A few months ago, in a conversation with Dr. Helder Martins, former Mozambican Minister of Health, he commented that Primary Health Care (PHC) does not exist in Mozambique. He argued that, contrary to what happened during the first years after independence, the health system is now nothing but the sum of a series of unarticulated programmes. He uttered those same statements publicly during the debate that followed the release of the film “A Luta Continua” in Maputo.
It is, no doubt, an extremely categorical assessment, but probably a rather accurate representation of the country’s health sector. Indeed, it is true that the diagnosis of reality, as we have already pointed out on previous blog articles, indicates that the majority of the financial and human resources are not at the service of PHC; on the contrary, they serve to promote vertical programmes which distort the health system and create inequities in terms of access to health services, leaving the most disadvantaged without the capacity to exert their right to health. Moreover, the country’s macroecomomic dynamics, based on market economy, with extractive industry as a central hub, fuel inequalities in an already fragile country.
Medicusmundi puts forward a strategy intended to make Primary Health Care a reality in Mozambique, based on strengthening, fostering and defending PHC. But, is it possible to defend something one lacks?
Those of us who participate in movements for the defence of human and social rights, such as health, are to face enormous obstacles and challenges. The globalisation of human and social rights runs well behind that of the capital. In this respect, one could even consider “logical” to think that the forces intending to turn health into a commodity instead of a right, would win the day in many countries in the planet, especially in the younger ones, which are eager to open up, such as Mozambique. The lucrative and non-lucrative private sectors expand indeed in search of new markets.
It is true that Mozambique cannot fight to prevent social advances, such as universal coverage, from being taken away, because they were never achieved in the first place. Neither can it struggle in order to prevent the privatisation of many services in certain rural areas, since those services simply do not exist. And the list is long. However, Mozambique can fight for an ideal that will contribute to progress in that direction, so that the right to health comes into effect: a public health system, with universal coverage and based on the principles of Primary Health Care. And the good news is that those people and institutions fighting for this ideal are not alone. Moreover, recent history, together with the impressive results achieved regarding the improvement of the quality of life guaranteed by PHC, are on our side.
The worldwide financial crisis has been the ultimate excuse for attacking public health systems once more, and Primary Health Care has become one of its major victims. In many European countries, cuts in public budgets, directly affecting the health care coverage of a major part of the population, have been implemented. The advances achieved after decades of fighting for the right to health to be accessible to all women and men are unravelling in only a few years.
We stand witness to the dismantlement of social achievements “in the North” and, as for what is left to be achieved regarding the right to health “in the South”, we are told it is just not possible. We are then pushed to believe there is no available option other than to consolidate “parallel models” within each country – briefly, quality and coverage for the rich and a precarious and basic system for the poor.
As things stand, there is no doubt now it is high time to join forces globally, and thus, it is clear that yes, we can defend something proven effective in other latitudes. A utopia, a dream come true in other countries (obviously adapted to the reality of the given country) can be defended, since now we know what is needed in Mozambique. We can make this our dream, and we can make this dream come true.
One of the main functions of the future Institute for Primary Health Care in Mozambique will be working with the people, with the civil society, with grass-root organisations and with all those people wishing to join the struggle for the right to health so that it becomes real and effective for the population. In this context, collaboration agreements with institutions such as IESE (Mozambican Institute of Economic and Social Studies) or such as MASC (Mozambican Mechanism to Support Civil Society) have already been signed in order to launch campaigns in defence of public health and advocate for public policies, among the government and their main donors. We are collaborating in parallel with other international movements, which will no doubt teach us good practices on this issue.
We believe the debate on the health care model which Mozambique is at present implementing has to be brought back to the people, and we are convinced that the most efficient alternative among those aimed at guaranteeing health for all women and men has to be defended: Primary Health Care within the framework of a quality public system.
To sum up: Primary Health Care in Mozambique will be a reality as soon as the policies and services aligned with it are strengthened, as soon as its values are fostered through education and research, and as soon as the active defence of its implementation is in the hands of its population.
Ivan Zahinos Ruiz
Director of Cooperation Projects