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Cooperation in healthcare: Prospectives for the sixth MDG

May 23, 2010

Growing international cooperation in the healthcare sector offers an opportuntity that can be leveraged with better coordination amongst stakeholders towards meeting the sixth MDG, says Andrea Dalla Palma. At the same time, ensuring the right to healthcare services needs focus not only on diseases and their cure, but also on the causes - the socio-economic complex of poverty, literacy and local cultures, she adds.

New pages. Literally and figuratively speaking. In the first case, we are speaking about the pages to be added to the The Charter of Trento for better international cooperation. The charter’s intention is to reflect on and review the line of action taken in cooperating with the global south, from year to year, in keeping with the priorities established by the United Nations through the Eight Millennium Goals. In 2010, the Charter of Trento will withdraw from the Sixth Goal: fight HIV, malaria and other diseases.

In the second case, we will instead take on a new approach and try to create a network, and promote an overall outlook that integrates and links the world of international solidarity and operators in the healthcare sector.

During the seminar on "Cooperation in the healthcare sector. Guarantee healthcare, together for better international cooperation" we spoke of, among other things, the relationship between the various operators that work in healthcare cooperation projects. There has been a substantial increase of these actors: from the “long-standing ones”, like the UN agencies, the European Union, bilateral agencies (for example USAID) and big international NGOs (Oxfam, Care, Doctors without Borders, to mention a few), until new actors as global funds (like GAVI – Global Alliance for Vaccine and Immunisation), local NGOs and private foundations (like the ENI foundation).

“In Trentino” says Lia Giovanazzi Beltrami Commissioner for International Solidarity and for a Culture of Coexistence for the Autonomous Province of Trento, “there are about 35 associations that deal with cooperation in the healthcare sector; along with, about forty doctors from Trentino working in international solidarity projects. Therefore, there is not a lack in numbers. What is missing is, instead, coordination”. With this in mind, the Regional Council and the Provincial-owned enterprise for Healthcare Services of Trento will start to work together to create a network between those working in healthcare cooperation.

Moreover, this will be the aim of a specific course, to be held at the Training Centre for International Solidarity of Trento.

The relationship between international cooperation and healthcare is not recent. On the contrary, administration of medicines and hospital interventions are, in emergency situations and development projects, the most primary actions that international cooperation can offer. But the right to healthcare services cannot be limited to this. Otherwise it would be, for the hundredth time, welfarism.

The right to healthcare services is linked to other social factors, like level of education, economic conditions, information, the quality of facilities etc., that in themselves can be the cause of inadequate healthcare conditions. Very often, the failures registered in interventions of cooperation within the healthcare sector are precisely due to the scarce attention given to the co-relation between healthcare and other developmental factors.

The main error, in healthcare cooperation (but not only), is concentrating on identifying the problem (disease) – corrective  intervention (cure). A case of malaria is found, and treatment is administrated. Little attention is given to the cause that brought on the problem.

“The eight Millenium Development Goals”, says Gianni Tognoni, one of the speakers at the seminar “have been created to repair shortcomings that the international community has identified. But no structure is built, or any kind of study of the causes of the shortcomings and no redefinition of longterm strategies is carried out”.

For example, the sixth Millenium Goal resolves to:

  • Stop the spreading of HIV by 2015 and start to reverse the spreading of HIV.
  • Guarantee by 2010 universal access to treatment for HIV for all those who need it.
  • Stop and begin to reverse the incidence of malaria and other major diseases.

The UN then identifies a number of indicators (HIV prevalence among population aged 15-24 years, child mortality rate, proportion of population with advanced HIV infection with access to antiretroviral drugs etc.) correlated to the goals but they make no mention of the causes that lead to HIV positivity, nor to the relationship between the disease and poverty, literacy, local cultures and so on.

“The language used in the medical sphere often tends to sterilise reality”, continues Tognoni. For example, statistics reveal that, in the slums of San Paolo, one can die of malnutrition.  True, but what statistics do not say is that behind these deaths there is the local mafia that controls incoming and outgoing markets, altering the costs of resources making them inaccessible to a large part of the population, that then dies of hunger and disease.

Therefore, cooperation must reacquire a more proper language and discover the causes, rather than deal exclusively with the treatment. Good services are not lacking. As Claudio Beltramello of CUAMM reminds us, there is the example of Tanzania where child mortality has been halved in the last 15 years. According to Beltramello, successful healthcare cooperation depends on :

  • More direct involvement of women
  • Eliminating barriers (physical, economic, social)
  • Involving local communities
  • Promoting cooperation between other strategic sectors for healthcare (water, agriculture, microcredit, education...)
  • Strengthening the public and private healthcare system
  • Empowerment of local personnel
  • Use of Healthcare packages (or some kind of instructions for use that science has developed to identify disease and situations)

All this is a must, according to Sunil Deepak of AIFO, together with treatment for certain diseases at a community level, since an approach at a community level is the key to a real and true right to healthcare.

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