Indicators of health are a mirror of what goes on within societies, of how the world works, and of who benefits most. The world over, poor people are more sick and die earlier than those who are better off. The 2013 World Health Organisation (WHO) Global Health Report sends out a strong message: people will continue to die of both infectious as well as of non-communicable diseases if governments continue to neglect the need for universal access to healthcare. Health and disease are profoundly political issues driven by inequality and other social factors. South Africa would do well to partner with friends in the Global South to make this issue a key feature of our foreign engagement.
Given the link between poverty and disease, pro-poor policies should become of greater global concern, to ensure equitable distribution of healthcare and medicines to impoverished populations. The term 'pro-poor' is used widely in development fields; there are policies that directly target poor people or are aimed at reducing poverty. Pro-poor policy processes allow poor people to be directly involved in the making of health policies and their outcomes.
The 67th session of the World Health Assembly (the body that governs the WHO) was held in Geneva in May.WHA delegates are sent from WHO member states, and discuss an agenda which includes climate change, drug resistance, essential medicines, health technology, hepatitis, health regulations, non-communicable diseases, TB, violence and social determinants of health. This year the most pressing agenda item has been the prevalence of antibiotic resistance, which is perceived as a global threat.
The WHA is specifically interested in the social determinants of health (SDH). These are the conditions in to which individuals are born, grow, live, work and age, including the national health system. These determinants are influenced by money, power and resources, which are influenced by policy choices. SDH are largely responsible for health inequity and the large divide between health statuses within and between countries. Pro-poor policy would differ from ordinary policies, in that every endeavour would focus policy decisions on the impoverished specifically, to bridge the health inequities between countries.
Inadequate access to health care and medicines is a persistent issue among impoverished populations in low-income countries. It is a recognised social determinant of ill-health, and is disproportionately borne by women and girls. A key agenda item for the WHA - which does not appear to be linked to social determinants of health - is that of pro-poor health policy around the globe. Key questions needing to be asked at the multilateral level of global health governance is whether international, regional and national organisations have committed pro-poor focus in their health policies, particularly regarding access to health care and medicines. This poses questions at a regional level, which apply to international and national levels of engagement as to whether health policy formation and implementation processes mobilise actors in the interests of highly impoverished populations, regarding access to health and medicines. Additionally, which practices are conducive to the emergence of embedded pro-poor health strategies and what can international, regional and national partners do to promote such practices.
The benefits of focusing efforts on pro-poor agendas are that all members of society will benefit. There is no implicit “pro-rich” agenda, but in poorer countries, where the wealthy can afford private healthcare, the lack of specific healthcare availabilities for the poor is starkly evident. South Africa is a good example of a developing country that has made progressive in-roads into pro-poor policy. South Africa’s system of social grants is one of the government’s primary initiatives in mitigating these levels of poverty. The challenges South Africa faces as an “upper-middle” income country, with social indicators comparable to the poorest countries in the world, include high rates of poverty and poor health services.
The National Health Insurance Plan (NHI) is an additional government effort towards establishing pro-poor health policy. The NHI is a system of funding that will create a single pool, the National Health Insurance Fund (NHIF), for money spent on health. This will require an increased national health budget. The fund will be supplemented by mandatory contributions made according to individual income (those who earn more, pay more and vice versa). User fees and co-payments are to be abolished for health care.
Health services in South Africa have slowly become accessible and more affordable for the poor. Despite this, the government is far from achieving universal access to healthcare and equity for the poor. The quality of services in public sector clinics and hospitals are often questionable. Those who can afford medical cover benefit from private healthcare. Those that cannot must use public health institutions, subject to delays and a lack of resources. These concerns are reflected in South Africa’s attempts to reach our Millennium Development Goals by 2015. South Africa has lagged behind on poverty and hunger reduction and reducing child mortality, possibly attributable to a lack of pro-poor policy for healthcare.
International and regional organisations provide a means of engaging international and national actors to engage on pro-poor issues. This is becoming increasingly prevalent for North-South and South-South development agendas, generating further development initiatives and research. There still remains, however, limited knowledge as to how regional commitments on poverty are being implemented and pro-poor initiatives in impoverished regions. The SADC Health Protocol is the guiding regional health policy in the SADC region, but does not contain pro-poor clauses or strategies. There needs to be increased focus at the WHA level of engagement which ensures adequate attention to pro-poor health policies, particularly in the form of social protection.
Fewer people will die and live miserable lives if the issue is taken up at the WHA decision making forum. South Africa, in partnership with other Global South partners such as Brazil and India, should make this issue a key feature of an emerging health diplomacy role regionally, internationally and multilaterally.
Researcher, Poverty Reduction and Regional Integration (PRARI) project, SA Institute of International Affairs