Africa: Reclaiming the state

RECLAIMING THE STATE: ADVANCING PEOPLES HEALTH, CHALLENGING INJUSTICE
Resolutions Of The Third Southern African Conference On Equity In
Health, Durban, South Africa, June 8 And 9, 2004
Noting:

* The 1997 Kasane meeting on Equity in Health that confirmed the
commitment to equity in health at all levels in southern Africa; the
1999 Southern African Development Community (SADC) Protocol on Health,
the 2003 Maseru Declaration on HIV and AIDS and the resolutions of the
SADC Heads of States Summit on food security held in Tanzania, 2004;
* The formation of EQUINET and our work since 1998 in support of these
commitments, to strengthen the understanding of, the evidence for,
advocacy of and implementation of this policy commitment to equity and
social justice;
* Our conception of equity and social justice in health, which aims to
address unfair differences in health and in access to health care
through the redistribution of the societal resources for health,
including the power to claim and the capabilities to use these
resources;
* The widening constituency we are building for equity and social
justice in health amongst governments, parliamentarians, health
professionals, trade unions and other organs of civil society,
researchers and communities at national and regional level;
* The challenges posed by neoliberal globalisation to our values of
equity and social justice, to government ability and flexibility to
implement the public policies that we choose and to the public sector
health and essential services and that are critical for our health;

The June 2004 EQUINET conference in Durban South Africa affirmed that
we stand for:

* Equity and social justice in health;
* Public interests over commercial interests in health;
* International and global relations that promote equity, social
justice, people's health and public interests;
* Increased unconditional resource flows from the North and fairer
terms of trade;
* Reduction and where possible restitution of flows of resources from
South to North;
* A conception of human rights that affirms the agency of communities
in claiming social and economic entitlements, the primacy of vulnerable
groups and that captures African traditions of communitarianism;
* Equitable health systems that provide healthcare for all and
redistribute and direct resources towards those with greatest needs;
* Rising investments in the state and public sector in health;
* Health (care) systems which promote collective, population oriented
strategies for health and comprehensive primary health care;
* Trade and agricultural policies that ensure food sovereignty and
household food security through land redistribution and investment in
small holder farming in ways that promote gender equity and sustainable
food production;
* At least 15% of government budgets invested in the public health
sector, as committed in Abuja, together with debt cancellation;
* Progressive tax-based funding of health systems;
* Fair financing for health, in which the rich contribute a greater
share of their income to health than the poor, with strengthened cross
subsidies for solidarity and risk pooling;
* Equitable and affordable access to generic drugs, with application
of essential drug policies across all health providers;
* Ethical and equitable human resource policies at national, regional
and international level, backed by compensation for regressive
south-north subsidies incurred through health personnel migration;
* Equitable public health and multisectoral responses to HIV and AIDS
for prevention and health promotion, treatment and care and to mitigate
the impact of the epidemic, particularly within and for young people
and vulnerable groups;
*The expansion of access to anti-retroviral therapy for people living
with AIDS in Southern Africa as an urgent priority, through funding and
approaches that strengthen, and do not compromise, our public health
services and systems;
* Democratic and accountable states, with full authority to exercise
policy measures necessary to protect the health of people;
* Powerful and effective participatory and representative mechanisms
at all levels of our health and social sectors and in the state more
generally;
* Effective and accountable mechanisms for public and stakeholder
contribution to decision making in health;
* Regional integration and co-operation within Africa to strengthen
democratic states, advance the health of people and challenge
injustices to health;
* Values based leadership across organisations working to promote
equity in health.

The conference set out a programme of work and action for EQUINET and
its partners to implement these goals.

RECLAIMING THE STATE: ADVANCING PEOPLE\'S HEALTH, CHALLENGING INJUSTICE
Facts, Figures And Quotes From The Equinet Conference, Durban, South
Africa 8-9 June 2004
* “Equity in health implies addressing differences in health status
that are unnecessary, avoidable and unfair. Equity in health implies
directing more resources for health to those with greater health need.
Equity in health means having the power to influence decisions over how
resources for health are shared and allocated.” - From a presentation
'Reclaiming the state: Advancing people's health, challenging
injustice'.

* “In the highly unequal societies of southern Africa, our health
challenges demand health systems that assertively redistribute the
resources for health and policies that reflect values of equity,
solidarity and universality. This can be achieved through rising
investment through the state and public sector.” - From a presentation
'Reclaiming the state: Advancing people's health, challenging
injustice'.

* “The gains of neoliberal globalisation?
- 4% GDP lost in unfair terms of trade 1970-1990
- Africa's FDI share from MNC investment 25% in 1970's, 5% in 1990s.
- Income gap richest to poorest 53x in 1960 and 121x in 2000
- 185 million people out of work
- 55 million people live on $1 a day
- Southern outflows increased.” - From a presentation 'Reclaiming the
state: Advancing people's health, challenging injustice'.

* “Despite a hostile global environment, which has the potential to
subjugate us to political and economic imperatives not of our choosing,
we can and must mobilize collective action to chart and implement our
positive vision and policies on the equitable health systems that we
want.” - From a presentation 'Reclaiming the state: Advancing people's
health, challenging injustice'.

* “ Impact of malnutrition on development:
- [A study of the long term impacts of the 1982-84 Zimbabwe drought on
665 children]…resulted in a loss of stature of 2.3 centimeters, 0.4
grades of schooling, and a delay in starting school of 3.7 months.
- [It is estimated] that this loss of stature, schooling and potential
work experience results in a loss of lifetime earnings of at least 7 -
12%.” - From a presentation on 'Household Food Security, Nutrition and
Equity.'

* “Only 3 out of 10 African countries show a decrease in severe
maternal nutritional status in the last decade.” - From a presentation
on 'Household Food Security, Nutrition and Equity.'

* “31 countries in Africa do not meet the 'Health for All' standard of
a minimum of one doctor per 5000 people.” - From a presentation 'Health
Personnel in Southern Africa Confronting Maldistribution and the Brain
Drain'.

“External debt of the USA is $2.2 trillion - almost the same as the
$2.5 trillion owed by the entire developing world…Every American
citizen owes the rest of the world $7,333 while every citizen of all
the developing countries only owes the rest of the world $500.” - From
a presentation 'Health Personnel in Southern Africa Confronting
Maldistribution and the Brain Drain'.

* “Estimating the cost of training a GP in the SADC Region to be $US60
000, then it can be assumed that there is a reverse subsidy from the
developing world of $500m per annum for health personnel alone.” - From
a presentation 'Health Personnel in Southern Africa Confronting
Maldistribution and the Brain Drain'.

* “UNCTAD estimates that US$184,000 is saved in training costs per
professional and that US saved US$3.86 billion as a result of importing
21 000 Nigerian doctors.” - From a presentation 'Health Personnel in
Southern Africa Confronting Maldistribution and the Brain Drain'.

* “Things are pretty bad here you know. South Africa is not the
Tropicana Hotel [in Durban, where the conference took place]. Since
independence the rich have been getting richer and the poor poorer.” -
Trevor Ngwane, Anti-Privatisation Forum, commenting in a parallel
workshop session.

* “The green rooms [negotiating forums at the World Trade Organisation
criticised for their lack of transparency] are basically where the
bully countries call in the smaller countries, beat them up and then
send them home with a message to their mothers.” - Riaz Tayob, SEATINI,
replying to a question on a presentation on global trade and health.