Health care strategy for the poor

by A.H.M. Nouman

Poverty Reduction Strategy Papers (PRSP) is not automatic deliberations by IMF and World Bank. It is the people’s movements that compelled the funding agencies to come in line with such initiatives. But regrettably, the papers again appeared in prototype prescriptions having imprint of certain dictating culture. Addressing to specific diseases like malaria, HIV/AIDS, TB etc. under donor prescriptions are sectoral interventions covering a particular group of people. It did not encompass the health problems of the vast majority of the marginalised population.

Globalisation came in from the middle of the 90s proclaiming competitiveness and virtually created a law of the jungle ‘survival of the fittest' across the continents. Globalisation of the world market goes to the benefit of the big agencies and transnational corporate bodies leaving little for the weakest majority.

Promotion of private sector, denationalisation of government institutions including the health sector became crucial. Social security and safety nets are continuously eroded. Governments are working under constraints and difficulties at the dictates of IMF, World Bank and WTO, and eventually the states are to act as trading house devoid of obligations to their citizens.

Health Crisis: Governments in the developing countries, because of their dependence on IMF and World Bank, have to accept many unjustified prescriptions of the donors by reducing health budgets and social expenditures causing infringement on constitutional rights and their commitments to the people. This jeopardises democracy creating social unrest and instability.

In Bangladesh, health and nutrition scenario is more crucial. 26 per cent of the population have no access to basic health care facilities, 56 per cent of the children under 5 years’ age are underweight suffering from malnutrition, more than 94 per cent of the children are victims of different grades of Protein Energy Malnutrition (PEM), about 70 per cent of the children and women suffer from iron deficiency, anaemia, and 25 per cent of the maternal deaths are associated with anaemia and haemorrhage, about 30 to 40 thousand children go blind every year due to Vitamin A deficiency. Bangladesh dietary average is 2000 calories as against FAO recommended intake of 2310 calories per day.

57 per cent of the population have no access to proper sanitation. 35 million people are drinking tubewell water with arsenic contents in 59 district out of 64 districts in the country.

Globalisation is resulting in monopolisation of global wealth including the health care systems accumulated in the hands of a few giant investors and private multinational corporate bodies. Protection of health is an universal human rights for all human societies and communities. Privatisation of health care and public health services under the overt and covert dictation and persuasion of international money lending institutions, and indigenous medicinal patent right conditionalities within the coverage of globalisation has damaged the locally available medical and health service provisions.

From the experiences of thousands of years, the medicinal practices were continued by and for the people. But subsequently, this practice was overshadowed by the overwhelming advent of pharmaceutical monopolies.

During last decades, governments budget for health care decreasing gradually. In addition, the available budget is also directed to the donor driven policies. Most of the governments' health budgets go to city areas with the poor at the rural areas receiving little. Very few hospitals and health care services were built during last decades under governments’ initiatives. Health care services are left in the hands of private sector beyond the capacity of common people. Thereby commercialisation of health services has been viewed according to ability to pay and not according to the people’s needs.

DORP (Development Organisation of the Rural Poor) as an integral part of PHA movement upholds human dignity at the top of the priorities. DORP profoundly believes in the People's health charter that was adopted as a guideline for ensuring comprehensive health services and accessibility to all essentials of primary health care systems including nutrition sanitation water borne diseases etc. DORP accomplished the following tasks in line as under:

* Prior to PHA conference held in December 2000, DORP conducted the regional seminars of the Chittagong Division by integrating more than 54 local NGOs with participation of more than 250 delegates working in health sector in the area.

Bottom-up practices were fully exercised for selection of health issues and agendas through participation of NGOs, civil societies and government representatives in the process of health movement.

DORP is already carrying an integrated approach of health care systems the slums of Dhaka and in the coastal area of Banskhali in Chittagong district, with the support of CORDAID, the Netherlands, through health services, sanitation, drinking water provisions combating water borne diseases, education, awareness and skill training programme which is supported by credit facilities for economic uplift of the deprived poor community.

Participation of community people to develop themselves and their declarations:

A search for comprehensive development putting health in the heart to achieve the following determinants:

* Participation of all to keep everybody's home neat and clean.

* Use sanitary latrines.

* Maintain health card and health Insurance.

* Adopting the agendas of primary health care : Polio, Hooping cough, DPT, TB, measles through proper vaccinations and preventive measures.

* Use safe drinking water

* Nutrition balanced agro farming and food habits.

* Population control and planned family.

* Safe motherhood and reduction child mortality rate

* Fruits, herbal and medicinal plants at all homestead/yard.

* All children above 5 years are school attendants.

* Increase use of organic fertilisers and compost materials as agro nutrients.

* Proper fish culture at all ponds and water bodies.

* Increased home farming, poultry and livestock.

* Disaster preparedness by all.

* Work together through cooperation and solidarity action for poverty alleviation.

* Formation of village committee, to solve problems by their own initiatives. Establishing linkage with local governments, thana, district and other national administrations to tap available resources.

* Voting for capable and dedicated representatives for promotion of good governance.

The writer is Secretary General, Development Organisation of the Rural Poor (DORP), Dhaka. The article is based on a memorandum submitted to the CEC early last month.

Source:The Independent, June 07,2001