by Sara Albiani, global health policy advisor at Oxfam Italy
Giving birth in a private hospital in Maputo means for a Mozambican woman, part of the poorest 40% of the population, having to spend everything he earns in a year. It is the shocking reality to which the course undertaken at a global level of reducing and increasing public health expenditure leads privatization sector, with dramatic consequences for health inequalities.
An orientation in total contrast with the lesson we should have learned from the almost 7 million deaths of the Covid-19 pandemic: the need to guarantee the right to health everywhere in the world, strengthening national public health systems and making them capable of prevention and response to health emergencies, as well as fair access to services.
Financial institutions led by high-income countries push for private healthcare in poor countries
The private healthcare model is also spreading thanks to the action of international financial institutions – such as the International Finance Corporation (IFC), the World Bank and the European Investment Bank (EIB) – which allocate huge public funds to the private sector with the stated aim of promoting it economical progress in the Global South, fight poverty and improve health services. But things are very different and the consequences are aberrant. The photograph of what happens is contained in two reports (Who e Who) published these days by Oxfamwho denounce many cases in which financing by financial institutions (led by countries such as the USA, Great Britain, France, Germany and Italy) to private hospital groups and other profit healthcare companies operating in India, KenyaNigeria, Uganda and other countries of the southern hemisphere have had an impact, contrary to what was hoped dramatic in people’s lives.
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Babies held hostage if you can’t pay, medical emergencies ignored, patients on the streets and no prevention of organ trafficking
The casuistry is a gallery of horrors, which it exemplifies what’s further away with respect to the protection of the universal right to health: detention of patients, including newborns, against non-payment of the health services provided; charging excessive fees to patients, who then drove themselves into poverty to meet them; prices of services and medicines out of reach for most of their users; cure negate to those who cannot afford them, even in cases of urgency or generalized emergencies; pressure on patients to agree to undergo medical procedures not necessary and expensive; a serious and failed prevention of human rights violations, including organ trafficking by health personnel.
The case of India, where private healthcare is worth 236 billion dollars in one of the most unequal countries in the world
In India, where the private healthcare sector is now worth $236 billion and is growing rapidly, the IFC has directly invested more than half a billion dollars in some of the largest hospital corporations in the country. While in many cases excessive tariffs are applied in relation to the type of treatment, healthcare assistance is denied, prices are rigged, taxes are evaded and free treatment is refused to indigent patients, despite this being a condition envisaged in the state cession of the land on which to build the hospitals. Not only that: of the 144 funded hospitals, only one is in a rural area and only 20 are in the 10 worst-performing states in terms of quality health care delivery. Four major hospital complexes in the region of Delhihave achieved profit margins of up to 1,737% on drugs, supplies and diagnostics.
In Mozambique, in the midst of the pandemic, requests for 6,000 dollars for oxygen and 10,000 for a ventilator
Same situation also in other realities analyzed by Oxfam. The Maputo Private Hospital in Mozambiquesupported by the IFC during the pandemic, charged COVID-19 patients $6,000 for oxygen and $10,000 for a fan. Similarly, in Uganda, Nakasero Hospital, funded by France, the EU and the IFC, is reported to have charged 1,900 a day for a COVID-19 ICU bed; while TMR Hospital, backed by the UK and France, submitted an account of $116,000 to the family of a patient who died of the virus.
While stillbirths increase, in a private hospital a cesarean can cost 2 years of salary
The number of mothers dying in pregnancy and childbirth is increasing worldwide, the average cost of an uncomplicated birth in these private hospitals is superior to one year’s income of the poorest 40% of the population, while the cost of a caesarean exceeds 2 years’ income. In Nigeria9 out of 10 of the poorest women give birth without a skilled midwife or birth attendant. Oxfam traced development funds from the EIB, Germany, France and the IFC to the exclusive private Lagoon Hospitals in Lagoswhere the simplest maternity package costs more than 9 years of income for the poorest 10% of Nigerians.
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Conversely, strengthening public health in Ethiopia has reduced maternal deaths by 70%
Things are different when it is the public sector that is financed and strengthened. L’Ethiopiafor example, has successfully used donor aid to achieve most of the health-related Millennium Development Goals by 2015, including reduction of maternal deaths by more than 70%. As proof, one figure: in low-income countries that have the best results in reducing deaths from childbirth, 90% of health services are public. But despite the fact that the pandemic has demonstrated the direct relationship between health, equity of access to quality services and the presence of a universal healthcare system, we are witnessing a narrowing of public health in favor of privateadopting a model where the market holds the primacy and the public sector ends up outsourcing its skills.
The Meloni government’s cuts to healthcare confirm a trend that comes from afar: in this way we will be unprepared for the next pandemic
A short-sighted and unfair line also pursued in Italy, where for more than a decade there has been a tendency to link more and more health and healthcare services to economic availability of the patient, with cuts in public health resources (also confirmed by the Meloni government) and the assignment of assistance and diagnostic services to private individuals.
If governments and international institutions do not change course and place the reinforcement of public health systems, we will turn out not only unprepared faced with the next pandemic, but the losers will always be the most vulnerable, both in rich countries and more so in poor ones.