Speech to the PSI Asia Pacific Regional Health Sector Network*
Dear
brothers, sisters, friends, colleagues, comrades, I wish to start by expressing
my heartfelt appreciation for being with you here today. This would be the
first PSI regional network meeting, strictly speaking, that I would be
attending since resuming as Health and Social Sector Officer.
Before proceeding on what I
have been asked to talk on, which essentially is to initiate discussion on the
tasks at hand for us together, in the
sector, permit me to say that my first impression of sisters and brothers
within the sector in this region is one of deep respect and high hopes. Even
before my resumption, I had received emails from comrades in all the regions
with questions and suggestions. But it was from the Asia Pacific region that I
received the most, and these were quite important.
From Australian affiliates
wanting to know how the working conditions of workers employed in France by the
Australian multinational corporation Ramsay Healthcare (to be better prepared
for a possible fightback as Ramsay buys up privatised health facilities in
Australia), to the request for the constitutions and insight into how nurses
organise in other regions from the South East Asian sub-region, to the sharing
of research work on multinational healthcare corporations in South Asia and the
Indo-UK Healthcare-driven push for PPPs in India, these were all very germane
and quite welcome.
We equally did promptly respond to the questions and
built on the knowledge sharing. We reached out immediately to the French
affiliates regarding Ramsay Healthcare who informed us of the abysmal
conditions in some of the establishments of the multinational corporation, and
also forwarded relevant documents to this effect. Constitutions of nurses’
unions from the Africa and Arab Countries Region and the Inter-Americas Region
were equally sought and sent to our comrades in the Philippines and the
knowledge sharing from Susana Barria in India led to even further insight on
the workings of the Peoples Health Movement, in the course of a long Skype
discussion.
The foregoing is not only to
express my sincere esteem and
expectations on the basis of this, from the AP Region. It is also to
underscore the essence of a global trade union federation which PSI is. The
value of our expansive reach lies in internationalist
solidarity. The bosses might have the powers of financial resources and
governments. But they are few and we are many. And we are not only many; united
and organised, we can learn together, think together, work together and fight together, drawing strength
from our collective experiences and the combination of our mass power, to bring
to birth a new, better world.
The work that we now have to
collectively address in the immediate future, rests on two interrelated
pillars. One has to do with the recent, landmark adoption of the final report
and recommendations of the United Nations High-Level Commission on Health
Employment and Economic Growth by the General Assembly of the United Nations
Organisation, in New York, last month. The other is the PSI’s Human Right to
Health Global Campaign, which we will flag off on December 13, at Geneva,
during the forthcoming PSI Health Sector Task Force (HSTF) meeting.
The High-Level Commission
which was co-chaired by François Hollande, President of France, and Jacob Zuma,
President of South Africa, was constituted on the 2nd of March by
the UN Secretary General, Ban Ki-moon. The PSI General Secretary, Rosa
Pavanelli represented the trade union movement, health workers and public
services, on the Commission.
The setting up of the
Commission was a response to the projected shortage of 18million health workers
by 2030, despite an estimated increase of 40million jobs in the sector. Most of
this shortfall, with dire consequences for the quest to attain sustainable
development, would be borne by developing countries in the Global South -which
already to a great extent, have fragile health systems-, if action is not taken, now.
The need for immense
investment in the health sector today, and particularly in the health
workforce, can thus, not be overemphasized. In the course of six months of
rigorous work, the Commission unambiguously debunked the often touted view by
proponents of the neoliberal project that expenditure on public health delivery
is simply a cost. With evidence-based research, it established the multiplier
effects of “investments in the health system…that enhance inclusive economic
growth, including via the creation of decent jobs”.
The final report of the
Commission was submitted with 10 cardinal recommendations aimed at transforming
the health workforce for the attainment of the SDGs on one hand and for
enabling the much needed changes of policy and practice to galvanise such
transformation.
The first set of
recommendations centre on:
-
Job creation: stimulating
investments in creating decent health sector jobs, particularly for women and
youth, with the right skills and the right numbers, in the right places;
-
Gender and women’s rights: maximizing women’s participation, and fostering their
empowerment, through institutionalising their leadership, addressing gender
biases and inequities in education and the health labour market, and tackling
gender concerns in health reform processes;
-
Education, training and skills: scaling up transformative, high-quality education
and lifelong learning so that all health workers have skills that match the
health needs of populations and can work to their full potentials;
-
Health service delivery and organisation: reforming service models concentrated on hospital
care and focus instead on prevention and
on the efficient provision of high-quality, affordable, integrated,
community-based, people-centred, primary and ambulatory care, paying attention
to underserved areas;
-
Technology:
harnessing the power of cost-effective information and communication
technologies to enhance health education, people-centred health services and
health information systems;
-
Crisis and humanitarian settings: ensuring investment in the International Health
Regulations core capacities, including skills development of national and
international health workers in humanitarian settings and public health
emergencies, both acute and protracted. And ensuring the protection and
security of all health workers and health facilities in all settings.
The second set of
recommendations dwell on:
-
Financing and fiscal space: raising adequate funding from domestic and
international sources, public and private where appropriate, and considering
broad-based financial reforms where needed, to invest in the right skills,
decent working conditions and an appropriate number of health workers;
-
Partnership and cooperation: promoting inter-sectoral collaboration at national,
regional and international levels; engaging civil society, unions, and other
health workers’ organisations and the private sector; and aligning
international cooperation to support investment in the health workforce, as
part of national health and education strategies and plans;
-
International migration: advancing international recognition of health
workers’ qualifications to optimise skills use, increase the benefits from and
reduce the negative effects of health worker migration and safeguard, migrants’
rights;
-
Data, information and accountability: undertaking robust research and analysis of health
labour markets, using harmonised metrics and methodologies, to strengthen
evidence, accountability and action.
From the foregoing, it could
be arguably stated that, as far as a United Nations document would go, this is
a decidedly progressive plank for us within the global public space, in our
struggle to enthrone universal access to public health, and in defence of
health workers, worldwide. And with a 5-Year Action Plan for the implementation
of the recommendations of the report scheduled to be unveiled by December, the
possibilities ahead created with the niche secured through work in the
Commission are quite significant.
PSI’s point of departure has
always been that health is a human right, and a primary responsibility of
governments. As Rosa Pavanelli pointed out shortly after she was appointed into
the Commission: “The tragic consequences of the failures to invest in public
health in Ebola affected West Africa reminds us that both the level of
expenditure and the method of delivery matter for health outcomes. Public
delivery is both more efficient and provides better health outcomes.”
It is quite laudable that the
Commission arrived at the robust conclusion it did. But, we will have to defend
the gains from this report, and build on it – fighting for and winning the
human right to health as an actuality, within the ambit of the 5-Year Action
Plan, and also independently, as a Global Union Federation, in alliance with other
active social forces within the civil society. This position is largely at the
heart of the PSI Human Right to Health Global Campaign. But, before I now go
over to this aspect of the discussion, I would want to point out a major
strength of the vigorous and fruitful interventions of the PSI within the
Commission, which buttresses my earlier assertion on our strength as a
movement.
Ever meticulous, with an eye
for details, and with a fighting working class’ spirit, Rosa did do PSI proud
in the Commission’s discourse. I must also salute the role played by Sandra
Vermuyten, the PSI Head of Campaigns and technical contact person during the
work of the Commission, for PSI. She worked tirelessly, often late into the
night at short notice, and even during the summer holiday.
But, undoubtedly, the
greatest heroes of PSI’s well thought-out interventions are you; members of
affiliates. There were submissions from affiliates across the world, on
different aspects of the work of the Commission, which provided the strong
winds of argument and commitment, on the sails of which Rosa Pavanelli soared
in stating the position of health workers, and poor working class people, who
bear the brunt of attacks on public healthcare delivery.
This is the same spirit we
must now bring to bear as we proceed to commencing the global campaign for the
Human Right to Health.
"The enjoyment of the
highest attainable standard of health," has been declared a human right,
since 1946, with the establishment of the World Health Organisation. Significant
improvements were made after this declaration, particularly in industrialised
countries, until the last quarter of the 20th century. But since
then, despite several inter-governmental covenants on universal health
coverage, we remain very far from ensuring the human right to health for all.
More than 1 billion people
live in poverty and have no access to drinking water, while 2.6 billion have no
access to sanitation. Wars, internal conflicts and climate change continue to
claim tens of thousands of lives, leaving millions more in utter misery. Health
workers pay with their lives for being at the forefront of the fight against
natural, man-made, and epidemiological disasters such as Ebola, Zika and MERS,
working without adequate protection or remuneration.
This gruesome reality stems from policies and
practices that put profit before people, as part of the neoliberal project of:
privatisation, liberalisation and cuts in the funding of social services,
driven by free trade agreements and conditions for “aid” and loan facilities
from international financial institutions. This has led to increasing
inequalities in health outcomes and the quality of life within and across
countries, generally, even during a period of remarkable growth, before the global
economic crisis.
The dire state of health for
the immense majority of the population particularly got worsened in poorer,
developing countries, where health systems were weaker and the policy space for
improving these were constrained with the structural adjustment programmes of
the 1980s-1990s. Now, a terrible situation has gotten worse. Austerity measures
in developed and developing countries alike have led to further the
pauperisation of millions on one hand and attacks on the public healthcare system.
Poverty has not only led to
the constriction of access to health for hundreds of millions of poor people,
out of pocket expenses for health equally contributes significantly to making
the poor, poorer still. According to the WHO: “about 100 million people
globally are pushed below the poverty line as a result of health care
expenditure every year”’[1].
This is a clear pointer to
the critical need for universal public health
coverage, for health as a human right to be realisable. But with the
pervasiveness of the neoliberal agenda, the health and social care sector has
witnessed significant restructuring with increasing for-profit private interests’ involvement in the provision of
health services, with explicit support of governments, formulated as health
reforms.
Such support often takes
different forms of privatisation, including PPPs as well as policies that
foster transnational corporations’ expansion into health services delivery and
pharmaceutical production. These health reforms are part and parcel of a
three-dimensional fiscal reforms: involving tighter systemic fiscal controls;
new priorities for the allocation of governments’ resources spurred by a
limited sense of growth, and; improvement in the use of resources, from the
standpoint of a lean state (Schick, 1998[2]).
But, the assumption held on
to tenaciously by policy makers that private provision of healthcare is more
efficient is not evidence-based. On the contrary: “(c)omparisons of total
health spending at national level show that countries with higher private
spending on health spend more on health care and achieve worse results in key
indicators of national health” (Lethbridge, 2014[3]).
Furthermore, the super-rich
and their transnational corporations continue to stash away trillions of
dollars from which more than enough to money to enthrone universal public
health coverage could be gotten, as yet another exhaustive study recently shows
(Philips et al, 2016[4]). This is despite the fact that funding for
critical social services such as health and social care have been grossly cut
as an avalanche of austerity measures follow in the wake of the global economic
crisis, supposedly due to dwindling resources of states.
The impact has been quite
“negative and damaging” to the health and social sector (Maucher, 2013[5]).
Budgetary cuts and introduction/increase in user fees have had “devastating
effects” on services delivery in both developed and developing countries. Salary
cuts are becoming generalised and job security, which used to be the norm in
the sector is fast becoming a mirage.
The health sector has
witnessed an expansion of informalisation of labour relations into diverse
spheres of work and staff cuts, including non-replacement of retired staff has
placed heavy workloads on the health workforce and increased precarious work,
particularly amongst young workers, where and when they do find employment.
Overstretched health workers
and increasingly frustrated patients, partly as a result of the added burden of
costs for accessing healthcare, which they have to bear has been a recipe for
the heightening of workplace violence. Women have been the most adversely
affected.
This general global picture
overlapping into the abysmal circumstances of poor wages, incapacitating
working conditions and under-funded public services in the Global South is
fuelling the migration of health workers, to the Global North. Such, often
poorly informed migration, have also quite often been on terms of peonage,
despite the subsisting WHO code on ethical recruitment. It is also contributing
severely, to the worsening of already fragile health systems and undermining their
crisis preparedness as evidenced in the high fatality of cases during the Ebola
outbreak in West Africa.
The current multi-faceted
debilitating state of health for the immense majority of the human population
quite clearly has systemic roots. It is about choices – it is political. While
there are windows of opportunity for turning the tide, such as the “renewed
global commitment to health, underpinned by target 3.8 for Universal Health
Coverage (UHC)” and the outstanding success recorded with the UN High Level
Commission of Health Employment and Economic Growth, with PSI’s robust
interventions[6],
now more than ever, we have to organise a mass global campaign for the human
right to health.
This would draw on the
commendable efforts of PSI and its affiliates in the sector across the
different regions, and the forging of alliances -and where need be,
coalitions-, with other global union federations, national trade union centres,
civil society organisations, associations of patients/users of healthcare facilities
and research bodies, to bring about change that would help enthrone universal
access to public health as a human right.
While the Head Office of PSI
would give the necessary leadership including coordination of the campaign, as
we did with work in the UNComHEEG, and in the traditions of the PSI as a global
trade union federation, the success of the campaign would rest squarely on your actions; at local, national and
regional levels.
There would be global days of
action, which would have little or no meaning without action being taken in your
different countries and localties. There are also peculiar challenges and
struggles in the different countries and regions, which we have to integrate as
tidal waves of the ocean of focused activities that the campaign aims to be.
We have no doubt in the
readiness of the Asia Pacific Region’s health network to meet up with the
demands of this historical moment. I have taken time to study the report of the
draft AP Regional 2011-2016 report and AP Regional 2016-2021 draft action plan,
with specific focus on the health sector. Not surprisingly, a host of the
general problems identified within the contextual background of the campaign
are very palpable in the region, and deep thinking have also been given to
tackling these.
We have also taken note of
the vibrant spirit of struggle very well alive and kicking amongst affiliates
in the region’s health sector, particularly, I must say – but not limited to-
our sisters.
From: the downing of tools by
members of the All India Government Nurses Federation (AIGNF) to protest
“retrograde recommendations” that would amount to worsening terms of employment
in February, with further protests last month, to; the general strike organised
by the Korean Health and Medical Workers’ Union (KHMU) against the
performance-based pay system and flawed labour market reforms, in September,
and; the glorious massive Convention organised by the All Sindh Lady Health
Workers and Employees Association in Pakistan where grievances against the
provincial government over salaries and other employment benefits were
brilliantly highlighted, the life-force of positive resistance needed to fight
for and win the human right to health, and indeed, a better world shines forth.
Our struggle would also not
be simply one of “action”. Our actions, in the cause of the campaign must be
rooted in rigorously thought out alternatives
which broaden our commons by enthroning quality public services, greater
involvement of workers and communities in decision-making, and a change in the
dominant paradigm of development, whereby the
concerns of people -including universal access to health- would come before
profit.
Affiliates in the AP Region
have also shown themselves ready for deep thinking, on the way forward, as much
as they have demonstrated their ability to dare
to struggle, and dare to win. The September 22 public meeting on
“neoliberalism and healthcare in South Asia, is an eloquent testimony to this.
So sisters, brothers,
comrades and friends, let us stand as one and rally around the call for human
right to health, for your health, my
health, our health, IS NOT FOR SALE!
Long live the Asia Pacific Region!
Long live the Public Services
International!!
Solidarity Forever!!!
* ADDRESS PRESENTED BY BABA AYE, HEALTH AND SOCIAL SECTOR OFFICER TO THE PSI ASIA PACIFIC REGION HEALTH SECTOR NETWORK, ON OCTOBER 10, 2016, AT THE ASIA PACIFIC REGIONAL CONFERENCE (APRECON) HELD AT THE ACCOR CONFERENCE CENTRE, FUKUOKA, JAPAN, ON OCTOBER 08-12, 2016
[1] http://www.who.int/mediacentre/factsheets/fs323/en/
[2] Schick, A., 2009, “Budgeting for Fiscal Space”, OECD Journal on Budgeting, Vol 9/2, OECD
Publishing, Paris
[3] http://www.world-psi.org/sites/default/files/documents/research/2014_-_financing_health_care_-_psiru_paper.pdf
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