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Background to the Campaign on Women’s Access to Health
Content
WAHC
Background to the Campaign on Women’s Access to Health
Women’s Global Network for Reproductive Rights
From 2003 to 2005 the WGNRR Coordination Office will
coordinate the Women’s Access to Health Campaign, in close
collaboration with the People’s Health Movement (PHM). The core
activities will be centered around, but not restricted to May 28;
International Day of Action for Women’s Health. The Coordination Office
will bring out campaign material to support Network members and other
interested groups and will be engaged in activities, meetings and
conferences that are organized around the campaign. Campaign participants
will regularly receive updates. The reports/articles they send to the
Coordination Office will be sent to other participants, in order to
stimulate and inform each other.
The campaign will focus on the specific objectives laid
down in the Alma Ata Declaration of 1978 (USSR) for the implementation of
Health for All by the Year 2000 and show within that framework the missing
themes vis-à-vis women’s health. We will in this way not just highlight
the failure of the implementation of the Alma Ata Declaration, but also
show our solidarity with the concept of primary health care which is the
larger theme taken up by the People’s Health Movement for the next few
years. At the May 1999 meeting of all health ministers at the World Health
Assembly the call of “Health for All in the Year 2000”, as agreed upon
in 1978, was reformulated to “Health for All in the 21st century”
and the targets reset to 2020. What happened to the Alma Ata vision?
The concepts outlined in the Alma Ata Declaration
(1978) will form part of the three subsequent Calls for Action (2003 -
2005). Specific reproductive and sexual health and rights angles will
serve to exemplify and strengthen the demands.
The 3-year campaign slogan will be “Health for All -
Health for Women”. The 3-year core demand is that primary health care be
provided for all people and peoples everywhere, taking into account, in
theory and practice, women’s reproductive and sexual health needs. In
2003 the Campaign’s slogan will be directed at national governments: “Governments
Take Responsibility for Women’s Health”. The slogans for the 2004 and
2005 Calls for Action will be decided upon according to WGNRR member’s
input, since the Network members have indicated their wish to form part of
the developments of campaigns.
Background
“Health for All” is really being pushed back by
health sector reforms and privatization with disastrous result in terms of
women and children’s lives. We therefore need to take up the call for
the inclusion of a focus on women’s health within the framework of
primary health care. This is an important means to reach out to as many
people as possible - both rural and urban and the underprivileged
everywhere who are currently excluded from any care at all.
Since 1993 the World Bank (WB) has taken a greater role
in the development and the implementation of health policies for
developing countries, whereas the role of the World Health Organization
(WHO) has been diminished. Government health policies, with the support of
WHO and the WB, have been redirected to focus on privatization,
cost-effectiveness and the development of public-private partnerships in
the provision of health care. This development has dramatically affected
people’s health in poor countries and specifically women’s health. We
find that the under the prevailing circumstances governments have had
little say in protecting the needs and interests of their people since
they are or claim to be dependent on the Bank for loans and hence ‘have
to’ agree to the conditions placed by this institution.
Over the years governments and religious
fundamentalists have denied women’s right to make decisions central to
their lives. They have done this by implementing policies that are more in
the interest of private businesses and cost-effectiveness and less in the
interest of equity and quality for all. Religious fundamentalists have
been able to influence policy makers with patriarchal attitudes related to
women’s sexual and reproductive lives. The right to health also eludes
many women who because of deeply internalized subordination and the
absence of enabling conditions, fail to claim this entitlement.
Women’s right to health has to be addressed by
comprehensive primary health care systems and comprehensive social and
economic policies all over the world. Our campaign will focus on getting
women’s needs highlighted at all levels of health policymaking and
programmes. We join the People’s Health Movement in their efforts to
spread support for the primary health care approach as widely as possible
and to mobilize through the PHM and our combined networks.
What do we plan to do?
According to the Alma Ata some of the fundamental
characteristics of primary health care include:
-
Universally accessible health
care
-
Community participation
-
Affordable and appropriate
services
-
Plans integral to social and
economic development
-
Prevention, promotion and
curative care
-
Inter and multi-sectoral
collaboration
The characteristics outlined above show that the Alma
Ata Signatories recognized health as a political issue related to
questions of socio-economic justice. The identified need for community
participation and intersectoral cooperation indicates that it was
understood that if we were to address not just the symptoms of ill health
but its root causes, a radical change had to be made in the medicalised
approach to health. The Declaration also called on governments to take up
their responsibility towards ensuring that Health for All becomes a
reality, a demand that needs to be highlighted in these times of increased
privatization and the shifting of responsibilities away from governments.
We have purposefully chosen to focus on the campaign on
women’s access to health i.e. not on health services. Although we find
health services very essential, they cannot in and of themselves ensure
women’s health and reproductive and sexual rights. While we wish to
address women’s needs for basic services that include reproductive and
sexual rights, we also want to address the ‘enabling conditions’ that
are essential for women to enjoy good health. International and national
policies that result in greater poverty of populations and an ever-growing
gap between the rich and the poor, as is currently the case, have a direct
impact on women’s possibilities to stay healthy or enjoy their
reproductive and sexual rights.
Under the banner of reproductive and sexual rights
there are several issues that interlink with women’s status - and affect
their health detrimentally. For instance women are more likely to be
infected with the HIV virus than men in sexual encounters; pregnant women
are more exposed to the risk of domestic violence; women are less likely
to demand and receive health care until they become seriously ill. Some of
the issues the women’s movement has been demanding attention for over
the years are listed below:
-
Violence against women
-
Maternal mortality and morbidity
-
Abortion rights and services
-
Sexually transmitted diseases
-
HIV-AIDS and PHC
-
Communicable diseases like TB
and Malaria
-
Need for safe and effective,
woman friendly contraceptives and policies not driven by population
control
No doubt some aspects of the problems/illnesses
mentioned above have received some attention within what existed as
primary health care in many countries. For instance in Argentina and
several other countries up until the mid-1990’s pregnant women did have
the possibility to have antenatal check ups during their pregnancy; a
certain amount of maternal and child care was provided for by health care
centers worldwide; free treatment for TB and malaria were offered and
programmes were set up to distribute oral rehydration therapy in case of
diarrhea. Above all in many parts of the world free contraceptives were
provided in the effort to reduce the birth rates, as part of population
control programmes. In fact in the context of India and Bangladesh the
complaint has been that primary health care centers often may not have
antibiotics to offer clients but definitely have hormonal contraceptives
that are highly questionable in terms of their effects on women’s
health.
Broadening the Campaign Beyond WGNRR’s Network
We will work with our members to develop the campaign
and the related annual Calls for Action. We propose to broaden the
campaign to include other social movements that may not have women’s
health and reproductive and sexual rights as a central focus. We believe
that including a wider range of groups will build solidarity and
strengthen our demands of reversing inter (national) health and other
policies that have a negative impact on women’s reproductive and sexual
health and rights and women’s access to health and to health care. In
particular we are linking with the People’s Health Movement (PHM, for
more information please visit their website at www.phmovement.org) and
coordinating a PHM working circle on the issue of women’s access to
health.
The Peoples Health Movement (PHM, formerly the Peoples
Health Assembly, PHA) has come out of an international initiative that
started in 1998. In that year, a group of health activists, doctors,
health and drug action NGOs, public health professionals and academicians
came together because of their deep concern at the deteriorating health
situation for the majority of people, especially in poor countries. The
idea was to elaborate an analysis of health policies internationally and
its effects on people on a national and local, and use such analysis as a
starting point for campaigns at all levels, to demand better health care
provisions for the disadvantaged worldwide.
Since June 1999 the coordination office of the WGNRR is
involved in the coordination, first of the Peoples Health Assembly in
December 2000 in Bangladesh, and more recently in international networking
under the umbrella of the PHM. Many activities are being undertaken by
grassroots organizations all over the world.
What we would like to see happen:
We join the People’s Health Movement the next three
years in demanding primary health care for all people everywhere.
Within that demand we would like to highlight for the
year 2003 that
governments take responsibility for women’s health!
DECLARATION OF ALMA-ATA
International Conference on Primary Health Care -
Alma-Ata, USSR, 6-12 September 1978
The International Conference on Primary Health Care, meeting in Alma-Ata
this twelfth day of September in the year Nineteen hundred and
seventy-eight, expressing the need for urgent action by all governments,
all health and development workers, and the world community to protect and
promote the health of all the people of the world, hereby makes the
following Declaration:
I
The Conference strongly reaffirms that health, which is a state of
complete physical, mental and social well-being, and not merely the
absence of disease or infirmity, is a fundamental human right and that the
attainment of the highest possible level of health is a most important
world-wide social goal whose realization requires the action of many other
social and economic sectors in addition to the health sector.
II
The existing gross inequality in the health status of the people
particularly between developed and developing countries as well as within
countries is politically, socially and economically unacceptable and is,
therefore, of common concern to all countries.
III
Economic and social development, based on a New International Economic
Order, is of basic importance to the fullest attainment of health for all
and to the reduction of the gap between the health status of the
developing and developed countries. The promotion and protection of the
health of the people is essential to sustained economic and social
development and contributes to a better quality of life and to world
peace.
IV
The people have the right and duty to participate individually and
collectively in the planning and implementation of their health care.
V
Governments have a responsibility for the health of their people, which
can be fulfilled only by the provision of adequate health and social
measures. A main social target of governments, international organizations
and the whole world community in the coming decades should be the
attainment by all peoples of the world by the year 2000 of a level of
health that will permit them to lead a socially and economically
productive life. Primary health care is the key to attaining this target
as part of development in the spirit of social justice.
VI
Primary health care is essential health care based on practical,
scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community
through their full participation and at a cost that the community and
country can afford to maintain at every stage of their development in the
spirit of self-reliance and self-determination. It forms an integral part
both of the country's health system, of which it is the central function
and main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family and
community with the national health system bringing health care as close as
possible to where people live and work, and constitutes the first element
of a continuing health care process.
VII
Primary health care:
-
reflects and evolves from the economic conditions and
sociocultural and political characteristics of the country and its
communities and is based on the application of the relevant results of
social, biomedical and health services research and public health
experience;
-
addresses the main health problems in the community, providing
promotive, preventive, curative and rehabilitative services
accordingly;
-
includes at least: education concerning prevailing health
problems and the methods of preventing and controlling them; promotion
of food supply and proper nutrition; an adequate supply of safe water
and basic sanitation; maternal and child health care, including family
planning; immunization against the major infectious diseases;
prevention and control of locally endemic diseases; appropriate
treatment of common diseases and injuries; and provision of essential
drugs;
-
involves, in addition to the health sector, all related sectors
and aspects of national and community development, in particular
agriculture, animal husbandry, food, industry, education, housing,
public works, communications and other sectors; and demands the
coordinated efforts of all those sectors;
-
requires and promotes maximum community and individual
self-reliance and participation in the planning, organization,
operation and control of primary health care, making fullest use of
local, national and other available resources; and to this end
develops through appropriate education the ability of communities to
participate;
-
should be sustained by integrated, functional and mutually
supportive referral systems, leading to the progressive improvement of
comprehensive health care for all, and giving priority to those most
in need;
-
relies, at local and referral levels, on health workers,
including physicians, nurses, midwives, auxiliaries and community
workers as applicable, as well as traditional practitioners as needed,
suitably trained socially and technically to work as a health team and
to respond to the expressed health needs of the community.
VIII
All governments should formulate national policies, strategies and plans
of action to launch and sustain primary health care as part of a
comprehensive national health system and in coordination with other
sectors. To this end, it will be necessary to exercise political will,
to mobilize the country's resources and to use available external
resources rationally.
IX
All countries should cooperate in a spirit of partnership and service to
ensure primary health care for all people since the attainment of health
by people in any one country directly concerns and benefits every other
country. In this context the joint WHO/UNICEF report on primary health
care constitutes a solid basis for the further development and operation
of primary health care throughout the world.
X
An acceptable level of health for all the people of the world by the year
2000 can be attained through a fuller and better use of the world's
resources, a considerable part of which is now spent on armaments and
military conflicts. A genuine policy of independence, peace, détente and
disarmament could and should release additional resources that could well
be devoted to peaceful aims and in particular to the acceleration of
social and economic development of which primary health care, as an
essential part, should be allotted its proper share.
The International Conference on Primary Health Care calls for urgent
and effective national and international action to develop and implement
primary health care throughout the world and particularly in developing
countries in a spirit of technical cooperation and in keeping with a New
International Economic Order. It urges governments, WHO and UNICEF, and
other international organizations, as well as multilateral and bilateral
agencies, non-governmental organizations, funding agencies, all health
workers and the whole world community to support national and
international commitment to primary health care and to channel increased
technical and financial support to it, particularly in developing
countries. The Conference calls on all the aforementioned to collaborate
in introducing, developing and maintaining primary health care in
accordance with the spirit and content of this Declaration.
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