A major focus of this edition is the need to go beyond the tokenism which favours profit-making for health companies of different sorts over the provision of quality health for all, presented as “universal health coverage.” A position the PSI has held for several years is that quality health for all is what we need, and this is possible only when it is publicly delivered.
The report of the Lancet Global Health Commission on High Quality Health Systems in the SDG era (HQSS), which was released in September, reinforces our point. It shows quite clearly that the universal health coverage strategy is not sufficient to improve health in low-income and middle-income countries (LMICs). Provision of good quality health care is essential for the attainment of sustained improvement in health outcomes and the full realisation of the human right to health.
The report, entitled “Time for a Quality Revolution” highlights the importance of strong health systems and the need for governments to invest in designing and building people-centred health systems that deliver safe, effective and quality care.
This perspective buttresses some of the views jointly expressed by the World Health Organization (WHO), World Bank (WB) and Organisation for Economic Cooperation and Development (OECD) earlier in July. In the document “Delivering quality health services A global imperative for universal health coverage”, the three international organisations observed that “better access to care without attention to its quality will not lead to desired population health outcomes.”
They further agreed “that high quality, safe, people-centred health care is a public good that should be secured for all citizens”, emphasising the fact that quality of care is the foundation of people-centred health care.
These are positions that Public Services International and its affiliates across the world have upheld over the years, in the face of reforms driven by international financial institutions that undermine the capacities of already fragile health systems. We have always advocated universal access to quality health services. PSI has also continually stressed the obvious: this is possible, only as universal public healthcare.
Thoroughgoing reform must be implemented by governments to carry out a quality revolution in healthcare. On this, there is a consensus by all stakeholders in the health and social sector, including PSI. But when it is argued, as in the Bellagio Declaration on high quality health systems, that “these reforms will not succeed without including the private health sector and other sectors”, a seeming truth acquires ominous undertones.
The question is not so much about involving the private sector, it is about how this is to be done. PSI has affiliates in the private sector which it represents. It might not be realistic to wish away some level of private sector involvement in health care delivery, but such involvement must take due cognisance of health as a fundamental right of all persons in truth and in deed. Consequently, it must be appreciated that health care is not a commodity, even when delivered through private providers. The marketization of health services must be curtailed, to make quality health universally accessible.
Starting from the 1980s as Private Finance Initiatives (PFI), and later through other forms of Public-Private Partnerships (PPPs), private sector involvement in public health, including through contracting out of services and staff, contributed to the crisis of quality we face today.
Pharmaceutical corporations and health insurance companies, which are giants of the private sector such as global health and social care companies, have also skimmed off billions of dollars that could have been invested into providing quality public health services, as rents – well beyond what could legitimately be considered as profits. Quite a few multinational health companies have equally been involved in tax evasion.
Besides, quality healthcare delivery by private providers is priced beyond the reach of the vast majority of the population, particularly in low-income and middle-income countries. The only way these people could have access to quality health care is with governments being firmly in the saddle of driving the process.
As I said at the time of the launch of the report:
Health is a fundamental human right. The responsibility to ensure that every woman, man and child has quality health rests squarely on the shoulders of governments. It is worrisome as the Lancet Global Health Commission observed, that we lose not less than 8 million people every year due to poor quality of care. We thus need to go beyond the dominant perspective of universal health coverage.
The challenge before governments all over the world is to put people over profit. Ordinarily this should not be a challenge, because governments are supposed to serve the people and not big business. But, the questionable influence of multinational corporations over governments and multilateral international organisations’ decision-making processes has become so pervasive in re-defining otherwise lofty goals. “Universal health coverage” for example, has not meant universal access to quality health.
Governments must invest adequately in the public health system, and promote concerted tripartite social dialogue in the sector, as agreed upon in the Working for Health: Five-Year Action Plan. They must also make sure that the private health care providers uphold quality standards in terms of service delivery and the working conditions of health workers.
Public Services International and its affiliates will continue advocacy for universal quality public healthcare. We will work with governments, international organisations and civil society organisations to make sure the future of health is genuinely people-centred. Thus, we will lay the foundations for a healthier, better world, as envisioned in the sustainable development goals.