Never in my life will I forget meeting Onenghi in his home, in a slum in Yaoundé, Cameroon.
Three weeks earlier he had watched his six-year-old daughter die in front of him in hospital because he had run out of money for her treatment. He told me that because of the hospital bill he could no longer afford the fees for his three other children to continue going to school.
Earlier that same week, I met Alliance with her one year old son, Ange. When in labour a year before, Alliance went to a local private clinic and was told she needed a Caesarean. For the little money she had, the doctors agreed to deliver the baby but nothing else. That’s literally what they did!
Once the baby was out, they quickly stitched up Alliance - leaving the placenta and several fibroids inside her -- and sent her home. The unbearable pain that followed meant Alliance had no choice but to sell her small plot of land to pay for surgery. But it was not enough. By the time she returned home from hospital, Alliance and her family had sold everything they owned to save her life.
What Really Matters to You?
I can think of no worse or more unjust impact of today’s extreme economic inequality than a woman not getting to see her baby grow up because she died giving birth, or a potential future extraordinary teacher, doctor or even head of state, being denied the education she needs to achieve her goals, because she is poor.
Ask anyone what really matters and the health of their families and their children’s education will be near the top of the list. Yet in many countries these things are only available to those with money. This is the focus of our report for Davos this year, ‘Public Good or Private Wealth’.
The report explains that underfunded privatised services drive up inequality. Conversely, universal quality public services are amongst the most powerful levellers in our societies and economies.
Public services like water and health care also give time back to women who work millions of hours unpaid to provide these essentials when public services fail. They can boost living standards, boost opportunity and earning potential; break the generational cycle of poverty; help close the pay gap between women and men; and boost social cohesion.
Free Health and Education for All
I think good quality free health and education for all, alongside other vital public services and social protection shout out fairness; that everyone matters equally; and that each one of us deserves the possibility of a good life.
Perhaps there are few who would disagree with this. But then I look at the chaotic, fragmented and highly political and ideological world of global health that I’ve been working in for the last 15 years and I do wonder what is driving some of the initiatives we see in the name scaling up health care for poor people. How on earth, for example, did we get to a place where some rich country governments and institutions like the World Bank, are handing significant funds over to private equity firms based in tax havens to invest in expensive elite private hospitals in countries like Kenya, India and Nigeria?
The reality is that global health and education is increasingly captured by those vested interests that push to keep taxes low for the wealthy, whilst pushing profitable market-based models of service provision.
The most clear-cut example of this is the pharmaceutical giants who use their economic and political clout to shape government policy on tax, trade and health in their interest.
Winds of Change
What hope then? I hold on to the stories of countries that buck the trend, making publicly funded and publicly delivered services for all a success. There is no contest between public and market-based approaches in terms of impact when this happens.
In the world of global health, Thailand is the shining star where everyone has access to quality health services free of charge and paid for by general taxation. What’s less well reported is that over 80% of Thailand’s highly regarded pro-poor health care is delivered by the government, whilst private health care providers are very tightly regulated.
The Power of the Public Sector
And that brings me to my favourite bit of new data in Oxfam’s new report that is unlikely to grab any headlines, but should serve as a serious challenge to those promoting an ever-greater role for the private sector in health.
The data from 61 low and middle income countries spells out clearly to me that if you want to solve the seemingly intractable horror of poor women dying in child birth, you must prioritise fixing, expanding and improving your public health care system.
In countries that have been most successful at reaching the poorest women at scale (between 60 and 100% coverage) with a doctor or midwife, 90% of the medical care is provided by the public sector and only 8% by the private sector.
Alliance said to me before I left her that if health care was provided free of charge by the government in Cameroon it would change her life and truly make her proud to be from Cameroon. She said that she thought it was most important for pregnant women - ‘why should a mother have to pay when she is trying to give life?’
I couldn’t agree more.
This entry posted on 22 January 2019 by Anna Marriott (@Anna_Marriott), Oxfam's Public Services Policy Manager.
What you can do now
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