Gezondheidszorg voor iedereen, overal

Op 7 april was het Wereldgezondheidsdag, welke jaarlijks door de Wereldgezondheidsorganisatie (World Health Organization, WHO) gehouden wordt. Tevens werd op deze dag het 70-jarig bestaan van de organisatie herdacht. In Suriname organiseerde de regionale gezondheidsorganisatie Pan American Health Organization (PAHO) op vrijdag 6 april een nationaal debat.

Sharda Ganga, directeur van Projekta, hield een inleiding, waarbij zij de nadruk legde op het universele recht op gezondheidszorg, voor iedereen, overal. Gelijke toegang is gebaseerd op het principe van solidariteit en het uitbannen van ongelijke toegang moet onze prioriteit hebben.

De problemen met het gebrek aan transparantie en accountability zijn ook in de gezondheidszorg groot. Ganga vroeg aandacht vroeg voor de driedubbele rol van civil society: zij zijn zowel dienstverleners, als pleitbezorgers (advocates) voor rechtvaardig beleid en wetgeving, als een watch dog. In deze laatste rol ligt voor civil society organisaties de taak om de regering, maar ook bijvoorbeeld ziekenhuizen en verzekeringsmaatschappijen te controlen op de uitvoering van hun taken en verantwoordelijkheden.

Kort samengevat is een participatieve benadering is hetgeen we dringend nodig hebben, waarbij structurele dialoog en investeringen in civil society om haar driedubbele rol te kunnen uitvoeren van essentieel belang zijn.

Lees de gehele inleiding (in het Engels) hieronder.

Universal Health Coverage, everyone, everywhere

World health day dialogue- PAHO-Suriname, 6 april 2018, Ballroom Torarica

Here is an almost universal truth: when you are healthy, you don’t think about health care. It is when you loose the battle against a tiny mosquito and suddenly find yourself fighting for your life in a broken down hospital bed, and have to deal with toilets with no running water, that you realize: thank god I just started a job that covers my insurance. That was almost 20 years ago, and the first time I realized not just the importance of health coverage, but also how health care is the most important indicator of inequality.

Because after 3 days of utter misery in the third class ward, I was moved, by the grace of friends, to the second class- which was pure heaven in comparison. I felt a bit guilty that I was so happy to leave my fellow 3^rd class patients behind, and embarrassed at how easily I forgot that one aspect that underlies the idea and the practice of universal health care: solidarity.

Last year I was again confronted with how unjust access to health care is- when a close relative was able to receive world class treatment outside of Suriname, simply because of the generosity of employers. Isn’t that the most offensive idea: that your right to live and the quality of care you can access, depends on your choice of job, and your socio economic circumstances.

Health care must be framed as a universal right, it’s access based on the principle of solidarity, and eradicating inequal access must be our priority.

It does come at a steep price, but are we sure that the price we are paying is the real price or are we paying way too much, and what are we actually paying for? Access to health care has been used as a political tool for too many years, for example- and we are still paying the price for the culture of garnering votes through distribution of ‘datra karta’, in the worst case using public service jobs as a gateway to the ‘datra karta’.

Non transparency, a lack of accountability, horrendous management and business practices, lack of checks and balances- the whole plethora of bad governance practices: they come at a steep price.

So this is one of the roles that civil society must take up, and wants to take up: holding duty bearers accountable. But civil society has more roles to play- what we call the triple role:

The first role is as Service providers- as through the Medical Mission, Stichting Lobi, the Diabetes Education One Stop Shops, and countless others, delivering essential services and creating public awareness. That is the role that governments and international organisations are comfortable with us playing, and would like to see us performing- how do I know that? Because that is usually the only type of program that they are willing to fund. And even then, they have us jump through hoops.

But civil society also has a role as Advocates-for citizens, healthy or not. We see a greater understanding of this role emerging- through for example, the Alzheimers Foundation, and Stichting Wiesje, who are now starting to understand that they need to move beyond service provision and need to advocate for legislation and policy change in order to have sustainable results that will truly benefit their constituents.

We do need to hear more from the citizens, the rights holders. For example, in the health care debate we witnessed the past months, we only heard governments and service providers- doctors, hospitals etc-, fighting over money. What we missed is that third voice- of citizens advocating for and demanding affordable, effective and efficient services, and having a say in how to achieve that.

The third role of civil society I already mentioned- the watch dog role, to hold all duty bearers accountable, not just the government, but also the insurance companies, the international organisations, the hospitals, the Vereniging van Medici, all health professionals, and service providers.

The other side of accountability is voice- you can only demand accountability if your voice is strong enough to be heard. Civil society must empower citizens to use their voice to claim their rights to access, and quality of care. But empowerment only makes sense if there are mechanisms in place for protection, so that you can dare claim your right and hold duty bearers accountable, without the fear that it would anger your doctor, or your insurance company to the point that your claim for your rights puts your health in jeopardy.

So ultimately, civil society must hold governments and partners, all duty bearers accountable, and empower citizens to claim their rights. But duty bearers need to ensure that citizens’ voices are heard, so that health systems are responsive to people’s needs.

In short: we need a more participatory approach, with structured dialogue, and investment in civil society’s capacity to undertake that triple role, not just as service providers.

Sharda Ganga

PROJEKTA &

Burgerinitiatief voor Participatie en Goed Bestuur (BINI)