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Health Focus/Development: Reviewing Another Broken Promise

By Marwaan Macan-Marka

MEXICO CITY, Dec 1 (IPS World Desk) - By this year, another global pledge was to have been achieved: primary health care for all.

Such care was deemed essential to enable all citizens of the world ''to lead socially and economically productive lives'', states a document from the landmark international health conference in Alma Ata, Kazakhstan in 1978, where the pledge was made.

But as 2000 draws to a close, it has become clear that both the governments and the international community that backed the Alma Ata Declaration have fallen far short of meeting their obligations. And an international health conference to be held in Bangladesh from Dec. 4-8 - the People's Health Assembly (PHA) - provides an opportunity for health experts, researchers and activists from over 90 countries to ask why another set of promises were broken.

But where should such a review begin?

Access to safe water and basic sanitation serve as a useful point of departure, given what was stated in the Alma Ata Declaration. It identified the ''provision of an adequate supply of water and basic sanitation'' among the essential features to secure the promise of 'Health for All by 2000'.

Yet, according to the findings in a report, released by the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) last month, close to 1.1 billion people in developing countries do not have access to ''an improved water supply''.

In addition, around 2.4 billion people still do not have ''any acceptable means of sanitation''.

Such deprivation results in 4 billion cases of diarrhoea in the world every year, ''with 2.2 million deaths, mostly among children under five'', note the authors of the report, 'The Global Water Supply and Sanitation Assessment 2000'.

For Gro Harlem Brundtland, the director-general of the WHO, and Carol Bellamy, the executive director of UNICEF, this situation is tantamount to being denied ''basic human rights''.

''Access to safe water and to sanitary means of excreta disposal are universal needs and, indeed, basic human rights,'' they state in the introduction they jointly wrote for the report. ''They are essential elements of human development and poverty alleviation and constitute an indispensable component of primary health care,'' they added.

Yet, as the Global Assessment reveals, such essential features remain a luxury for a large slice of the world's rural and urban poor.

In Africa, for instance, close to 30 percent of the rural water supply systems do not function, while in Asia, it is 17 percent, and in Latin America and the Caribbean, four percent.

Regards sanitation, only 35 percent of the wastewater is treated in Asia, while in Latin America, it is 14 percent. And in Africa, ''only a negligible percentage''.

For Dr. Richard Jolly, who heads the Water Supply and Sanitation Collaborative Council (WSSCC), a Geneva-based international organisation, such widespread lack of sanitation is inexcusable.

''It is shameful, a scandal that almost half of the world's population does not have access to adequate sanitation,'' he is quoted as having said in a WHO media release.

According to the WSSCC, if the prevailing scenario is to be reversed, a ''people-centred approach'' needs to be followed, thus ensuring greater public involvement in decision-making. And already, the WSSCC has two success stories to serve as models under its 'Water for People' initiative.

''In the Indian state of Gujarat, for example, we have shown that rolling out water and sanitation services according to the precepts of (the 'Water for People' initiative) has had a dramatic impact on the health and well-being of the state's citizens,'' says Jolly.

Furthermore, he adds, it has also brought down the costs of ''improved water and sanitation services'' and mobilised ''local resources to handle local problems''.

In Uganda, on the other hand, the initiative has been led by non- governmental organisations (NGOs) in the water and sanitation sector. Consequently, it has resulted in communities drafting a blue-print to satisfy their needs for safe water and adequate sanitation.

''Their recommendations were divided between those actions which the communities could do themselves, and those requiring external assistance,'' states a WSSCC report.

According to David Sanders, however, such initiatives to combat water-borne diseases do not sit well with the health care industry, given its emphasis on the ''curative aspects'' of health.

And he argues, furthermore, in a background paper prepared for the PHA in Bangladesh, that such logic has also been embraced by public health policy makers.

''Hence, oral rehydration therapy for diarrhoea management is proposed as an essential component of a core health package while water and sanitation, which have indirect and less easily quantifiable impact on diarrhoea, are deemed 'cost-ineffective' and therefore not recommended as an area for public sector investment,'' writes Sanders, the Africa regional co-ordinator of the International Peoples Health Council.

So the PHA provides a useful forum for members of the health community in the developing world to question such thinking, consequently helping to secure the right to safe water and basic sanitation for all. (END/IPS/HE/mmm/da/00