Letter from the Prime Minister of the Republic of Mozambique - People's Health Assembly - December 2000
Letter from the Prime Minister of the Republic of Mozambique,
Dr. Pascoal Manuel Mocumbi, to the People’s Health Assembly 4 December 2000
Read By Dr. Martinho Dregdge
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Dear Mr. Balasubramian,
In the first place, I would like to thank you for inviting me to participate in the People’s Health Assembly, in Bangladesh from 4th to 8th December. I was preparing to come and contribute to the initiative, which will bring a ray of hope to all those who are ‘excluded’ from today’s globalisation process.
Unfortunately, I must remain in Mozambique in order to fulfil my obligations in relation to the parliamentary session currently underway, which requires my presence on exactly the same dates as those of the People’s Health Assembly. I would have liked to have been able to share my concerns and thoughts personally.
In my country, when we won national independence, in 1975 we successfully launched a people’s health initiative, based on primary health care for all, as an integral part of our national development programme. Unfortunately, we were unable to continue our integrated rural development programme, because we were struck a by man-made disaster.
The war ended in 1992, and since then we have begun to rebuild. With our southern African neighbours and partners, now free from apartheid and colonialism, we are building the Southern Africa Development Community, SADEC.
The challenge we face, and which I believe confronts all the peoples of developing countries and beyond is: what is the role of the State in social development in the context of the prevailing ideology of globalisation?
In countries such as mine, where 70% of the population lives below the absolute poverty line and where maternal and perinatal mortality ratios are extremely high, the State must assume the responsibility of guaranteeing access to healthcare. Nonetheless, thought must be given to how to ensure that the health systems are sustainable, if there is not or has not been community participation in its design and operation.
In our experience, community empowerment is a key guarantee of sustainability.
Community involvement in the health system creates better empathy between health technicians and members of the community. Furthermore, knowledge of local culture and traditional customs is essential to the proper functioning of the health system, particularly in rural areas.
The community must see the health or school unit as a public property, in relation to which it has the right to know who it is serving, how it does it and how to preserve it so that it can continue to work for community development.
It must be said that there is an intrinsic relation between health, poverty and economic development. The reality is that the greater the level of economic development, the more resources can be allocated to improving health services. However, if a worker is not healthy, for example, suffering from Malaria - an endemic disease in our countries- his or her contribution to economic development will be minimal. Thus expenditure on health is an investment in human capital just as much as expenditure on education and supplying potable water.
As a result of the reform process on which many countries have embarked, there appears to be a lack of clarity as to the role of the State in ensuring the minimum basic conditions that will enable society and citizens to do the rest for themselves.
Our poverty frequently means that various matters are seen as public; part of the common good: health is one of them. But here we must find a balance that will define the frontiers of State and community responsibilities. The community must be participatory actor in the health system that is designed for it and directed towards it; there must be an interaction between the community and the State unless we want the community to be a mere receptacle for what the State decides. Major emphasis must therefore be given to preventive and primary health care, because community education in these areas will contribute both to more active public participation and to reducing expenditure at the level of health systems.
The national and international health systems must be rethought in such as a way to empower communities as national level, aiming to establish stimulating and beneficial partnerships between civil society, NGOs, and the State itself. Decisions on what should be done and how cannot be hostages to political party agendas. At international level,
reforms in the UN system, the WHO and so on must be introduces. How can citizens’ voices make themselves heard at that level, and how can their contributions help to achieve an effective system that corresponds to the real concerns of the communities?
Peace is a precondition for social and economic progress.
With reference to the African continent, we must struggle to bring all the conflicts to an end, and to strengthen Africa’s presence on the international stage.
We must recognise that the industrialised countries are also having difficulties in managing their health services. Rocketing costs are forcing them to rethink their systems,
but we cannot allow the principle of health for all to be placed in jeopardy.
Once again, I wish the People’s Health Assembly every success. Through you, I send my best wishes to all the participants.
Yours sincerely
Dr. Pascoal Mocumbi
Prime Minister of the Republic of Mozambique
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