Sharing knowhow and joining forces towards Health for All

MMI Network News, February 2013

photo: (c) SolidarMed
photo: (c) SolidarMed

Editorial: The political context of Universal Health Coverage

Dear reader,

While reading the outcome statement and background document of the joint World Bank/WHO ministerial level meeting on Universal Health coverage held last week, two clear issues emerge: The first one is getting political commitment to UHC at the highest government level; the second one is that “fiscal realities (in poor countries in particular) greatly constrain the ability to rely predominantly on public funding. Still, countries do not need to be rich to make progress towards UHC, experience suggest that political commitment is essential.”

The papers seem to suggest that fiscal reality is cast in stone and that within this fiscal reality countries have the political space to move forward to UHC. This approach, in essence, tells us something about the sad situation we have come to live in. A reality in which the financial oligarchy have taken over country democracies, according to Simon Johnson’s The Quiet Coup. A reality in which economic inequalities have an enormous negative impact on health equity and social wellbeing. Untaxed private wealth hinders many countries to finance strong public systems to reach or maintain Universal Health Coverage.

It is not only a problem of poorer countries. We have the same within the European Union. For instance 23.400 “mailbox” companies are registered in the Netherlands, with its infamous tax heaven industry. It lead for instance to Portuguese and Spanish multinationals to avoid paying tax in their respective countries. Both Spain and Portugal have to severely cut their public spending on health expenditures and privatize part of their health services, as required by austerity measures set by the European Union. Even the G20 starts to recognize that the tax avoidance by big business is a big problem for the social development of societies.

These examples merely indicate that the issue of fiscal space and progress on UHC are closely interlinked. The Lancet Article “Political and economic aspects of the transition to universal health coverage” explains it as follows: “UHC will only be achieved if public policies ensure that a large share of this increased spending is pooled through a mechanism that promotes equitable and efficient utilization of care. The exact mechanisms for pooling will depend on social processes and political action that establish the parameters for an acceptable public role in health care. In some cases, the result will be a government that primarily regulates the health-care sector, in other cases a government that finances or directly provides care.” In many emerging economies, such as South-Africa, Indonesia; but also in European countries with traditional generous social security systems, there is strong political pressure to remain attractive for international (financial) investors. In parallel there is similar pressure to reduce public spending on health care and create space for health insurance companies in the market of (mandatory) social insurance packages. Authors have coined this process of tax competition “a race to the bottom in slow motion”, with specific policies becoming less generous without disappearing, or creating a public debt that will eventually force their termination.

The authors also suggest a mechanism to mitigate this race to the bottom, the so called social protection floor. The idea underpinning this initiative is that all states would commit to agreed minimum levels of social protection tailored for their respective country. The UN General Assembly resolution concerning universal health coverage acknowledges the link between universal health coverage and social protection mechanism, and urges member states to give priority to these links within their national social programs and policies.

The contradiction is obvious: There is a strong drive to have Universal Health Coverage included in the post 2015 development agenda and for countries to advance UHC at national level. At the same time these countries are dealing with (global) tax competition, tax evasion and a deregulated financial sector that is playing with casino capital at a global level. It is a good first step that WHO and World Bank work with member states to increase capacity and undertake steps towards universal health coverage. Actors working on advancing UHC inevitably will come to the issue of claiming national policy and fiscal space as a basic macro-economic condition for a country to advance its coverage of social protection and health services. Good examples in these include Brazil and Thailand.

The question is whether all the countries that are now supporting the cause of UHC are willing to make progress on further regulation of the financial sector and reform of their fiscal policies. Are these countries able to agree on global redistribution mechanisms and regulatory mechanism to curb the massive amount of untaxed wealth and casino capital, and hence free considerable resources to fund the national social protection floors? Will countries be able to develop true “progressive” taxation schemes, not merely income or VAT based, but rather on wealth and CO2 emission? Or do we want rather global philanthropy to provide the complimentary funds for advances in UHC and social security?

Bottom line: Universal Health coverage is in essence linked to political demands, choices and inherent power relations, both at the national and global level. If we all agree to have UHC included in the post 2015 agenda, then we should be willing to be truly involved in the political and ideological battle that will enfold over the coming period.

Remco van de Pas, Wemos



MMI Network: Events, news and resources

MMI marketplace: “NGO in search of research: our request – and our offer”
Desired Motherhood Gambia. Proposal by Association Suisse Raoul Follereau

“Most women in Africa do not know about their cycle and the fertile window. As a result one quarter of all pregnancies are unwanted. In our practical training for mostly illiterate women in The Gambia we use a simplified "Modified Mucus Method". Research should show whether the training helps women to control their fertility.”

This is the very first NGO research proposal put on the newly established MMI marketplace “NGOs in search of research: our request – and our offer". We invite other Network members and partners to do the same. NGO proposals are not binding, but shall allow the start of a dialogue. The Medicus Mundi International Network will provide and promote this marketplace, but will leave it up to the interested parties (NGO, researcher, training institution) to lead this dialogue, to eventually agree on terms of cooperation and to establish an appropriate contractual relation.

Call for proposals:


Network event: medico international
Pulling the Emergency Brake - Diagnostic and therapeutic options
for world trade related diseases
Berlin, 6 March 2013

This year again medico international will be part of the German Public Health Congress Poverty and Health. We invited partners and other well know speakers (MMI secretary Thomas Schwarz will provide an input on "Health Workers – Human capital for the global market?") to discuss with us the ill-effects of the current global trade regime and financial market.


Network event: Doctors with Africa Cuamm
Stop TB in my lifetime: ancora al fianco di mamme e bambini
Milano, 14 March 2013

At this event related to the World TB Day (24 March), Doctors with Africa Cuamm presents its strategy for the organization's involvement in the fight against TB in the next three years - in Italian only.

Network event: Medicus Mundi Switzerland
Primary Health Care and NCDs in Eastern Europe and Central Asia:
Where do we stand and where to go?
Basel, 10 April 2013

Over the past two decades health systems in Eastern Europe and Central Asia have undergone substantial changes in relation to their financing and the way how services are delivered to the population. In many countries a shift from hospital centred to primary health care focused systems have taken place: the number of hospital beds and hospitals were reduced in an important way and family doctors sometimes embedded in family medicine teams are today the first point of contact to deliver essential services to the population. At the same time Non-Communicable Diseases (NCDs), such as cardio-vascular disease or diabetes, have become more predominant and are today responsible for a significant share of the burden of disease in these countries. The symposium will allow participants to learn from recent experiences in countries of Eastern Europe and Central Asia in strengthening primary health care services and their relation to NCD prevention and treatment. (Symposium of the Swiss TPH, a member of the Network Medicus Mundi Switzerland.)

Network event: Medicus Mundi Switzerland
A future without AIDS - Realising a vision
Bern, 11 April 2013

A future without AIDS is possible. However, it takes concerted efforts by all to make this vision come true. will together with stakeholders from South and North assess and reflect on what we reached so far and identify and discuss promising and successful initiatives and strategies to face challenges for the future of the AIDS response. A special focus will be on role and priorities of in the joint struggle toward a future without AIDS. ( is a project coordinated by Medicus Mundi Switzerland)

Network paper: Doctors with Africa Cuamm
Alma Ata takes its revenge

"Thailand and Brazil, countries with deeply different traditions and cultures, have both opted to invest in primary care to guarantee all citizens the right to care. A lesson for all of us, 34 years after the Alma Ata Declaration. Despite of this, in Europe universalistic health systems are likely to be swept away by the neo-liberal policies."

Gavino Maciocco in: Health and Development No. 65, "Bridging the gap", December 2012. Health and Development is the quarterly journal of Doctors with Africa Cuamm. Download the journal in order to read the full article.

Conference report: medico international
Global Social Protection Scheme - Moving from Charity to Solidarity

“Charity once was a driving force of what became social protection. It no longer is. Social protection is not about charity. When we pay our taxes or social insurance fees, we are not donors of aid, we are paying our dues; when we receive support in the form of subsidised health care or teachers for our children whose salaries have been paid, we are not recipients of aid. We pay our dues and we use our entitlements, and we consider it a collective effort to build a fair and equitable society. That is solidarity, not charity.

Can we imagine a funding mechanism for Global Social Protection between people living in different countries, relying on each other and supporting each other, contributing to a fair and equitable global society? – medico international and the Hélène de Beir Foundation can. We think that most people can adhere to the principles of Global Social Protection. We do not aim for a global social protection scheme that replaces national social protection schemes; we think that national social protection schemes will benefit from a global scheme. We think we can learn from social protection equalisation schemes, like they exist within and among many high-income countries (Australia, Belgium, Canada, Germany, and others). The objective of a three days expert workshop on Financing Global Social Protection was to challenge the metaphorical devil in the detail. We know we must move from global charity to global solidarity.” (Workshop Reader edited by Jens Holst on behalf of medico international and Hélène-de-Beir Foundation)

Network news: Medicus Mundi Switzerland
Malaria: The BIG Picture

The Swiss Malaria Group (with Medicus Mundi Switzerland as a member) hosts an online photo contest: "Malaria affects the lives of millions across the world. The Swiss Malaria Group* online photo contest seeks to highlight the realities of those living at risk of malaria and the work of those dedicated to changing that reality. The contest is open to all. Send in your photos and captions that tell a story about malaria between 15 February and 24 March via the competition website, where you will find details of the three submission categories. The public will then vote to determine the finalists and a panel of expert judges will select the winners. Have you got a photo that can tell a story about malaria? Then send it in!"

Network project: Medicus Mundi Italy

A humanitarian campaign in Burkina Faso promoted by Medicus Mundi Italy and Spedali Civili Hospital (Brescia, Italy): Make sure a weaning child in Burkina Faso receives enriched flours for 4 months. Because he or she needs to grow just like our children.


International Health Policy: MMI updates

Bits and pieces of news on international health policy: each “MMI update” is 140 characters or less - these are the rules of the game on twitter. Just enough for a headline, eventually an author, a date, the source – and a link to the website where you find the full information. Have a look at some of our “tweets” published during the last month. As usual, it’s a bit much, so take it or leave it. And, as usual, you will see how difficult it is to put a resource under the “right” heading.

Health systems strengthening
Health services, health financing (national and global level)
Health statistics and health systems research

MMI thematic guide:


Universal health coverage

MMI thematic guide:
And see below: health post-2015


Human resources for health
Migration of health professionals

MMI thematic guides:


Access to medicines and vaccination
Medical research and development
Neglected diseases


Women’s and children’s health
Sexual and reproductive rights and health

MMI thematic guide:


Equity, equality and human right to health
Social determinants of health
Poverty and social protection

MMI thematic guide:


Global health governance and policy
WHO reform
Role of NGOs in global health

MMI thematic guides:


Health beyond 2015
MDGs and SDGs

MMI thematic guide:


Non-communicable diseases


World Cancer Day


Other topics


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