growing, ble to humankind children bearing lucrative one at that, estimated at and major advanc- the brunt of poor US$5.8 trillion per year. es made in healthcare access to health. Over the last decade of delivery, this situation is To set and maintain the normative global economic crisis, millions of indefensible. context which protects business poor people in high-income coun- interests, multi-stakeholder part- 12 December was first marked tries have also not been able to nerships are promoted, often by as Universal Health Coverage day enjoy quality health services as a foundations. Whilst these foun- several years ago by UHC 2030, result of austerity measures, lib- dations might not have direct ties a multi-stakeholder partnership. eralisation of health services and with for-profit entities and thus This was subsequent to the United commodification of health. could formally be said to have Nations General Assembly’s adop- no conflict of interest in pushing tion of the resolution on glob- Health for all is not only desira- for public-private partnerships al health and foreign policy (A/ ble, it is possible. But this requires in healthcare delivery and the RES/67/81) which recommended categorical political decisions by international health policy pro- the inclusion of universal health governments which challenge the cess, they are essentially philan- coverage in the discussions on the dominant neoliberal model of de- thro-capitalist mechanisms that post-2015 development agenda. velopment. The responsibility for undermine the capacity and vision Attaining universal health cov- accelerating humankind’s “tran- needed for states’ commitment to erage by 2030 was subsequent- sition towards universal access universal public health care. ly included as Target 3.8 of the to affordable and quality healthcare services” rests squarely on Sustainable Development Goals, Continued page 6 in 2015.

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From page 5

There is no doubt that all hands In line with the human rights- A better future with health for all have to be on deck to ensure based approach to health, the underlines the SDG Target 3.8. health for all becomes a reality. mobilisation of communities and Two years ago, PSI kicked-off its But, the primacy of public health- civil society to hold governments global campaign for the Right to care delivery as the bedrock of to account for realisation of the Health, convinced that this will universal healthcare cannot over- right to health is sacrosanct. be achieved as universal public emphasized. This is often missing Ensuring that multinational cor- healthcare. PSI, its affiliates and or at best accorded passing atten- porations pay their fair share of allies will continue to campaign tion in the universal health cover- tax to ensure adequate domestic for universal health care, built on age discourse. Whilst it is argued resource mobilisation for the pro- strong public health systems that by proponents of universal health vision of quality health for all is es- unambiguously put people over coverage as a multi-stakeholders sential. Development cooperation profit, and thus actually ensure project that the role of the private must contribute significantly to that no one is left behind. q sector in moving towards a gov- enabling poorly-resourced coun- ernment-led UHC is unclear, what tries fund public health. Health is clear is that businesses stand employment and decent work in for profit maximization. the sector must also be promoted to ensure quality care delivery.

n the week of 15- 19 November 2018, over a thousand del- 4th Peoples Health Assembly Iegates, including grassroots health activists, civil society organisations, academic institu- holds in Bangladesh tions, NGOs and policymakers by George Poe Williams from across the world, including a delegation from Public Services International, gathered in Savar, Dhaka, Bangladesh for the Assembly acknowledged the level service. The threat on Obamacare fourth People’s Health Assembly of progress made over the last in the USA is a classic example. (PHA-4). four decades towards the attain- The intentional underfunding of Convened in the year marking the ment of Health for All. public health systems in low- and 40th anniversary of the Alma-Ata middle-income countries has However, PHA-4 observed with Declaration, the 4th People`s become a norm simply to ren- dismay the slow pace at which Health Assembly provided a der those systems as not work- these gains are made at the ex- unique space to analyse global able, as a means to justify their pense of millions who die of pre- health, share experiences, mutual privatisation. ventable conditions, especially in learning and jointly strategize for low and middle income countries, Carefully analysing the statis- future actions towards winning while policymakers forge selec- tics, participants clearly pointed Health for All. The Alma-Ata tive healthcare plans under neo- out the divide between the rich Declaration for today’s world was liberal schemes that exacerbate and the poor and indicated how critically discussed during several inequality and do not conform to directly proportional wealth is to sessions. the principle of Primary Health health. For example, around the Factoring in shared experi- Care - the availability of quality world, under-five mortality rates ences and the realities from health care that is accessible and dropped by 47% from 78 deaths different regions of the world, affordable to all. per 1,000 live births to 41 deaths making comparative analysis of per 1,000 live births during the On the contrary, it was observed Comprehensive Primary Health period 2000 to 2016. that healthcare is increasingly Care (CPHC) and other global becoming expensive and inac- Even so, 5.6 million children initiatives such as the SDGs 3 and cessible as healthcare provision under-five died in 2016 as doc- 5 aimed at tackling the health is gravitating more towards umented in the Global Strategy needs of the world, and consid- privatisation than as a public for Women`s Children`s and ering the available statistics, the

6 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 A cross-section of participants at a workshop organised by PSI at PHA-4

Adolescents` Health (2016- healthcare they need, and family educative, objective and demon- 2030). Regrettably, the Global planning needs are increasing strated togetherness in the Health Observatory (GHO) data in double digits with population advocacy for Health for All. The reported that 46% (2.6 million) of growth, while 225 million women assembly calls for the return to those deaths were neonatal (oc- who need family planning are yet Comprehensive Primary Health curred in the first 28 days of life to gain access. Care as prescribed in the Alma- i.e. 7,000 newborn deaths each Ata Declaration, an end to the day of their first week of life!) All of the above show that some- privatisation of health services, The statistics indicates children thing is terribly wrong with the increased budgetary support in poor communities to be more way in which the issue of health to health care by governments, vulnerable. Worse of all, 60 coun- is being handled in our world donors and other partners and tries will not meet the neonatal today. But more troubling still is the setting up of mechanisms mortality SDG target by 2030, if the fact that researchers believe of accountability in the health there is no change in the current if we continue with the current systems. course of affairs. status quo, it will take 250 years to achieve Health for All! The People`s Health Movement In the same vein, maternal and its allies, including PSI, mortality has decreased by 37% The world cannot wait that long recommitted themselves to the from 2000 to 2015. However, to stop the preventable death cause of a more robust advocacy about 303,000 maternal mor- of women and children in their for Health for All in the coming talities were recorded globally in hundreds of thousands and years and tasked themselves 2015 alone. Sadly, the majority of millions annually, especially when with the objective of expand- these deaths were due to pre- we already have a health care ing human rights-based health ventable conditions. It was also delivery model which started off campaigning networks to more recorded that maternal mortality forty years ago. Delegates at the individuals, groups and countries. is the major cause of death of assembly reasoned that if health q teenage girls between 15 and 19 is, indeed, a basic human right, years of age. it should be given the Alma- George Poe Williams is the Ata Declaration’s redress which General Secretary of the It is especially alarming to note makes it available, accessible, National Health Workers’ Union that amidst all the progress affordable and of quality to all. of Liberia (NAHWUL) made thus far, in developing countries, it is reported that only The five-day cordial interaction of half of women have received the members from the global community was thought provoking,

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Report, which contextualises the global state of health within the social-economic and political dy- namics of the world.

Amit was also the moving spirit behind the WHO Watch which brings young health activists and academics together as volunteers during WHO governing bodies’ meetings. They analyse items on the agenda of these meetings and document proceedings from Salute to Amit Sengupta! a people’s perspective, making them available at real time to by Baba Aye public health activists across the world, electronically.

r Amit Sengupta, a leading World leaders had promised In the last two years, PHM has be- figure in the global struggle “Health for All by 2000” at the come a close ally of PSI, and Amit Dfor the right to health, died International Conference on a very good friend, brother and on 29 November in a swimming Primary Health Care held at Alma- comrade of ours. After discus- accident off the Betalbatim beach Ata on 6-12 September 1978. sions with him, PSI gladly made in Goa, India, at 60 years of age. With their failure to deliver on this the conference hall at our head For four decades, he committed promise, it became clear that the office always available for the his life to the struggle for a bet- people had to fight to win univer- WHO Watch workshops. We were ter world, a struggle which priori- sal health care from below. And also proud to have had him on tised the furtherance of scientific this could only be as public health the health panel during the 30th knowledge and public health for all. for all. PSI World Congress in 2018. And, Amit Sengupta has been the only He graduated from the Maulana Sengupta was one of the activ- person from outside PSI to have Azad Medical College in Delhi in ists who saw the need at the turn contributed an article, at our re- the 1980s and established a gen- of the century to take action in quest, for the Right to Health. eral practice. This was however this direction. They organised the just for a short while. Convinced of First People’s Health Assembly at His death is a great loss to us. He the need for the expansion of sci- Savar, Bangladesh where dele- will be missed not only because entific knowledge and making this gates adopted a People’s Charter of his tireless drive and selfless accessible to the average woman of Health. This was where the contributions, but as well for and man, he left general practice People’s Health Movement was his wittiness, simplicity and rich to help build the Delhi Science formed. sense of humour. We will remem- Forum and later the All India ber his message at the PSI World People’s Science Movement. By Over the next 18 years, Amit Congress that we have to fight the early 1990s, he was involved threw himself energetically into politically, including marching on in the Total Literacy Campaign in building PHM as a network that the streets to win the full reali- India, helping to teach urban and now spans 70 countries, bringing sation of universal public health rural poor people how to read and together organisations, academ- care. And we will also never forget write. ics and activists committed to the the ripples of his soft laughter. struggle for a better world with Dr Sengupta left his biggest foot- health for all. We extend our condolences to his prints as an outstanding organiser wife Tripta, and son, Arijit. Whilst in the global movement for health He was associate global coordina- Amit is irreplaceable, we pray they for all. The first step in this di- tor of the PHM and editor of the find solace in knowing his work rection was taken in 2000, when Global Health Watch (GHW) which touched lives across the globe he contributed to founding the was launched by PHM in 2005. and will continue to inspire many GHW is the civil society’s alterna- People’s Health Movement (PHM). more, until health for all is won.q tive to the WHO’s World Health

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undreds of people including policy-makers, aca- Hdemics and civil society activists gathered for the Global Conference on Primary Health Care at Astana, Kazakhstan on 25-26 October. This was to com- memorate the 40th anniversary of the first International Conference on Primary Health Care, which was held in Alma-Ata, Kazakhstan.

The 6-12 September 1978 conference was a watershed, defining health as a fundamental human right in the Declaration of Alma- Ata. This opened the floodgates for advocacy for primary healthcare as an anchor for guarantee- ing health for all. The world, however, failed to achieve the aim of “Health for All” by the Year 2000 Astana Conference: set by the conference. The Astana Conference, which 40 Years after Alma-Ata like the Alma-Ata Conference was convened by the World Health Organization (WHO) and UNICEF was thus seen as an opportunity to reignite commitment to the spirit of Alma-Ata, “to achieve universal health coverage and the These are: empowering people to this core message is missing in the Sustainable Development Goals”. take ownership of their health and commemoration of that historic healthcare; making bold political moment. But, without address- The Astana Declaration on Primary choices for health; putting pub- ing the social-economic context Health Care, which was endorsed lic health and primary care at the of healthcare delivery, achieving by the WHO Member States at the centre of UHC, and aligning part- health for all might continue to be beginning of the conference, ap- ner support to national policies, a tall order. pears to have captured the hopes strategies and plans. which Alma-Ata had kindled, with The neoliberal model of develop- its sub-title “From Alma-Ata to- There were a series of side events ment which dominates discourse wards Universal Health Coverage organised as “café sessions” by and practice today is a major and the Sustainable Development civil society organisations. These obstacle to realising the right Goals.” included the Medicus Mundi to health for the immense ma- International’s “Calling for a New jority of the world’s population. The Declaration, which aims at Global Economic Order - the for- Winning a new global econo- framing the role of Primary Health gotten element of the Alma-Ata mic order which puts people over Care (PHC) within national ef- Declaration,” which was support- profit is thus central to ensuring forts to achieve Universal Health ed by PSI. universal health care. Coverage (UHC) and proposing clear actions for achieving pro- This session noted that the po- The Astana conference also fea- gress, is hinged on four pillars to litical core of the Alma-Ata tured audio-visual exhibitions, address “today’s challenges and Declaration can be found in its call which included two PSI health seize opportunities for a healthy for a New International Economic videos. q future.” Order (NIEO). Forty years later,

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For Decent Care Work: Time to Act

are work, both paid and un- children, 300 million elderly peo- We must take collective action. paid, is at the heart of hu- ple and almost 190 million people Social care and care work have Cmanity and our societies”. with disabilities. to be properly remunerated. The From cradle to grave, as children, proper value of care work has to adults and elders, directly or in- This means that women as moth- be recognised and appreciated by directly, care work ensures our ers, sisters, daughters and rela- authorities at municipal, regional self-development and the repro- tives will still continue to bear the and national levels in all coun- duction of social life. More than brunt of unpaid care work in their tries. The ever-widening gender three quarters of care givers are families. If the amount of labour pay gap must be bridged, and this women and girls. And most of time spent as unpaid care work must be done with a sense of ur- these provide unpaid care work were to be valued on an hourly gency. And the conditions under in their families. This contributes wage basis, it would reach around which care is delivered must be significantly to the reinforcing of US$11 trillion, which is 9% of the humane and mindful of the dig gender inequality. global GDP. nity of care givers.

There are currently 209 million In this context, it will be impos- Trade union organising is central care workers worldwide. This sible to achieve the Sustainable to our taking collective action. PSI number is expected to rise to 475 Development Goal 5; gender affiliates in the care sector will be million care jobs by 2030, because equality. Inability of a significant supported to better defend their of changing family structures, proportion of the world popula- members and expand with mem- increasing care dependency ra- tion to access quality care will bership drives that bring larger tios, and changes in care needs. equally undermine the achieve- numbers of care givers into the Increasingly ageing populations ment of Sustainable Development trade union movement. With in- across the world, as well as an Goal 3; good health and wellbeing creasing union power, we will be increase in women’s employment for all. better placed to influence policy on care work and care jobs. outside the home, means that How can we avert this looming fewer are delivering unpaid care crisis? How can we ensure uni- work at home. Affiliates in all other sectors will versal access to quality social care also be encouraged to include However, even this increase is and ensure that millions of women issues such as childcare in their not likely to be enough for the and girls who would otherwise be collective bargaining process- provision of quality social care. In trapped in the thankless rhythm es. For example, crèche services 2015, 2.1 billion people needed of unpaid care work can realise should be provided by employers care in the world. By 2030, the their full potential in various fields for nursing mothers, but in many figure is expected to rise to 2.3 of human endeavour? workplaces, they are not. In such billion. These will include 2 billion cases, trade unions should add

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this very important item to their brothers from other trade unions The meeting facilitated exchange collective agreements. across the world for a “Global of knowledge and experiences Unions strategy meeting on the amongst the Global Unions and That the time is now for us to take care economy” on 22–23 October their affiliates on the challenges decisive action was driven home in Nyon, Switzerland. and opportunities for organising by 8,000 women in Glasgow in in the care sector. It also called October. These members of two The meeting, which took place for policy-makers to consider care PSI affiliates (UNISON and GMB) just as our sisters in Glasgow were as a common good where invest- in Scotland organised a 48-hour commencing their strike, was or- ment should be made to ensure strike over gender-based pay dis- ganised by the International Trade quality jobs as a basis for quality crimination in the public services. Union Confederation (ITUC) and social care delivery. They included care workers, school five Global Union Federations: staff, cleaners and caterers. And Public Services International (PSI), Working in solidarity with other they spoke with one voice, after International Union of Food, trade unions and the civil socie- a 12-year tribunal battle and the Agricultural, Hotel, Restaurant, ty movement, PSI and its affili- repeated refusal of the Glasgow Catering, Tobacco and Allied ates will vigorously campaign for city council to act against gen- Workers’ Associations (IUF), improvement in the wages and der-based pay discrimination. Education International (EI), working conditions of care work- International Domestic Workers ers, and the provision of quality It cannot be overemphasized that Federation (IDWF) and UNI glob- child care as key elements of our we need united action to win, in al union, with participation of commitment to achieving gender the struggle for decent care work Women in Informal Economy equality by 2030. q and gender equality. Thus, PSI Globalising and Organising and its affiliates joined sisters and (WIEGO).

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Financing Social Protection

he international labour • SDG 1.3: Implement nationally conference was an opportunity to movement is examining the appropriate social protection engage in discussions that high- Tquestion of financing so- systems and measures for all, lighted the adverse consequences cial protection on the national including floors, and by 2030 of such “innovation.” and international levels. PSI and achieve substantial coverage of other unions took part in the the poor and the vulnerable Social protection is a human 1 Global Conference on Financing right , which is key to achieving Social Protection organised by • SDG 3.8: Achieve universal sustainable development, includ- the International Trade Union health coverage (UHC), including reducing poverty and social Confederation (ITUC) and Friedrich ing financial risk protection, ac- inequality and building a more Ebert Stiftung (FES), on 17-18 cess to quality essential health inclusive society. Consequently, September 2018, in Brussels. care services, and access to governments are bound to take safe, effective, quality, and af- decisive actions nationally and in- PSI has a long-standing record of fordable essential medicines ternationally, to realise universal campaigning for publicly-fund- and vaccines for all social protection2. ed universal social protection. Realising the need for concerted • SDG 8.b: By 2020 develop and The “social protection is not af- efforts to attain universal social operationalize a global strate- fordable” argument is not ten- protection and the importance of gy for youth employment and able, as “there are alternatives 3 social protection floors, PSI was implement the ILO Global Jobs even in the poorest countries ” . one of the founding member or- Pact. These include: re-allocating public expenditures; increasing tax rev- ganisations of the Global Coalition The responsibility for implement- for Social Protection Floors enues; expanding social security ing social protection systems and coverage and contributory rev- (GCSPF) and remains active in the social protection floors rests on coalition’s Core Team, as a Global enues; eliminating illicit financial governments. It is thus important flows; using fiscal and foreign -ex Union Federation, along with the to challenge perspectives which ITUC. change reserves; managing debt present private sector-driven i.e. borrowing or restructuring ex- Social protection floors are rel- means of financing social pro- isting debt, and adopting a more evant to achieving three key tection as value-neutral alterna- accommodative macroeconomic Sustainable Development Goals tives to publicly provided social framework. Targets: protection. The September global

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There are definitely challenges American sub-region. The exam- PSI thus urges restraint in consid- to financing social protection. ple of AMUSSOL in the Dominican eration of “innovative” ways that However, these have to be situat- Republic shows that “encourag- are not evidently situated within ed within a broader perspective of ing formalisation” is necessary an anti-austerity, human rights- the neoliberal “consensus”, with for consolidating gains made in based logic. At the heart of social its pillars of cuts in social spending, expanding social protection for protection is the essence of our privatisation and deregulation. workers in the informal economy8. solidarity as human beings and Related to this is the centrality of the primacy of public financing Confronting the challenges to fi- public provision of social securi- and provision. It thus has to be nancing social protection requires ty for achieving universal social hinged to other relevant areas of that we strive for policy influence, protection. our work geared towards building including an alternative approach better and more inclusive society, that clearly puts people before The 2019 World Development including tax justice and building profit in the policy process, both Report draft frames universal people-centred development co- nationally and internationally. social protection as a response operation. q mechanism to the increasing Ten years into the global econo- number of people not covered by mic and financial crisis, austerity contributory schemes, due to the measures have only worsened the changing nature of work. But the 1 Article 22 of the Universal Declaration of Human Rights sorry state of vulnerability faced changing nature of work is not by most of the human population, merely technical. Precarious work 2 International Covenant on Social and particularly in low and middle-in- is becoming widespread precise- Economic Rights, ILO Social Security come countries. It is thus essential ly because safeguards of Labour (Minimum Standards) Convention, 1952 at this moment for the trade un- Market Institutions have been (No. 102), SDG 1.3 ion movement and civil society to rolled back over the last few dec- 3 Ortiz, I., Cummins, M. and Karunanethy, K., send a clear message that sustain- ades. In essence, “universal social able social protection financing is 2015. Fiscal space for social protection and protection” as envisaged by the the SDGs: Options to expand social invest- not only possible, but indeed nec- report, is more of a renewed form ments in 187 countries., ESS Working Paper essary to ensure social stability of “targeting” Social Protection 48, International Labour Office, Geneva and economic recovery. The voice benefits and “social safety nets”, of workers and the broader civil on one hand, and the IFIs expan- 4 Sharma, A., 2017. Innovations in social society movement must be loud sion of Social Protection to “social protection financing: Impact Bonds. http://socialprotection.org/learn/blog/ in the development discourse and spending” on the other. policy process in pointing out that innovations-social-protection-financing-im- only a rights-based approach can Further, as the International pact-bonds ensure this. Steering Committee of the Global 5 Ortiz et al, Op cit. Labour University correctly points Thus, we need to be wary of “in- out, “what is proposed in the 6 NUPGE, 2016. Privatization by Stealth: The novations in social protection fi- draft Report effectively amounts Truth About Social Impact Bonds. nancing” which are firmly rooted to shifting the entire burden of https://nupge.ca/sites/default/files/docu- in the logic of privatisation, such ments/Privatization-by-Stealth-Oct-2016. financing social protection to the pdf as Social Impact Bonds. They are nation state,” to the benefit of presented as an “evidence-based multinational enterprises. 7 ECA 2018. Public Private Partnerships in the 4 solution ”. And Colombia’s launch EU: Widespread Shortcomings and Limited of SIBs in 2017 was heralded as The evidence abounds, as Ortiz Benefits. “an innovative PPP” means of et al (Op cit), stressed, that the https://www.eca.europa.eu/Lists/ social protection financing5. This major challenge confronting so- ECADocuments/SR18_09/SR_PPP_EN.pdf reflects the increasing expansion cial protection spending is not so 8 Ghesquière, H.,2016, Amussol: informal of SIB projects as the new face much a lack of resources but rath- workers have access to social security in the 6 of “privatisation by stealth” . But er public policy choice, including Dominican Republic!, WSM Thematic Report PPPs in general have “widespread those inspired by international fi- Latin America No. 2, Wereldsolidariteit – shortcomings and limited bene- nance institution conditionalities, Solidarité Mondiale. fits7” and should be rejected in and tacit support for profit over our consideration of social protec- people by states. The artificial 9 Open letter of Mr Juan Pablo Bohoslavsky tion financing. constriction of social protection the United Nations Independent Expert on the effects of foreign debt and other related financing has “been worsened by international financial obligations of States PSI is committed to research austerity and earlier labour re- work and policy advocacy in line on the full enjoyment of all human rights, forms, including freezing wages or particularly economic, social and cultural with the ILO Transition from the lowering minimum wages, labour rights to Mr Jim Yong Kim, the World Informal to the Formal Economy market deregulation, social secu- Bank President: https://www.ohchr.org/ Recommendation 2015 (No. rity privatisation and targeted so- Documents/Issues/Development/IEDebt/ 204), particularly in the Latin cial protection schemes9”. LetterWorldBankAugust2018.pdf

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 13 INTERNATIONAL

Eliminating workplace violence in the health sector

by Sandra Massiah

SI participated in the 6th Addressing Workplace Violence in 4. Manage the impact/con- Violence in the Health the Health Sector.” PSI serves on sequences of aggression/ PSector conference that was the Steering Group, working with violence held in Toronto on 24-26 October other international organisations with the theme “Advancing the and Oud Consultancy. The health Sandra Massiah, sub-region- Delivery of Positive Practice.” The and social services sector is a key al secretary for the Caribbean, conference provided a platform sector for the PSI; one third of its represented Public Services for all parties confronted with affiliates, organising not less than International at the conference the phenomenon of violence in 8 million members, are in this and presented the PSI positions healthcare to develop and pro- sector. The majority of them are and statements on: pose strategies for the imple- women. • An ILO convention backed by mentation of positive practice, a recommendation on ending that would help them proactively The conference programme was designed to: violence and harassment in respond to this complex problem. the world of work; Positive practice is defined here 1. Advance the delivery of positive practice through • PSI’s Right to Health as practice sufficiently informed Campaign: #PublicHealth4all by capacities and technologies understanding the causes to minimize violence such that and patterns of aggression/ • Fighting economic injustice the central task of the healthcare violence and harassment of Lady service – delivering the best help 2. Examine initiatives to reduce Health Workers in Pakistan to its users – can be achieved. aggression/violence to ad- • PSI’s tax justice campaign PSI’s involvement in this and vance the delivery of positive the previous five conferences practice The keynote addresses, parallel sessions, workshops, site visits started with the preparation and 3. Share resources aiding the 2005 publication of the joint ICN, and networking events provided advancement and the deliv- many opportunities to share in- PSI, WHO, ILO training manu- ery of positive practice al “Framework Guidelines for formation, strategies and lessons

14 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 INTERNATIONAL

learned in tackling violence in the the Health Sector - A Trade Union health sector – in developed as Response.” The study, updated well as developing countries. The in 2018, integrates the latest local organising committee com- achievements of PSI’s affiliates in prising nurses’ unions in Canada the health sector. included many trade union allies who shared their efforts in high- PSI urged all present to be allies lighting the increasing instances with trade unions in calling on of violence in the sector as well their governments and employers as the collective action taken to to support the ILO convention change the status quo. and recommendation on ending violence and harassment in the “As nurses, we reject violence as world of work. q ‘just part of the job’ and we will be part of the solution!” - CFNU President Linda Silas said in a discussion paper by the Canadian References Federation of Nurses’ Unions • Proceedings of the 6th (CFNU). Violence in the Health The CFNU is Canada’s national Sector conference federation of nurses’ unions, “Advancing the Delivery of representing close to 200,000 Positive Practice”, Toronto, frontline care providers and Canada 2018 nursing students. “Enough is • Proceedings of previous enough” issues a national Call to conferences Action to provincial and federal governments, employers, unions • Framework Guidelines and frontline nurses themselves for Addressing Workplace to work together to put a stop to Violence in the Health violence in healthcare. Sector (English, French, Spanish and Russian versions In her keynote address, Christiane available for download). The Wiskow, ILO Sector specialist Training Manual is a com- in Health services, shared tools plement to the Framework and resources. She highlighted Guidelines. Taken together the increasing attacks on health they should facilitate dis- workers in emergencies and con- semination and effective flict situations, utilisation of the Framework “Violence is a human rights issue Guidelines. The Manual is and particularly the deliberate intended for a wide range of targeting of health facilities has operators in the health sec- drawn attention as it is a viola- tor, including health person- tion of international human rights nel, members of professional and humanitarian laws.” associations, trade unionists, administrators, managers, The conference ended with trainers, decision makers and a Special interactive plenary practitioners in general. session and debate about the current achievements and future required initiatives. PSI used the opportunity to highlight the work Sandra Massiah is the PSI of affiliates and especially the up- sub-regional Secretary for the dated report “Tackling Violence in Caribbean

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 15 AFRICA AND ARAB COUNTRIES

Healthcare in South Africa - #NoToXenophobia

peaking at a meeting of the International South Africa, Mr Health Insurance (NHI) scheme. National Educational Health Mostoaledi is trying to scapegoat The gazetted National Health Sand Allied Workers Union migrants instead of taking urgent Insurance Bill limits the rights of (NEHAWU) in November, the steps to improve access to af- refugees and asylum seekers to: South African Health Minister, fordable and quality health care for emergency health care services; Mr Aaron Motsoaledi said the all persons in South Africa. This is services for notifiable conditions country’s health system is over- a demonstration of contempt for of public health concern, and; burdened by foreigners. This is a several international covenants paediatric and maternal servic- dangerous playing up of the xen- the South African government has es at primary health care level. ophobic card, to deflect attention signed, including the International Undocumented migrants are ex- from the major challenges facing Covenant on Economic, Social and cluded from any form of care un- public healthcare delivery: inade- Cultural Rights, the Convention der the Bill, reflecting the mindset quate funding; poor governance, on the Elimination of All Forms expressed by Mr Motsoaledi. and sharp social inequality which of Discrimination Against Women reinforces health inequity. and the Convention on the Rights PSI submitted a memorandum ad- of the Child. dressing this and other salient is- Public Services International de- sues in the NHI Bill. A key marker fends access to quality healthcare The South African deputy pub- of the realisation of the right to services as a fundamental human lic protector, Mr Kelvin Malunga, health is universality of access to right. Human rights cannot be re- rightly pointed out that the health health services. This requires the duced to the citizenship status of minister made “a desperate state- strengthening of public health- persons. Over the years, South ment after failing to address the care delivery and not discrimina- Africa has been a leading voice in systemic issues” confronting pub- tion against migrants, many of Africa and globally, in calling for lic health. whom contribute significantly to “Health for All”. The statement by the growth and development of It is particularly worrisome that Mr Motsoaledi is thus a step back- the South African economy. q wards, which should be frowned at. the minister of health made this statement at a time that the South As noted by Shenilla Mohamed, African government is in the pro- Executive Director of Amnesty cess of fashioning out a National

16 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 AFRICA AND ARAB COUNTRIES

Environmental Health and Universal Health Care in Nigeria

he health situation in Nigeria are poor. The spread of emerg- healthcare, the priority it de- is similar to that in many ing infectious diseases, particu- serves. Despite verbal commit- Tother countries, where in- larly in low- and middle- income ment to primary health care, sufficient funding is allocated to countries, points at the need for more resources are used on cu- environmental health and univer- greater concern of governments rative care in practice. Further, sal health care and people suffer to preventative health. the importance of environmental as a consequence. Femi Abolade, health as an integral element of an Environmental Health Officer From Africa to Asia and the primary health care is often not and a member of the Medical and Americas, there is still so much recognised. Health Workers’ Union of Nigeria, room for progress to be made denounces the situation not to ensure health for all. Disease Air, soil, water, microbes, plants, only in his country but across all burdens remain unacceptable. animals and humans are major continents. Maternal and child morbidity and components of the environment. mortality are still too high. Poor Imbalances in the relationship of “Health, it is said, is wealth. environmental sanitation and one of these with the others may Governments thus have a respon- lack of basic hygienic facilities are have a catastrophic effect on sibility for ensuring the soundness some of the reasons for this terri- them all. Management of the envi- of mind and body of the popula- ble situation. ronment in such a way that there tions they serve, for their coun- is healthy balance between its dif- tries to be prosperous. Poverty Most governments have not giv- ferent components, contributing reigns where health outcomes en environmental health, an im- to the prevention of outbreaks portant aspect of preventive

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 17 AFRICA AND ARAB COUNTRIES

of disease, is what environmental the highest killer of children under In summary, we must understand health stands for. five in sub Saharan Africa, due to that the health of one person is the presence of stagnant water by extension, the health of all. Making the environment less haz- that encourages the breeding of The economy of a nation thrives ardous for humans is at the heart mosquitos. Incidences of diar- only when its citizens are healthy. of sanitation and environmental rhoea, typhoid fever, Lassa fever Diseases, no matter how insignif- health. It is an art as well as a sci- and Ebola virus diseases are all icant they may seem, affect pro- ence. It deals with the prevention heightened by neglect in sanita- ductivity, social wellbeing and col- and control of disease factors in tion and hygiene. lective prosperity. the environment, because prevention is cheaper and better Air pollution from industrialised We must therefore work together than cure. areas is a major cause of climate as individuals, groups and govern- change. It also poses a serious ments to expedite actions on pro- Components of environmental threat to health and can lead to moting environmental health in health include: housing sanitation, cancer and other infections, lead- order to achieve universal health water sanitation, food hygiene ing to early death. All these show care.” q and safety, health education, that we have neglected our com- school health services, air pol- mitment to environmental health. lution control, care of the dead, It is now time to turn the tide. sanitation of markets and business premises, prevention and Universal access to potable water control of communicable diseas- should be a major concern to gov- es, and control of noise pollution. ernments at all levels in Nigeria. Never again should women and It is without doubt that environ- children need to travel far in mental health, if properly har- search of safe water. nessed, will contribute significantly to achieving universal health Open defaecation in and around care. our communities must be dis- couraged and stopped to prevent In Nigeria today, as in many other the continued outbreaks of pre- developing countries, a significant ventable diseases such as chol- number of homes lack basic hy- era and diarrhoea. Governments gienic facilities such as toilets and must help ensure that there are potable water, exposing them to no households where toilet facil- grave health risks and dangers. ities are lacking. Solid waste is not properly managed. People (most often young Governments must, as a matter girls and women) travel more than of urgency, improve on the devel- five hundred metres to get water opment of critical infrastructure, which is often not clean enough especially in rural areas. These to drink. include good roads and proper drainage to help channel waste Young girls face significantly in- water and prevent breeding of creased risks of sexual harass- malaria-transmitting mosquitoes. ment, including rape, in homes This would also help to enable ac- without toilets, especially when cess to an improved waste man- they have to go out to ease them- agement system. selves at night. Malaria remains

18 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 AFRICA AND ARAB COUNTRIES

Honourable M. Anwar Husnoo, Minister of Health & Quality of Life

Collaborating for quality health in Mauritius

he Government Services concerted efforts of the govern- workers is central to ensuring bet- Employees Association of ment, health workers and other ter health for all as well as eco- TMauritius (GSEA) organised stakeholders could contribute to nomic growth and development. a Health Day on 9 August 2018 lessening costs. at the GSEA headquarters in col- Apart from the discussions held laboration with the Ministry of In his address, Brother R. Sadien, during the event, the GSEA or- Health and Quality of Life. It was GSEA President, said that the un- ganised free health screening an awareness-raising programme, ion will mobilise the support of activities for breast cancer and which a huge participation of health workers in Mauritius for all cervical cancer, and blood dona- members of the Association and public health initiatives aimed at tions. Non-communicable disease the public. reducing the burden of non-com- (NCD) profile tests were also done municable diseases. for free. In his speech at the opening cer- emony, the Minister of Health “As a trade union, GSEA is con- Following the positive response and Quality of Life, Hon. Anwar cerned with improving conditions from those present, the GSEA Husnoo, stressed that eradicating of service of its members. We plans to organise similar activities or reducing non-communicable recognise that this is inseparable across the country and reach a diseases needs joint action by the from efforts aimed at realising wider audience with the message Ministry, development organisa- the right to health of all people of intensified collaboration to tions, trade unions and NGOs. The resident in Mauritius. This is nec- make quality healthcare available collaboration with GSEA, he thus essary for building a better and to all Mauritians. q noted, is essential. more inclusive society,” he said.

He explained the high cost to The United Nations High- tax payers of treating patients Level Commission on Health suffering from non-communica- Employment and Economic ble diseases (NCDs) such as dia- Growth report also shows that betes and renal failure, and that improving employment and working conditions of health and social

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 19 AFRICA AND ARAB COUNTRIES

Fighting for a People’s National Health Insurance in South Africa

by Naadira Munchi

n 29-30 August 2018, the than providing a framework for The transitional model proposed PSI Southern African Sub- equal access to health care for all. by the government towards full regional Office hosted a implementation of the NHI also im- O In the market economy, health Conference entitled “Towards poses medical aid schemes pack- a People’s National Health care has become a commodity. A ages on formal sector employees, Insurance”. The conference was recent inquiry into South Africa’s throwing a lifeline to medical aid an initiative of PSI Young Workers, health system highlighted the schemes. In addition, the Medical and brought together approxi- deep inequality between private Aid Schemes Amendment Bill mately 27 trade unions, civil so- and public provision of health aligns the schemes with the NHI. ciety organisations and progres- services. A privileged 16% of the This is an example of how the pri- sive academics to debate and population who have access to vate sector has used lobbying to wrestle with the National Health medical insurance, are serviced by influence government policy. Insurance (NHI). The main objec- 70% of the country’s doctors in tive of the conference was to cre- the private sector, with an excess In a discussion on migrant rights, ate alliances with other CSOs that of bed capacity. In contrast, the it was resolved that the NHI support social justice to push for public health system battles with should return to its initial position a National Healthcare policy that a devastating shortage of beds, in the White Paper, which gave guarantees universal access to equipment, medicines and staff. migrants full access to NHI ben- quality healthcare. efits packages. Under the current PSI General Secretary Rosa Bill, undocumented migrants have In June 2018, the South African Pavanelli opened the confer- no rights to access even emer- National Department of Health ence and introduced PSI’s Right gency care. published the NHI Bill, which to Health Campaign. She spoke outlined government’s inten- about the importance of a pro- There is also inequality between tion to create a National Health gressive taxation system, and the the responses to rural and urban Insurance Fund to act as single need to end fiscal breaks or incen- health needs: rural health requires public purchaser and financier of tives for corporations in order to urgent overhaul as mismanage- health services, as well as relat- fund the NHI and invest in public ment, corruption, staff shortages ed official bodies to administer facilities. This is particularly perti- and lack of funding have depleted the NHI in South Africa. The Sub- nent as the NHI Bill is accompa- its capacity to provide effective Regional Office in Southern Africa nied by legislative Bills that under- services. The NHI Fund will only welcomed the Bill with cautious mine the principles of Universal purchase health services from ser- optimism and submitted com- Health Care and as well the no- vice providers who comply with ments on how the Bill in its cur- tion of an equal and single benefit the Office of Health Standards rent formulation, reproduces class package for all. Compliance (OHSC). divisions and discrimination rather

20 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 AFRICA AND ARAB COUNTRIES

This will foster continued health PSI made the following recom- Public Services International will inequity as few audited public mendations on the Bill: continue to work with trade un- health facilities have been able ions and civil society organisations to meet those standards, due to 1. Medical Aid Schemes must to push for a public healthcare many years of being underfund- be unlinked from the NHI. system that guarantees univer- ed. This means that the NHI is The NHI Fund must be a sin- sal access to quality healthcare more likely to contract services gle tax-funded system, which in South Africa. The PSI Southern from private health care provid- purchases a single compre- African sub-regional office is pre- ers, entrenching inequality in the hensive package for all us- pared to act as a catalyst of joint system. Unfortunately, the Bill re- ers of the NHI irrespective of campaigns and actions to push for class, race, gender, sexuality mains silent on how services will quality and equality in health. q be improved in the most margin- and nationality. alised areas. 2. The Board of the NHI Fund PSI and its affiliates called for must be subject to greater more accountability and transpar- accountability and oversight ency and the inclusion of labour mechanisms. Naadira Munchi is the PSI Project Officer for the Southern and civil society representatives 3. The Minister must immediate- Africa Sub-region. on the various decision-making ly cease the implementation Boards of the institutions and of and promotion of transi- bodies that have been created, tional funding arrangements. to ensure that the interests of the people who are to use the fund 4. There must be greater invest- are raised from a position of ex- ment in Public Healthcare. perience and not assumed knowledge. This is where labour and 5. Health workers must obtain community voices are essential. improved employment and working conditions.

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 21 ASIA AND PACIFIC

India: is “Modicare” the answer?

he Indian government Considering that half a billion substandard health services. launched what it describes as people are meant to benefit from the largest health insurance this scheme, it should ordinarily A well-funded public health sys- T tem is therefore important for scheme in the world, in September. be a welcome development. But Prime Minister Narendra Modi said the devil is in the details. While improving health outcomes and the ‘Ayushman Bharat -Pradhan the scheme is projected to cost reducing health inequities. But Mantri Jan Aarogya Yojana (AB- US$1.6bn annually, the amount Modicare is not geared in this di- PMJAY)’ programme will pro- set aside for the first-year budget rection. On one hand, it is obvi- vide health cover to the tune of of the scheme is just US$300m. ous that it will be underfunded. 500,000 rupees ($6,900) a year This is not significantly larger than On the other, the EHCPs include for the poorest 100 million fami- the amount set aside for health private providers who will be lies in the country. insurance in previous budgets. It paid the market price for services is barely 27% of what the govern- provided. AB-PMJAY, which has been ment used to bail out the coun- dubbed “Modicare” by both the The main beneficiaries of the try’s ailing sugar industry during scheme might thus turn out to be government and mainstream the year. media in India, will replace pre- private health insurers and private vious programmes. It actually It is also a mere 0.01% of the health providers, and not the poor comprises two components. The Indian GDP. Grossly inadequate Indian people. It is also plausible Ayushman Bharat which is meant funding of public health has been to consider the scheme as an to create 150,000 health and a major handicap. While the electoral gimmick, considering the wellness centres for the provision Indian constitution guarantees timing of its launch as the country of Comprehensive Primary Health free treatment for all, the govern- enters an electoral cycle. Care (CPHC), and the Pradhan ment spends just over 1% of GDP Indeed, Sanjay Nirupam a leader Mantri Jan Aarogya Yojana on health - 70% of all healthcare of the opposition Congress Party (PMJAY) apparently designed to in India is provided privately and said “this is going to be another provide access to secondary and paid for out of patients’ own pock- scam. It will benefit only private tertiary care for the poor and ets. So the rich who can afford the insurance companies. The citizen most vulnerable through a net- high charges of private hospitals of the country will realise later work of Empanelled Health Care access quality health services, that it is nothing but an election Providers (EHCP). whilst the poor are condemned to gimmick.”

22 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 ASIA AND PACIFIC

What is needed in India today, for ally of PSI lists a range of public • community accountability of the achievement of quality health policy innovations which are ur- public health services for all, is strengthening the public gently needed to ensure health health services and not a model of and health care for all the people • strengthening of primary privatisation of healthcare, which in India, which we share. These health care in rural and urban is essentially what Modicare are: areas linked with District represents. health systems, and • public systems to ensure ade- In this regard, Jan Swasthya quate supply of free medicines • establishment of Right to Abhiyan (JSA) an Indian coali- Health Care. q tion of civil-society networks that • upgrading of Primary Health forms part of the global People’s Centres and Community Health Movement (PHM) and is an Health Centres

Unions defend aged care in Australia by Michael Whaites

ustralian PSI affiliates’ cam- evidence, and criminal charg- The study made recommenda- paigns in aged care are es can follow, recommendations tions for an appropriate skill mix Againing momentum as the made from an RC are not en- of careers, and minimum hours. industry comes under significant forceable. The Government’s an- Nursing unions are calling for the and broad scrutiny. nouncement has been considered recommended hours and skill mix hasty, with the terms of reference to be legislated. In a report entitled Who Cares, unknown when it was made. the popular TV news programme This is a call the government, and ‘4 Corners’ exposed indus- On the other hand, the announce- employers in workplace agree- try-wide cases of elder abuse and ment is also seen as a delaying ments, have been rejecting for neglect in aged care facilities. The tactic, with politicians hoping the years. However, the recent ex- programme backed the Australian heat will fall out of the issue before posés have seen progressive pol- Nurses and Midwives Federation’s the RC is finalised in 18 months’ iticians begin to pledge their sup- call for improved staffing. time. This has led unions to call port in the lead up to the Federal for action now and not await the Election due by May 2019. Over the last 30 years, residential outcome of the Aged Care RC. aged care in Australia has shifted Brett Holmes, General Secretary The Health Services Union has from being a mixture of public- of the ANMF NSW Branch, said been calling for an increase in ly-owned and charitable institu- that ratios need to be implement- funding, which it says should go tions, to an increasingly private, ed into law as the first step. “We towards staffing and improved for-profit industry. And the public cannot wait for the conclusion wages. The Federal Government sector has practically disappeared of yet another Royal Commission has cut $2billion from projected in most states. Changes to the which extends the timeframe for funding on aged care, a move the funding mechanism, which pre- politicians to have to make a deci- HSU says has led employers to cut viously allocated funding specifi- sion,” he stressed. staffing and refuse decent wage cally for staffing, coupled with de- rises. Gerard Hayes, General creased funding projections from The Australian Nurses and Secretary of the Health Services the Federal Government, have Midwives Association (ANMF) Union, says, “It is not acceptable seen staffing levels reduced to NSW Branch has been fighting to for our workers to be told to wait unsafe levels, as companies chase have legislated career-to-resident until a person’s incontinence pad profits. ratios introduced into aged care. is 70 percent wet before chang- The Federal ANMF commissioned ing, or that they are only allowed The night before the TV pro- the National Aged Care Staffing one set of gloves per shift, or that gramme aired, the Federal and Skills Mix Project Report 2016 only $6 a day is spent on food for Government announced a Royal that showed the care hours allo- residents.” Commission (RC) into the aged cated to residents by employers care industry in an attempt to are inadequate (2.84hrs per res- The two campaigns, along with avoid adverse political fall-out. ident per day instead of the rec- the exposure of abuse and ne- Although RCs in Australia can ommended 4.18). glect, have built strong community compel witnesses to provide support for improvements in aged

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 23 ASIA AND PACIFIC

care, and for increased account- The largest company, BUPA, had almost $7.5 billion in total ability by the aged care provid- income in Australia (2015-16) but paid only $105 million in ers to ensure that any increased tax on a taxable income of only $352 million. funding flows to resident care. This call for increased accounta- • BUPA’s Australian aged care business made over $663 bility has been bolstered through a Tax Justice Network Australia million in 2017 and over 70% ($468 million) of this was (TJN) report, commissioned by the from government funding. ANMF Federal Office. • Funding from government and resident fees increased The report by Jason Ward, who is in 2017, but BUPA paid almost $3 million less to their now the Principal Analyst for the Centre for International Corporate employees and suppliers. Tax Accountability & Research Tax Avoidance by For-Profit Aged Care Companies: Profit Shifting on (CICTAR), exposed the tax minimi- Public Funds. Proposals for Transparency on Government Spending sation practices of major for-prof- (2018) TJN. p. 5. it aged care providers in Australia. Global health industry player companies use to avoid paying BUPA was amongst those named. transparency in their financial accounts. However, complex com- their fair share of tax. In Australia, aged care operators pany structures and the use of A newspaper report exposed receive funding from government stapled trusts have seen their tax the seven figure pay packets depending on the level of care bills drastically reduced. BUPA, of for-profit aged care compa- needed per resident, and they given its corporate structure, has ny CEOs. With workers earning can charge additional fees for ser- the least transparent financial considerably less, some being vices. The providers also require practices of those named in the amongst the lowest paid workers residents to provide bonds. These report. in the country, the community is are so high as to force families to clearly getting the message that sell the family home in order to The TJN report was received with aged care is seen as profitable for access care. The bonds are re- alarm, triggering a Senate Inquiry some, but that it is at the expense turned to the family, minus some into Financial and tax Practices of residents’ and workers’ rights. fees, and the company keeps any of for-profit Aged Care Providers within two days of the TJN report interest earned on the amount. The unions are clear that the pro- This practice has been referred to being released, somewhat of a record in Australia. The Inquiry has viders can afford decent pay and by some as an enforced privatised improved staffing. Their members death tax. revealed that BUPA is amongst many aged care providers that continue to be active in taking the message to their communities With 75% of their income com- are being investigated by the ing straight from government, Australian Tax Office. The recom- and the politicians. q one would expect that the com- mendations from the report seek panies would be good corporate changes to Australia’s tax laws, Michael Whaites is the PSI tax citizens, and for there to be removing some of the loopholes sub-regional Secretary for Oceania

24 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 ASIA AND PACIFIC

From challenge to success – Organising hospitals in the Philippines

SI has been providing solidar- fund (15% of total dues) and hire 5. One plan, One direction ity to the Alliance of Filipino dedicated staff. They identified Workers (AFW) to build pow- potential hospitals to organise 6. 100% Mapping of the target P hospital er by organising new members. and selected the Asian Hospital. PSI asked its affiliate the SEIU, the The plan was to test a new pro- 7. Registered nurses must be largest health sector trade union cedure for obtaining “recogni- 50% of the leadership in the USA, to partner with the tion” through a worker petition. AFW to transform their approach Although they initially obtained One of their key findings was to growth amongst hospital work- over 60% support, Government that nurses had not been suffi- ers with positive results now officials administering the process ciently organised and yet are the emerging. turned a blind eye when manage- backbone of hospitals. They rec- ment began pressuring workers to ognised the need to give nurses AFW represent healthcare work- withdraw. The union was forced a stronger, independent voice in ers in 12 private hospitals. The 12 to go the more traditional route the union and any hospital they hospitals have had AFW led col- of an election. Even then, hospital covered. So the AFW created the lective agreements for up to 45 management launched an aggres- RN Taskforce – a network with- years and AFW has been servicing sive wave of threats and intimida- in AFW that would specifically members there on a regular ba- tion. Ultimately, their attempt to champion the rights of nurses sis. AFW has documented exam- unionise was unsuccessful as they and act as an informal branch of ples of healthcare workers being failed to get the 50% required the union. The initial members of paid starvation wages, facing vi- by law. But rather than let their the RN Taskforce, drawn from the olence from employers and being disappointment stop their plans, membership and governance, un- forced to act as unpaid personal they carefully analysed what had dertook a ‘listening tour’, going to carers and labourers for hospi- gone wrong and came up with a all AFW hospitals to better under- tal management. While workers list of seven lessons learnt - a list stand the concerns and demands in unionised hospitals enjoy bet- that still stands prominently in the specific to nurses. ter conditions, stronger solidarity office. and, importantly, a voice in their The listening tour was a success. workplace, AFW has not grown The key lessons were: It gave AFW a more solid base to for several years. The Executive organise nurses, identified fur- Committee made the decision to 1. We should have 75% worker ther union leaders and delegates expand their organising capacity support to the union before and also allowed nurses to raise and resolved to unionise “green- vote collective concerns with manage- fields” or non-unionised hospitals. 2. Political Education about un- ment following the meetings. But success did not come easily. ions and employer responses Another key lesson drawn from The decision to move to an or- is needed the initial failure was that organ- ganising model was made demo- 3. Must have unions leaders in ising needs to start with a core cratically, involving members and all departments team of union leaders and re- officials, passing a vote at AFW spected workers in every depart- Congress. The union resolved to 4. Precision in numbers ment of the hospital before pro- create a dedicated organising ceeding. Using these lessons, the

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 25 ASIA AND PACIFIC

AFW team targeted Providence Hospital, a hospital that included staff who had transferred from one of the unionised hospitals covered by AFW. These workers proved indispensable, being able to provide the story of hope – of what a unionised hospital could achieve – to other workers and bring together a group of like- minded colleagues to ignite the campaign and complete the mapping needed.

The earlier failure also gave the team a better understanding of the possible tactics of management to undermine the union and they used this to inoculate workers prior to the vote. One of the most hostile union busting tactics popular was to provide 3 in 1 cof- team of organised delegates and used was to sack or suspend un- fee packs with information about members they are confident that ion activists within the hospital. the vote yes campaign printed on they can quickly move to a mem- The union immediately brought them. Almost all the nurses drank ber-driven collective bargaining these cases to the Department of coffee during their shifts and the process and agreement. Labour and Employment (DOLE) packs spread around quickly. and were successful in having The success of unionising a number reinstated. The un- The initial team of core organisers Providence Hospital strengthened ion continues to fight for justice continued to map the hospital and the resolve of the AFW leadership for two of the dismissed union identify actively interested col- to continue with the organising leaders. leagues who became information approach and they have already points and created conversations identified two further hospitals Management circulated hostile with other colleagues in informal with members ready to lead a disinformation about a union- settings. Eventually all staff had campaign. The organising drive ised workforce, including bizarre conversations with the expanding has the potential to radically claims that unions “discourage team and were being updated on transform the lives of healthcare individuality” and loss of freedom the campaign, and invited to be workers for the better as well and urged workers to vote no. But active in it, on a regular basis. This as the quality of care offered in the organisers were ready and had was important because the sus- a country with large healthcare inoculated the workers against pension of some of the core team needs, and PSI and SEIU are con- the claims and scare tactics. would have seriously undermined tinuing to support the strategy to Consequently, the management the campaign if they were the ensure health workers enjoy the campaigns and attacks on union only workers able to talk about rights and collective power they members often back-fired, serving the value of unionising. to create outrage amongst work- are entitled to. q ers and increased the frequency Finally, when the day of the vote * PSI’s affiliates Vision (Sweden) of conversations. The union cam- arrived, the team was nervous but and UNISON (UK) also contributed paign was now front and centre proud that they had run a well or- support towards this organising of most coffee break and informal ganised campaign and they could initiative. conversations. feel the solidarity of the staff growing, particularly across the The team came up with a range nurses. They won the vote with of creative ways to reach nurses 63% yes votes - well in excess of in the hospital. One of the most the 50% required. With a strong

26 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 ASIA AND PACIFIC

Fiji nurse questions privatisation at World Bank’s Annual Meeting in Bali

wenty thousand Government evidence that health related PPPs I have gathered from attending and global financial leaders can be extremely risky and costly. these meetings make it clear that Tmet in Bali, Indonesia, as the The report suggest that health- PPPs are a version of privatisa- World Bank and the International care PPPs should be avoided, tion. The community and health- Monetary Fund held their Annual especially in low-income, low-ca- care workers in Fiji don’t know Meeting on 12-14 October 2018. pacity contexts where they can enough about what PPPs will do constitute a threat to the entire to healthcare. I will take this infor- Amongst civil society attendees health system. The Taking Back mation back to Fiji to discuss with was Fiji Nursing Association’s Control report demonstrates that the unions, communities and rel- National Council Executive mem- when healthcare privatisations evant government ministers.” q ber Mr Isimeli Radrodro Tatukivei. fail it comes at great costs to the Speaking at a meeting on Public community, in both health out- Private Partnerships, Mr Tatukivei comes and financially as the state raised questions about the effec- is left to pick up the pieces. More information: tiveness of PPPs in healthcare, concerned that Fiji’s Government It’s not just the usual suspects de- Read full articles: is proposing to privatise two pub- nouncing PPPs. The International • Press Release: Report ex- lic hospitals. Monetary Fund’s own analysis poses how PPPs across the demonstrates that the benefit of world drain the public purse, “As nurses we have a responsibility privatisation is usually only an “il- to know what the impact of PPPs and fail to deliver in the pub- lusion” and highlight that privati- lic interest might be for our communities and sation has left the UK in a poor the workers” said Mr Tatukivei. fiscal position (see reports in the • Independent: https://www. His inquiry comes at an important Independent and the Guardian independent.co.uk/news/ time as Fiji enters into National for further comment). The IMF business/news/britain-pub- elections in mid November. has repeatedly come out and said lic-finances-worse-than- there is not a good business case PPPs have received bad press in gambia-uganda-kenya-imf- for PPPs as they create hidden lia- recent times with several reports report-a8577671.html bilities for governments. showing that PPPs in healthcare • The Guardian: https://www. are failing. Taking Back Control, a And yet the World Bank continues theguardian.com/socie- report from an inquiry in Australia, to push privatisation and PPPs, ty/2018/oct/10/uk-public- outlined failures in over nine ex- making it a condition of loans and finances-among-weakest-in- amples of healthcare PPPs and key reform targets. world-imf-says wholesale privatisations. And a report by Eurodad, History “We don’t know why our gov- RePPPeated provides a case study ernment has been recommend- of hospital PPP failures in Sweden ed to privatise Lautoka and Ba and Lesotho. hospitals through PPPs” said Mr Tatukivei. “We are often told the According to Eurodad, Lesotho’s PPPs are not a form of privati- experience supports international sation, however the information

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 27 ASIA AND PACIFIC

France: What care model do we want for the elderly?

n France, EHPADs are residen- and that the human and finan- many took to the streets to ex- tial establishments for elderly cial resources currently allocated press their frustration. dependent people, sometimes to the sector are not enough to I CFDT Health and Social Care ac- known as a retirement homes. provide the elderly with adequate EHPADs house elderly people over care and dignity. Recruitment tivists chanted slogans saying the age of 60 who have lost some problems and high turnover are “Nous sommes une richesse” (We physical and/or mental faculties exacerbating the staffing situa- are valuable), stressing the un- and are no longer able to live at tion. The sector no longer attracts quantifiable value of care workers home. There are 7,200 EHPADs people who feel they have a voca- for quality elderly care delivery, in and 10,000 home care services tion for this kind of work. response to the politicians who in France. They house or provide only see health workers as a cost. support for 1.4 million elderly Staff working with elderly depend- Families, the elderly, managers people and employ more than ent people speak of the “lack of and local councillors all joined the 700,000 workers. dignity”, “institutionalised abuse”, movement, with slogans like: “I “staff burnout” and of staff “feel- am here because my grandfather Unfortunately, the elderly persons ing responsible for poor quality lives at an EHPAD and I agree with sector in France faces structural provision”. The sector’s employ- your demands.” problems that pose a threat to ers and EHPAD managers make quality care provision. The CFDT the same kind of observations. The series of social movements Health and Social Care sector Everybody is agreed on the ur- that have been taking place since is campaigning against serious gent need to ensure more digni- last summer prompted a response understaffing and deteriorat- fied housing, support and care for from the government, which pro- ing working conditions. A survey the elderly. poses an increased budget allo- on staffing levels conducted in cation for the sector as part of a September 2017 was repeated in On 30 January and 15 March “grand plan to meet the challenge June 2018 and the results were 2018, tens of thousands of of growing old”. But the funds are just as damning. Of the 1,723 workers from retirement homes, not enough to meet the needs. responses, 35% felt that staffing EHPADs, long-term care and The CFDT criticises the govern- levels on the day of their response home support throughout France ment’s tendency to make regular to the survey did not ensure safe came out in support of national but very small increases in spend- and quality care or dignity for strikes backed by the entire trade ing, while the unions deplore gov- patients. union movement. The strikes ernment announcements that were well-supported because “completely ignore the urgen- All trade unions agree that care workers are at the end of their cy of responding to the sector’s provision for the elderly has dete- tether. All categories of workers demands,” namely an increase riorated to an unacceptable level have reached breaking point, and in staffing levels, better pay and

28 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 ASIA AND PACIFIC

career structure, improved work- the elderly and not just an in- and immediately introduce ing conditions and permanent crease in the budget. The CFDT minimum “bedside” health- funding for home support. supports the recommendations care worker staffing levels at made by the Economic Social and all EHPADs. President Emmanuel Macron con- Environmental Council (CESE)1 in ceded that low staffing levels is “a its report “Vieillir dans la dignité” We hope that the French govern- real problem” and “a key issue for (Growing Old with Dignity) pub- ment will adopt a long-term strat- today and even more so for to- lished on 24 April 2018: egy that provides the public with morrow.” The French government a genuine way forward. The CFDT has committed to dealing with the • Prevent, anticipate and fund is ready to put the necessary work mess that currently characteris- the loss of autonomy; in to ensure the emergence of a es care for the elderly and says it new model for the care of the will respond to the demograph- • Adapt residential and service elderly. Everyone has a right to provision to meet needs and ic challenge posed by an ageing health! q population. expectations;

CFDT Health and Social Care • Find new ways of working to- believes it is urgent to have a gether to respond to the chal- comprehensive understand- lenge of providing compre- 1 CESE : http://www.lecese.fr/ ing of the question of care for hensive and dignified support travaux-publies/vieillir-dans-la-dignite

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 29 EUROPE

Turkey: Health workers charged for rendering humanitarian services

eo Hyde from Public Services At the time, Cizre was facing votes to secure power and many International was an ob- one of the harshest curfews in Kurdish militants were focusing Lserver at the opening of a modern history, imposed by the their attention on the Rojava pro- trial against 14 health workers, Turkish army to root out militants ject, south of the border. However, accused of supporting terrorists of the Kurdish Workers Party Rojava’s growing strength com- for trying to help civilians during (PKK). With hundreds of civilians bined with a changing electoral the Turkish army siege of Cizre in trapped in the city without access situation delivered Erdoğan the 2016. Here’s his report from the to healthcare or basic supplies, hand he needed to abandon talks trial: the Trade Union of Employees in and begin a military operation to Public Health and Social Services stamp out the PKK. If Incilay Erdogan is stressed, she (SES) and the Turkish Medical doesn’t show it. In the morning, Association (TTB) put out a call for Cizre was one of many villages a trial which could put her behind volunteer medics. across the region where young bars for years will begin. But she Kurdish activists dug in, building spends the evening laughing with “When I heard the phone calls barricades in the streets and re- friends, drinking tea, and breaking from people trapped in base- fusing government orders to sur- into spontaneous dance. “When ments, asking us if it was safe render. The response was swift they told me the court case was to drink their own piss, I knew it and brutal. A blanket curfew was here in Mardin, I couldn’t have was my medical duty to respond,” imposed while heavy military and been happier. What a beautiful says Sadık Mulamahmutoğlu who long-range snipers took positions place to face judgement.” joined Incilay on the volunteer on the hills surrounding the vil- team. Apart from their work as lage. By the end of the 79 day It’s not the first time Incilay, who doctors, Sadik and Incilay help curfew, many parts of the town lives in Istanbul, has visited the run a jazz-bar in Istanbul’s Taksim lay in ruins. “Cizre was a lesson region. In February 2016 she was neighbourhood. Still, they put all – not just for Kurds but also for part of a group of fourteen health their activities aside to help the those who took part in the Taksim professionals from across Turkey people of Cizre. square protests and anyone op- who assembled a voluntary am- posed to the Erdoğan regime,” bulance crew in Mardin. Their goal Just a few years ago a peace deal Incilay says. “If you resist, we can was to reach the Kurdish-majority between the PKK and the Turkish and will crush you – that’s what town of Cizre, 100 kms to the government looked increasingly the government is telling us.” east. possible. Erdoğan needed Kurdish

30 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 EUROPE

South-eastern Turkey: a through the 79-day curfew. “They Many of the accused doctors gave region oppressed would shoot at anything that evidence for the case and believe moved: men, women and children a ruling against the government Arriving at Mardin airport the day alike. Helicopters, heavy artillery, will strengthen their hand in their before the trial, we’re swept into a full-scale siege. Many of Cizre’s own trial. a small Renault by Derya, a TTB health workers perished. The member and biochemist at the lo- army even converted part of our Incilay seems relieved. “In oth- cal hospital. She blasts Kurdish bal- hospital into a base.” er cases I’ve had judges literally lads from the stereo as we speed snoring while I spoke. At the very along the steep motorway to the The full scale of loss may never least he seemed to be listening!” be known. Despite calls from the ancient fortress city. “My father – The health workers debrief at the Turkish, my mother – Kurdish. Me United Nations for an international investigation, the government SES Union’s office in Mardin. The – confused,” she laughs. Derya re- walls of the office are covered cently moved back to the Kurdish consistently restricts foreigners and NGOs from entering the with smiling photos of now de- region to reconnect with her roots ceasedunion activists. One post- after years living in Ankara. area. Malzumder, a Turkish human rights group which managed er displays the faces of over 100 We squeeze into a small Mardin to collect some testimonies after comrades murdered in the 2015 restaurant where the accused the end of the curfew, believes bombing of a union rally in Ankara. the number of deaths is in the workers, union leaders, and NGO SES Co-President Gönül Erden hundreds. representatives have assem- reads out letters of solidarity bled. Sweating over the stove is from other unions and workers Mustafa Benli, a former tax of- Most casualties occurred in the city’s basements. Witnesses claim across the world. “We are not ficer who lost his job in the purge alone. The government is under of public workers launched by the army stood by, blocking the entrances as one building with huge economic and diplomatic Erdoğan after the failed coup in pressure right now and our in- 2015. “We make a point of eat- seventy people inside went up in flames. “Their charred remains ternational partners will be lever- ing here to support our dismissed aging this power to lobby for all comrade,” Derya tells us. were removed along with the rest of the rubble and dumped into the of these charges to be dropped,” Salih, our interpreter, chimes in: Tigris river. Many families received she tells the crowd of assembled “I was also recently fired from my little more than a few burnt bones supporters. to bury,” Kuni tells us. job as Kurdish Professor at the Later, back in Istanbul, we perch University here…. but at least now Medical ethics on trial on chairs haphazardly arranged in I have time to translate books into front of Incilay’s bar. A stream of Kurdish– I just finished translating A golden bust of Ataturk, the musicians, activists, doctors, film- Orwell’s 1984. Now this is a book makers and unionists swarm her our people need.” founder of modern Turkey, sits perched above the courtroom, with hugs and “welcome homes.” Over lunch, the workers discuss surveying the scene as the de- She sips on Budweiser, laughing the difficulty of developing a legal fendants filter in. The judge, a with friends late into the night. As strategy for a politically motivat- stoic, business-like man in his we get up to leave, I ask how she ed case. The government’s claims mid-thirties gently raises his remains so relentlessly positive. rest on the fact that, because the hand for silence. Incilay is the In one swift motion she finishes requests for health assistance first to take the stand. “Doctors her bottle, throws her bag across came from the PKK, the volunteer like us have been responding to her shoulder and cracks a crook- ambulance journey to the region calls for help since the time of ed smile. “For us, as long as you represents a form of participa- Hippocrates. On trial here today is believe resistance is possible, you tion in a terrorist organisation. the very principle of medical eth- know that hope is possible. The However, the health workers an- ics,” she tells the room. struggle doesn’t stop with me, or nounced their plans publicly – and this case, or with Cizre. The strug- advised the Ministry of Health One by one the workers testify as gle continues.” the judge sits attentive yet poker and the Interior Ministry before q their arrival. Despite this, once faced. At the end of proceedings, in Mardin they were detained by he announces the trial adjourned police and refused entry to Cizre. and the workers free on bail un- They never managed to help the til December 26. The date of the dying civilians who the govern- next hearing is important. On ment says were terrorists. November 13th, the European Court of Human Rights (ECHR) be- Serdar Kuni, a medic from Cizre, gan its hearing of a case brought tears up as he remembers living by survivors of the Cizre curfew.

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 31 EUROPE

Dismissed care workers reinstated in Germany

armen Laue and Heike much improvement in the terms become increasingly necessary in Schmidt were reinstated and conditions of its employees. the coming period. as employees of the so- C The victory of Carmen and Heike The expansion of global health cial care company Celenus, by a ruling of the Labour Court in was not just judicial. It is a tes- companies has been matched Nordhausen in central Germany, tament to the power of work- with disdain by these multina- on 17 October, 2018. The two ers’ solidarity. Workers across tional corporations for workers’ union activists are members of countries in Europe where Orpea welfare. Meanwhile, now more Ver.di, a leading affiliate of PSI operates organised series of ac- than ever, there is a pressing and the European Public Service tions in support of the campaign need for promoting decent Unions (EPSU). for the reinstatement of the two work and social dialogue in the Ver.di activists. These included health and social sector, for the They had been sacked earlier France, Austria, Belgium, Italy Sustainable Development Goal in April by the management of and Spain. Target 3.8 to be achieved and Celenus, for distributing leaflets health for all enthroned. as part of a long-running, and An injury to one, as the old trade continuing campaign for better union saying goes, is an injury to PSI, EPSU and our affiliates will pay. Celenus, which is a sub- all. This victory will inspire con- continue to fight for the rights sidiary of the Orpea social care tinued solidarity in our struggle and promote the interests of our multinational company, has been in defence of labour and trade members. The workers united making increasing profits without union rights. Such solidarity will cannot be defeated. q

32 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 INTER-AMERICA

PSI warns: transnational companies are bad for your health!

ransnational companies international financial institutions pressure to bear on companies (TNCs) have increased their do not monitor compliance with and raising public awareness Tinvestments in Brazil’s health these obligations. about the threat posed by pro- sector. They have made a big ad- jects funded with these loans and verse impact, causing deteriora- The situation has become more their impact on labour, society tion in working conditions and a problematic because of the par- and the environment. fall in the quality of services. liamentary, legal and media coup that recently ushered in a new era In order to make progress in this TNCs borrow from internation- of neoliberal promotion of private struggle, we are monitoring in- al financial institutions, suppos- foreign investment, and labour formation and using new special- edly for development purposes. reforms that cut workers’ rights ised partners, such as the Centro However, the reality is different. and create doubt and uncertain- de Monitoramento de Empresas They acquire philanthropic and ty. The result has been a stream e Direitos Humanos and the public service organisations and of legal disputes over labour law, International Accountability proclaim their commitment to especially in the health sector, on Project (IAP) to help us scrutinise technological innovation, job cre- issues such as length of working these loans and to use collective ation and improved service ac- day – increased to a maximum of bargaining or complaints to in- cess and quality. However, they 12 hours with 36 hours rest – (for ternational organisations (ILO, fail to live up to these promises which it is uncertain if collective Inter-American Court, OECD, IDB, and avoid dealing with the trade agreements are valid or not), mas- IFT) to promote more appropriate unions. sive reductions in staffing levels, lending. unfair dismissals for minor rea- By accessing loans classified as sons, failure to pay bonuses for Health cannot be treated as a “investments for development”, hazardous work (as required by mere commodity to be exploited. these companies are required to Brazilian legislation on the health Health is a public good and not comply with labour legislation sector), etc. a product. Onwards with the and engage in collective bargain- struggle! q ing with trade unions. However, In this context, training, trade there is a lack of accountability union campaigns and action by because national authorities and workers are all crucial for bringing

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 33 INTER-AMERICA

Health care staffing levels: an election issue in Quebec!

or the last few years, the health care safety and developed number of patients with similar 75,000 members of the an online tool for use in high- health problems. This minimum is FQuebec health care workers’ lighting poor working conditions. then adjusted in accordance with union, the FIQ, have been cam- In January 2018, a young nurse patient needs. Following FIQ’s paigning for the government to working in long-term care ques- campaign, there have been no allow them to provide quality and tioned the health minister on so- fewer than 13 initiatives to deter- humane health care. A lot of prob- cial media. mine and introduce safe staffing lems can be avoided by having levels in medicine, surgery and stable well-staffed work teams. Visibly distressed, she complained long-term health care residential about the excessive number of centres. Safe staffing levels have been suc- patients she was expected to care cessfully introduced elsewhere in for – 70 patients per night – and Four other projects will be the world, notably in California the effect this had on her work. launched soon (emergency ser- and Australia, benefitting both This triggered a wave of com- vices, home care, a private in- patients and health care workers. plaints about working conditions in stitution, inhalation treatment). More time spent with patients and the health care sector in Quebec. These initiatives have a national quality care provision mean few- The FIQ seized the opportunity and local structure based on lo- er falls, infections and accidents, and launched a media offensive to cal joint committees. They are the etc. It has been demonstrated raise awareness among the public first step towards the introduction that safe staffing levels save lives. and decision-makers about exces- of safe staffing levels throughout sive workloads and the impact on Quebec. q The FIQ has long helped its mem- health care. bers to denounce inadequate working conditions. For example, The staffing levels recommended it has provided training on advo- by the FIQ set minimum num- cacy, published a “black book” on bers of health care workers per

34 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 INTER-AMERICA

Americans want better healthcare for all

ealthcare is the most im- At far less cost, the publicly fund- must be placed over profit for a portant issue of concern to ed British National Health Service handful of the super-rich who HAmericans today. In an exit (NHS) for example, provides free own the health corporations and poll conducted by the Cable News quality healthcare for all at the determine the pace of service de- Network (CNN) during the mid- point of delivery. Meanwhile, delivery. Universal public healthcare term elections, 41% of respond- spite the vast amount of mon- is not only possible but necessary ents voted for healthcare as the ies sunken into the system in to ensure a fairer and more just “most important issue facing the the US, almost 30 million people USA. country”. Immigration, economy are not covered by health insur- and gun policy received 23%, 21% ance, leaving them vulnerable to PSI affiliates continue to lend their and 11% of the poll respectively. catastrophic health expenditure. voices to the need for overhauling These include an additional 4 mil- the health system in the interest This was six weeks after Mr lion people who have lost their of the American people. They are Ban Ki-Moon, immediate past health coverage since President part of the movement spreading Secretary General of the United Trump was elected. across the Fifty US states de- Nations denounced the United manding qualitative health for all, States healthcare system as polit- Vested private interests are the as a fundamental human right. ically and morally wrong. He went primary beneficiaries of this health a step further to call for a publicly system which perpetuates health This demand is not going to go financed healthcare system as a inequity. These are big pharma- away until it is heeded. The move- fundamental human right in the ceutical corporations, health in- ment will not abate until the right country. surance companies and chains of thing is done. The American peo- health clinics. Their profit comes ple want better health for all. The United States’ health sys- first before the good health and United, as trade unions, civic or- tem is the most expensive in the well-being of American people. ganisations, community-based world. Expenditure costs over associations and the electorate, $10,348 per capita. At $3.2 tril- Americans are sending home a we will win. q lion per annum, this accounts clear message to policy-mak- for 17.8% of the country’s gross ers, now: enough is enough. domestic product (GDP). But it is Realisation of the right to health also probably the most inefficient is not negotiable. People’s health amongst high-income countries.

RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018 35 http://www.world-psi.org/PublicHealth4All

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36 RIGHT TO HEALTH - ISSUE 5 - NOVEMBER/DECEMBER 2018