Global Health Watch 1 in one file

Health care systems | B1
the high technology and urban bias of resource distribution and will lobby
against any measures to change this. Many parts of the private sector have
reasons to block movement in the direction of the PHC Approach. These
vested interests can be overcome only by a political effort, which includes
the mobilization of those who are disadvantaged by the current system and
their political and civil society representatives. Where communities face a
commercially driven health care sector, they need to lobby for a regulatory
framework to hold providers and the health system accountable. Where neoliberal
reforms are undermining public systems and shifting state obligations
onto communities, they need to mobilize in support of the public sector.
The need to engage with actors and policies from beyond the local area
poses a particular challenge. Social movements may need to bring together the
concerns of several communities and find ways of presenting collective views
and concerns at the national or international level. This form of community
involvement requires an advanced level of organization, capacity building and
civil society networking. Examples include the Treatment Action Campaign
in South Africa, which challenged the patent monopolies of drug companies
on anti-retroviral drugs and the failures of the South African government to
provide treatment for HIV/AIDS, and the mobilization of civil society against
the privatization of health services in El Salvador.
The role of international NGOs in acting as a conduit for the demands and
needs of poor people in developing countries is important. International NGOs
in developed countries should help develop the capacity of Southern-based
NGOs and work with and through them. UN agencies must find ways to create a
more prominent involvement of Southern-based NGOs, academics and health
institutions in shaping the international health policy agenda.
Public and community involvement in health care systems For public sector
bureaucracies to work effectively, efficiently and fairly, they need to be held accountable
– internally through rules and codes of ethical conduct but, equally
importantly, externally to communities and the public.
The spectrum of appropriate community involvement includes community
mobilization to assert rights, challenge policies and present alternatives;
monitoring of services by communities; involvement in planning and decision-making;
and involvement in the implementation of PHC programmes
and services. All too often, the role of civil society organizations within health
care systems is given inadequate attention, or is used to cover up other agendas
such as transferring government responsibility onto communities or rubberstamping
central decisions.
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