Global Health Watch 1 in one file
Global Health Watch 1 in one file 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. 90
Appropriate community involvement should also be enhanced by health care systems through effectively empowered community structures and forums (such as district health committees, clinic committees and hospital boards), as well as by inculcating a culture of consultation and respect for lay people. Health care systems can disseminate information about local health services and the rights of service users, as well as publicize disparities in key indicators such as maternal mortality and immunization coverage to encourage a social commitment towards reducing inequity. However, because communities are themselves stratified, health workers need to make sure that community involvement does not entrench privilege. More effective assistance from donors and global initiatives Donor and international health agencies must improve the quality, coordination and appropriateness of their programmes and initiatives. They must learn to develop a better understanding of local contexts and to adopt policies that place the long-term self determination and development of Ministries of Health and the citizens of recipient countries at the heart of all decision-making. Donors must reaffirm the generic principles of a coordinated sector-wide approach to health systems development. More investment should be aimed at developing, retaining and motivating public sector staff, and donors must be prepared to fund the recurrent costs of public sector health care systems in the poorest countries for at least the medium-term. Donors should also divert more funding away from agencies based in donor countries towards the public sector and NGOs in recipient countries. Donor programmes and international health initiatives must translate the rhetoric of implementing disease-based programmes in ways that strengthen health care systems in practice. Disease-specific initiatives must explicitly explain and demonstrate how they are strengthening the overall development of comprehensive health care systems. Philanthropic agencies must recognize the need to balance investment in medical technologies with the need to invest in human resources, health systems and multi-sectoral approaches to health promotion and disease prevention. Donors must avoid self-promotion and no longer insist that governments show quick results from their grants. Donor funding should be judged instead by the performance of the overall health care system over time. Donors should adopt a more incremental, problem-solving approach to health sector development, rather than the blueprint approach currently favoured by foreign technocrats. Technical assistants need to be selected with greater attention to the appropriateness of their skills; their willingness to learn the local cultural Approaches to health care 91
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Appropriate community <strong>in</strong>volvement should also be enhanced by health<br />
care systems through effectively empowered community structures and forums<br />
(such as district health committees, cl<strong>in</strong>ic committees and hospital boards),<br />
as well as by <strong>in</strong>culcat<strong>in</strong>g a culture of consultation and respect for lay people.<br />
<strong>Health</strong> care systems can dissem<strong>in</strong>ate <strong>in</strong>formation about local health services<br />
and the rights of service users, as well as publicize disparities <strong>in</strong> key <strong>in</strong>dicators<br />
such as maternal mortality and immunization coverage to encourage a social<br />
commitment towards reduc<strong>in</strong>g <strong>in</strong>equity. However, because communities are<br />
themselves stratified, health workers need to make sure that community <strong>in</strong>volvement<br />
does not entrench privilege.<br />
More effective assistance from donors and global <strong>in</strong>itiatives Donor and <strong>in</strong>ternational<br />
health agencies must improve the quality, coord<strong>in</strong>ation and appropriateness<br />
of their programmes and <strong>in</strong>itiatives. They must learn to develop<br />
a better understand<strong>in</strong>g of local contexts and to adopt policies that place the<br />
long-term self determ<strong>in</strong>ation and development of M<strong>in</strong>istries of <strong>Health</strong> and<br />
the citizens of recipient countries at the heart of all decision-mak<strong>in</strong>g. Donors<br />
must reaffirm the generic pr<strong>in</strong>ciples of a coord<strong>in</strong>ated sector-wide approach to<br />
health systems development. More <strong>in</strong>vestment should be aimed at develop<strong>in</strong>g,<br />
reta<strong>in</strong><strong>in</strong>g and motivat<strong>in</strong>g public sector staff, and donors must be prepared to<br />
fund the recurrent costs of public sector health care systems <strong>in</strong> the poorest<br />
countries for at least the medium-term. Donors should also divert more fund<strong>in</strong>g<br />
away from agencies based <strong>in</strong> donor countries towards the public sector<br />
and NGOs <strong>in</strong> recipient countries.<br />
Donor programmes and <strong>in</strong>ternational health <strong>in</strong>itiatives must translate the<br />
rhetoric of implement<strong>in</strong>g disease-based programmes <strong>in</strong> ways that strengthen<br />
health care systems <strong>in</strong> practice. Disease-specific <strong>in</strong>itiatives must explicitly<br />
expla<strong>in</strong> and demonstrate how they are strengthen<strong>in</strong>g the overall development<br />
of comprehensive health care systems. Philanthropic agencies must recognize<br />
the need to balance <strong>in</strong>vestment <strong>in</strong> medical technologies with the need to <strong>in</strong>vest<br />
<strong>in</strong> human resources, health systems and multi-sectoral approaches to health<br />
promotion and disease prevention.<br />
Donors must avoid self-promotion and no longer <strong>in</strong>sist that governments<br />
show quick results from their grants. Donor fund<strong>in</strong>g should be judged <strong>in</strong>stead<br />
by the performance of the overall health care system over time. Donors<br />
should adopt a more <strong>in</strong>cremental, problem-solv<strong>in</strong>g approach to health sector<br />
development, rather than the bluepr<strong>in</strong>t approach currently favoured by foreign<br />
technocrats. Technical assistants need to be selected with greater attention to<br />
the appropriateness of their skills; their will<strong>in</strong>gness to learn the local cultural<br />
Approaches to health care<br />
91
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