GATS Ruins Third World Health

The General Agreement on Trade in Services (GATS) is destroying public health in Third World Countries. This was the view of the speakers in the International Conference on Challenges in Health Work Amidst Globalization and War held last Nov. 8 at the Palm Plaza Hotel in Manila.

BY ALEXANDER MARTIN REMOLLINO
Bulatlat.com

(Left) Maria Hamlin Zuñiga of Nicaragua, global coordinator of the International People’s Health Council, delivers the keynote address at the international health conference in Manila, Nov. 8. 
(Right) Dr. Mira Shiva of India speaks on drugs and Trips

The GATS, which aims to liberalize the entry of multinational corporations in the service sector, was one of the items in the agenda of the failed 5^th Ministerial Meeting of the World Trade Organization (WTO) in Cancun, Mexico last September.

The GATS is seen as a mechanism that would pave the way for the further commercialization of public health services in the Third World, a process started by the International Monetary Fund (IMF) and the World Bank (WB).

In a paper read at the health conference, Alliance of Health Workers (AHW) chair Emma Manuel said that for the past two decades or more, the structural adjustment programs of IMF-WB forced governments to dismantle their public services and allow foreign-based health care, education and water corporations to provide services for profit.

Health for a fee

Citing a report by the WB in 1998, Manuel noted that 40 percent of projects in the Bank’s portfolio are on health, nutrition and population and nearly 75 percent of projects in sub-Saharan Africa included the establishment or expansion of user fees.

“The World Bank’s health ‘reforms’ have included making people pay for their health care, reducing public services to a few programs, and turning over the rest of government services to profit-making endeavors,” Manuel said.

Because of this, she said, people cannot afford medicines and thus die of curable diseases.

In Ghana, for instance, user fees in rural clinics contributed to the doubling of child mortality between 1983 and 1993. Likewise, in Zambia, life expectancy dropped from 54 to 40 years as a result of the commercialization of health services. In one of the regions of Nigeria, maternal deaths rose by 56 percent and hospital births declined by 46 percent after user fees for admission were introduced.

In Ghana, Nigeria, and Kenya, people’s use of clinics and hospitals usually dropped by half within the first two weeks after user fees were introduced.  

As health services are liberalized, governments are forced to decrease subsidies for public hospitals. As a consequence, fewer and fewer people are able to afford public health services. For example, in Manila’s San Lazaro Hospital, a government hospital that serves people stricken with communicable diseases, admission decreased from 22,774 patients in 1999 to 17,444 in 2002.

Health care as service

Health is one of the social services on which the programs and policies of the IMF-WB and the WTO have taken their toll.

According to Maria Hamlin Zuñiga, global coordinator of the International People’s Health Council, “Health care reform, in many of our countries, is synonymous with the increasing privatization of health services and the contracting of services within the public health system. While those who are wealthy have the opportunity to access health care, the distribution of risks is immensely greater for the poor.”

Citing the WB 2004 Development Report, Zuñiga, who hails from Nicaragua, said that the Bank itself  “recognizes various important issues that civil society and social movements have been stressing for years: “Basic services are failing poor people; there is no such thing as a ‘one-size-fits-all’ recipe to readdress this issue; and social accountability and citizens’ control and participation are keys to make things better.”

Manuel, meanwhile, said that third world governments abandon their responsibility to peoples as they comply with the provisions of GATS. “The governments’ adherence to the neoliberal doctrine of globalization and the WTO has kept the Third World countries in perpetual crisis,” she said.

“In the Philippines, contrary to the promises of economic development and prosperity, with the WTO the country remains sick and utterly dependent,” she added.

Manuel also said that the solution to the problem of deteriorating health systems rests on changing the whole international economic order. Bulatlat.com

Photo courtesy of Council for Health and Development

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