December 2000


Participants of the recent People’s Health Assembly in Bangladesh blame globalisation, liberalisation and privatisation for the deterioration in health services around the world, and call for the restoration of the primary health care approach.

By Ranjit Devraj

Savar (Bangladesh): Primary health care must be put back up on the global agenda, immunised from damage caused by economic liberalisation and the privatisation of health services, activists said at the end of the People’s Health Assembly (PHA) here on 8 December.

Meeting in this remote setting 40 kilometres outside Bangladesh’s capital Dhaka, the activists demanded the restoration of the primary health care approach adopted at a 1978 international health conference in Alma Ata, Kazakhstan.

The demand is the cornerstone of a ‘People’s Charter for Health-2000’, endorsed at the end of four days of deliberations and testimonies by more than 900 delegates gathered here from 92 countries.

Although the charter reflected the Alma Ata Declaration in many ways, it sought to remedy setbacks suffered by the global health sector caused by the more recent processes of liberalisation, globalisation and privatisation pushed by the World Bank and the International Monetary Fund (IMF).

‘Unlike the World Health Organisation (WHO), the World Bank and the IMF are Bretton Woods institutions and not true UN bodies,’ said Halfdan Mahler, who served as WHO Director-General for 15 years and played a key role in discussions here.

Mahler blamed the ‘hijacking’ of the global health agenda from WHO by the World Bank after 1993 and its emphasis on market-driven policies for deteriorating health services around the world, the main concern of the PHA.

‘Governments have a fundamental responsibility to ensure universal access to quality health care, education and other social services according to the people’s needs, not according to their ability to pay,’ the charter laid down as a basic principle.

‘You can’t reverse globalisation, but you can stop people from suffering its consequences - if large numbers come forward and protest,’ said Prem John, Asia coordinator of PHA and director of the Asian Community Health Action Network.

Indeed, activists said public pressure had a role to play in changing the priorities of global institutions like the World Bank.

Asked how the just-finished PHA can change the Bank, Zafrullah Chowdhury, programme coordinator of Gonashasthaya Kendra, the assembly’s host organisation, said the mood created by people’s movements encourages their politicians to put pressure on the World Bank and the ‘mafia’ which now runs it behind closed doors. ‘Our aim is to make it (the Bank) democratic so that every country has one vote,’ he added.

Olle Nordberg of the Dag Hammarskjold Foundation, the major donor and supporter of PHA, said: ‘The PHA has wider implications than health. It helps people build up their own strategies and provide an important balance.’

The World Bank and the WTO took a beating from experts and activists at PHA 2000 for ‘arrogating unto themselves’ the right to set the world health agenda on hard-nosed business principles rather than as a people-oriented service.

The charter pointedly said health was ‘primarily determined by the political, economic, social and physical environment and should, along with equity and sustainable development, be a top priority in local, national and international policy-making’.

‘Health should find a prime place. No one has the right to commodify it,’ Abdul Matim Khasru, Bangladesh’s minister for law, justice and parliamentary affairs, declared at one of the sessions.

Heeding demands set out by the charter was asking for ‘transformation of the global trading system so that it ceases to violate social, environmental, economic and health rights of people and begins to discriminate positively in favour of countries of the South’.

Reforms, the charter demanded, should cover intellectual property regimes such as patenting and the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. It also asked for firm commitment in the WTO framework to support measures to protect public health, which, Mike Rowson - an economist with the United Kingdom-based activist group Medact - explained to the delegates, is missing.

‘While the WTO gives individual governments rights to adopt or enforce measures to protect human, animal or plant life or health, these are not defined, leaving it open to the danger of prioritising the interests of trade and restricting definitions considered necessary for public health measures,’ Rowson said.

Rowson said the TRIPS regime particularly affected the rational use of drugs, and threatened to put essential drugs out of the reach of ordinary people. ‘Disputes have already risen over the leeway given through compulsory licensing and parallel imports,’ he added.

Activists from South Asia, such as Zafar Mirza from Pakistan and Mira Shiva from India, said the 20-year window given for pharmaceutical companies to determine global prices for new drugs threatened to affect the control of diseases such as malaria and hepatitis.

The charter called for radical transformation of the World Bank and the IMF so that these institutions reflect and actively promote the rights and interests of developing countries, and demanded a reining in of transnational corporations (TNCs).

On social and political challenges, the charter commented that economic globalisation and privatisation have ‘profoundly disrupted communities, families and cultures’.

‘Public institutions have been undermined and weakened. Many of their responsibilities have been transferred to the private sector, particularly corporations, or to other national and international institutions which are rarely accountable to people,’ it said.

The charter itself was honed by a special committee of experts communicating with one another over the Internet for at least two years, but each section was put before the PHA delegates here.

At a special session on 7 December, members of the committee heard and accommodated demands by delegates asking, for example, for a ban on the use of sanctions for military purposes since it affects the health and social development of civilian populations. The charter came down hard on militarist tendencies.

‘Increased arms procurement and an aggressive and corrupt international arms trade undermine social, political and economic stability and the allocation of resources to the social sector,’ it said.

The charter also took note of environmental challenges such as water and air pollution, rapid climate change, ozone-layer depletion, nuclear energy and waste, toxic chemicals and pesticides, loss of biodiversity, deforestation, and soil erosion, all of which affect the health of people.

But most of all, it called for a people-centred health sector and the provision of universal and comprehensive primary health care, irrespective of people’s ability to pay. ‘Health services must be democratic and accountable with sufficient resources to achieve this,’ it stated.

Finally, activists in closing the health assembly, made clear they would persist with their campaign after the meeting and said PHA plans to function over the Internet and meet again in two or three years.

Said John: ‘It took 15 years to collect funds ($1.7 million) for this one but there is momentum now.’ - Third World Network Features/IPS


About the writer: Ranjit Devraj is a correspondent for Inter Press Service, with whose permission the above article has been reprinted.