Is the World Health Organisation contributing to the reinvention of structural adjustment? The People's Health Movement comments on the latest WHO Global Health Governance Report.
The world is well off track in terms of achieving the 2030 global targets for 'universal health coverage'. Almost two billion people, or about one fourth of the world’s population, experienced catastrophic health spending or impoverishment due to healthcare costs according to the most recent data available (2019).
Financial protection has gone backwards since 2000. The (extremely basic) service coverage indicator has stagnated since 2015. UH WHO's Executive Board will review the global failure to progress C at its meeting in Geneva from 22 January 2024.
The report which the Board will consider (EB154/6) does not explore the reasons for the failure of WHO’s Universal Healthcare (UHC) strategy. Instead, it calls for “re-doubling efforts to accelerate progress towards UHC” and repeats all the earlier policy mantras. It calls for redoubled effort from countries, from the big ‘development assistance’ funders and, now, from the international development banks.
The People’s Health Movement holds that this is not just a failure of implementation but a failure of strategy, as rolled out across most low- and-middle-income countries. What was required was the strengthening of publicly funded and publicly administered healthcare services, where the services are provided as public goods. Such a strategy finds little space in the UHC discourse. Instead ‘universal health coverage' has been used to promote publicly sponsored health insurance with strategic purchasing of a very limited package of essential services from a mix of service providers, complemented by a marketplace of private health insurance plans and private providers for services beyond the package.
This marketised, privatised model of UHC is completely consistent with neoliberal policy prescriptions for restricting the need for public spending on health and other public goods in order to limit taxation and free up revenues to service national debt. The consequence of such policies includes the growth of an unregulated private sector.
In order to retain a semblance of legitimacy the neoliberal program endorses a series of vertical programs of disease control, which fragment health systems, overburden governments with application and reporting bureaucracy and involve the purchase of large quantities of increasingly expensive medicines, diagnostics and vaccines from big pharma. This leaves less and less funding for strengthening comprehensive primary healthcare.
In an apparent response to the lack of financing for PHC, the new report presents a new initiative called Health Impact Investment Platform which involves the African Development Bank, the European Investment Bank, Islamic Development Bank and the Inter-American Development Bank, joining hands to make an initial €1.5 billion available to LICs and LMICs in concessional loans and grants to extend the reach and scope of their PHC services.
WHO country offices are being incentivized with liberal project funds to write-up financing proposals that countries will then sign on to. While it comes with high sounding politically correct affirmations of the importance of primary health care, it overlooks the fact that most LMICs are already deeply indebted, and this will only add to their indebtedness. Most countries are paying more for debt servicing than on welfare.
Some of these banks are already supporting corporate investment in healthcare, through private sector arms – like IFC in the case of the World Bank. Meanwhile the inclusion of investor state dispute settlement clauses in many bilateral and plurilateral treaties can greatly reduce the policy space available to governments for promoting quality, efficiency and equitable resource allocation.
The structural adjustment regime from the 1980s is being reinvented, with WHO support, through unsustainable debt, and conditional bailouts.
The UHC Report is also remarkable for its silences. The most notable of these is the challenge of access to essential medicines at affordable rates within the current global policy structure.
PHM calls on WHO to bring forward alternatives to the UHC model based on a conceptualization of primary health care as a public good. This will require that the delivery of care is dominated by public providers with public accountability for the quality, efficiency, equitable resource allocation and population health-oriented health care. Financing must remain tax based or social insurance with a progressive movement towards single payer funding.
The policies that are called for include: (a) an increase in health funding, (b) the efficient and equitable use of such funding, (c) the strengthening of the health and care workforce, and (d) the expansion of primary health services and the orientation of health systems towards a primary health care approach. These have not been put in place or taken to the scale required.
The full PHM commentary on this item provides a more detail and references. See also Tracker links to previous discussions of UHC.
The WHO Tracker and PHM item commentaries are produced as part of WHO Watch which is a project of the People's Health Movement in association with Medicus Mundi International, Third World Network and a number of other civil society networks. WHO Watch contributes to democratising global health governance, through new alliances, new information flows and by broadening the policy discourse.
See the WHO Tracker page for this EB154 session (here). See PHM’s integrated commentary on the full agenda of EB154 or read the flipbook version. To ensure that you receive Update Alerts subscribe to the Updater.
Original source: People's Health Movement
Image credit: Vanessa Olvera/Change.org