A radical new development idea: Everybody insured!

The Millennium Development Goals want to increase health care for the poor, children and women in development countries, but it doesn’t look like it’s going to reach that target by 2015. ‘It’s impossible to improve health care in an efficient and effective manner if the investments done in the sector stay below a certain minimum level’, claims Gorik Ooms based on plenty of international research.
‘In 37 of the 54 countries classified by the World Bank as Low- Income Countries (LIC’s), government expenses on health care in 2004 stayed below ten dollar per capita per year. The Commission on Macro economics and Health calculated that forty dollar is the necessary minimum to guaranty everybody an acceptable package of health care, including aids treatment’, writes Ooms in his PhD that he defended the beginning of march at the university of Ghent.

Self-sufficiency could kill

The fact that many developing countries are not able to provide enough money for minimal health care shouldn’t be a surprise. Most of the countries have a very low Gross National Product and collect so little taxes that there’s a shortcoming on every level of human development. But there is an additional reason for the underinvestment in health care, and that made Gorik Ooms initiate his research. When he was working for Doctors Without Borders in Mozambique and was involved in the preparation of an extended Aids program, it became clear to him the government couldn’t just spend the increasing aid resources as they want to.
The International Monetary Fund (IMF), that urges governments for a cautious fiscal policy, has put a brake on the rising cost of staff paid with development aid. Ooms: ‘The IMF considers development funding too unreliable as a source of income. And undeniably: the donor darlings of today could easily become the donor orphans of tomorrow. In Mozambique, people realize very well that a new president and a new political climate in Zimbabwe could very quickly shift an important share of their development support to Zimbabwe, which for the moment is as good as abandoned by international donors.’ There is something to be said about the caution of the IMF then? Ooms isn’t convinced.
 ‘The result of that – unwritten but nevertheless applied – rule is that no less than 73 percent of the additional development aid received by the African governments between 2000 and 2006, has not been used.  That’s the figure given by the IMF itself. Instead of using the money to pay doctors, nurses and medicines, the African countries had to save it to build up their dollar reserve or use it for advanced payments of their central loans. That’s incomprehensible, no?’  Even more worrying for Gorik Ooms is the realization that the world of NGO’s hardly reacts against this line of thoughts.
‘Because the NGO community is a firm believer of the necessity of financial self-sufficiency in the South. Everyone knows and repeats the illustration of the fish and the teaching to fish. And so everybody fears a health care system that would be completely dependent on foreign aid for the next decennia. The result is that hundreds of millions of people are denied one of the most fundamental human rights: health.’

The duty to render assistance

If health is a human right, it’s the state’s duty to provide it. When it becomes clear that it is impossible for a government to guarantee that basic right, the moral responsibility shifts to the international community who can. After all, there is such a thing as the duty to render assistance to people in need. This might seem a controversial reasoning. The neoliberal globalization aims to strip the social security system down rather than to globalize it. The author takes the globalised reality serious however, but more on the subject of human solidarity.
While some Belgian politicians want to split the social security along the linguistic borders, Ooms pleads for the construction of a globalised social security system, financed through contributions defined by ability and wealth. This means that the world has to accept that the budgets for health care of the Low- Income Countries will continue to be financed by steady contributions from the richer parts of the world. This could take place through a Global Fund, comparable to the Global Fund to Fight Aids, Tuberculosis and Malaria. For Ooms, every country can choose its own way of contributing to this Fund; whether it be an airplane tax, Tobin tax or whatever they see fit. At the same time, there has to be some sort of a control system to assure that the governments in the South optimize their share of the work.
‘Countries that want to benefit from a Global Health Fund, should by 2015 be spending at least three percent of their GNP on health care. Most of the LIC today spent hardly one percent’, says Gorik Ooms. In an article in the 8th of march issue of the leading medical magazine The Lancet (Global action on health systems: a proposal for the Toyako G8 summit) four professors warn that the mere increase of budget will not necessarily lead to a better health care. ‘Egypt, for example, increased the production of doctors so strongly that today more doctors graduate per capita in Egypt than in the USA. But today, there is still a scarcity of doctors and functional hospitals in rural areas, while in the cities many doctors have to find a different profession.’

A first step towards change

It’s allowed to dream, but are there people in power who are willing to listen to such a radical new vision? ‘Yes, there are’, confirms Gorik Ooms. At the beginning of April, Ooms was invited to a round table discussion by the Global Fund to fight Aids, Tuberculosis and Malaria in South Africa. On the agenda was the idea of expanding the Fund to a sort of social security.
The French minister of foreign affairs, Bernard Kouchner is working on a comparable proposal. And a Japanese study group that is preparing a text on the health issue for the G8 summit this summer in Toyako, showed interest in the ideas, says Ooms. ‘I hope that certainly the European leaders will realize that the guarantee of social security all over the world will also work in our own advantage. As the Dutch Sociologist Abram de Swaan already knew in the early nineties: if we want to protect our social security, we have to promulgate it.’