Global Governance for Health: EQUINET experiences in Southern and Eastern Africa

RANGARIRAI MACHEMEDZEEQUINET/ SEATINICape Town, South Africa6-11 July 2012

EQUINETa network of professionals, civil society members, policy makers, state officials in east and southern Africa that aims to advance and support health equity and social justice through:

• sharing information and experience

• research

• building critical analysis and skills

• networking and building strategic alliances.

Visit www.equinetafrica.org

Introduction

The nature of global health has changed dramatically in the past two decades, bringing in many actors to expand responses to global health needs: service delivery, prevention, and research and development

Besides governmental activities, the involvement in health of non governmental organizations, non-state providers of health, industry, faith-based organizations and civil society has increased.

Global Health Governance Architecture

Source: Rekacewicz P Le Monde Diplomatique, September 2005

Limitations

This increasingly complex architecture: has led to concern about the lack of effective co-

ordination across UN policies and the inadequate machinery for monitoring

implementation of the hundreds of multilateral treaties, which although sectoral in character, also impinge on global public health.

The dominant economic paradigm that our countries have been forced to follow in the past two-three decades is neo-liberalism

Emphasises the free market ideology (washington consensus principles)

Trade liberalisation, financial deregulation, cuts in government spending, IP rules (US model), binding membership of WTO regulations, compliance with IMF and international financial institutions rules etc

African experiences

Trade liberalisation - negative outcomes for Africa IMF/World Bank Structural Adjustment Programmes

entry point to economic liberalisation Resulted in structural changes in virtually all sectors Social services sectors: health, education negatively

affected Health sector effects included commercialisation (fee

charges), public sector cuts, freeze or cuts health worker employment, fall in real wages for health workers

African experiences

African experiences: the global context

US-Africa US-Africa (AGOA)(AGOA)

US-NAFTA US-NAFTA US-FTAAUS-FTAA US-APECUS-APEC

IMF &

World Bank WTO

- PRSPsPRSPs- Debt Relief & Debt Relief &

HIPCHIPC- Aid, LoansAid, Loans- Economic Economic

Reforms (SAPs)Reforms (SAPs)

US EU

EU-SA FTA EU-SA FTA Cotonou/EPAs Cotonou/EPAs EU-MED FTA EU-MED FTA EU-EU-

MERCOSUR MERCOSUR

- Binding Binding AgreementAgreements s

- DSBDSB

Trans National Corporations

African Governments

Economic and Trade Reforms Lock in

Washington Consensus

Policies

World Trade Organisation Agreements and Health AoA

Liberalising agric Removal of tariffs (revenue) Food sovereignty/food

security nutrition

TRIPs Access to medicines Farmer’s rights GMOs

GATS Privatisation of health

services User fees

SPS/TBT-health issues, infectious disease control, food safety, environment, food security, biotechnology

EQUINET experiences and struggles for better governance in Health

EQUINET is officially recognised by governments in ESA and by SADC and ECSA health community

Works with governments over the years in SADC, ECSA to build regional solidarity, integrity and political coherence to: Engage globally in these processes Resist unfair and unjust policies

EQUINET experiences

Participates in official processes and meetings

-doing advocacy on different issues e.g. reclaiming the economic resources for health from unfair global policies

-demanding equitable health systems

Demanding national governments to implement laws at national levels to

◦ Fully use flexibilities in trade agreements particularly GATS and TRIPs

◦ Protect indigenous knowledge systems◦ Resist WTO plus obligations in bilateral or regional agreements◦ Regulate the movement of goods and services (domestic

regulatory framework)

EQUINET Experiences

Participating in Global Health Governance working on: Supporting regional integration on health related issues

especially demanding fairness in economic partnership agreements

Collaborating with other institutions and networks beyond the governments and intergovernmental bodies

Publications on different areas Newsletter Policy briefs Discussion papers Reports

Available on: www.equinetafrica.org