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Ebola: Some thoughts from my time in Liberia By John Spray, ODI Fellow, Ministry of Commerce and Industry, Liberia.

 

A lot has been written about the Ebola crisis in West Africa in the last few weeks. Many excellent articles have highlighted the plight of those suffering with Ebola (Newsweek), and the people on the frontline trying to tackle the virus (Time) and the consequences on the affected countries as a whole (How we made it in Africa). However, the real tragedy is how an inherently preventable virus was able to spread like wildfire throughout West Africa and why public health facilities failed on such an enormous scale.

I first heard about Ebola in March 2013, four months after the first patient died of the virus in a small village in south-eastern Guinea, the first ever in West Africa.
With the death toll rising across the border in Guinea, discussions in Monrovia turned to the threat of it reaching the capital: “no previous outbreak has killed more than 300 people”, “it is easy to avoid just don’t go near sick people and you are safe”, and “the disease kills people so quickly it will die out before it reaches Monrovia”. The general message was “it is scary, but we can control it with basic public health.”

Despite these reassurances, everyday you check the news: how many infected? How many died? How many health clinics were beginning to shut due to healthcare workers leaving their posts? Despite the growing chaos, we in Monrovia continued to rationalize the situation. We knew things were getting worse but we didn’t act in time.

So when did it get “out of control”? Was it when MSF declared it to be so in June? Was it when the virus hit Conakry, Freetown and Monrovia, making control of the disease in crowded urban environment increasingly hard? Perhaps it was when the Liberian-American Ministry of Finance consultant died after flying to Lagos, inadvertently putting a planeload of passengers and Africa’s most populous country at risk.

Whenever it was, there is no question that we are now in the middle of an unprecedented crisis. Every day, I dread reading the news. The front page of every newspaper is full of articles discussing the bleak picture of Liberia’s largest slum quarantined like something out of a science fiction novel. I read about the almost complete collapse of the government’s health care facilities and the justifiable fear of the healthcare workers too scared to go to work. We hear terrifying stories of suspected cases being turned away from treatment centres because there is no space to treat them, and bodies left on the street for days without someone coming to pick them up. Most of all, I fear for the secondary threats should countries follow through on plans to impose economic embargoes on the country.

Already five airlines have stopped flying to Liberia through fear of the disease. Earlier reports that West African ports have refused entry to vessels which have docked in Liberia appear false, but raise an alarming prospect of the country cut off from essential imports. This is dangerous given that Liberia is completely dependent on imports with an import bill equal to 60 percent of GDP including two of the most important commodities, fuel and rice. Even without an economic blockade importers are worried.

Early reports suggest for the last four weeks the number of import certificates are down 30 percent from the previous year. Not to mention, the travel restrictions inside the country making movement of agricultural goods from farm to market next to impossible. These developments will raise the price of essential goods necessary for the Liberian economy to function and will harm the very poorest. They also raise the possibility of riots on the street and a return to the days of anarchy last seen during Liberia’s bloody civil war.

So how did this happen? The underlying causes of this outbreak are many and difficult and will be discussed for years to come. Fundamentally, they focus on the fragility of West African states and the failure of emergency planning to tackle the crisis when it was at a manageable level.
What can we do about it? Despite the fear, there are many brave West Africans and foreigners continuing to fight this disease. The Ministry of Health is working to open new treatment centres, MSF continues to fight the battle on the front line and are managing patient care alongside national governments. The World Bank has promised USD200million to fight the disease in West Africa. The African Development Bank has promised USD210million to build West African public health facilities. The World Food Program has begun the process of bringing in food to tackle the secondary crisis. NGOs on the ground, including Oxfam, have begun gearing up awareness campaigns to get the message out that Ebola is preventable. These things are vital to the immediate fight and the world needs to react, and react fast.

Once the immediate crisis is brought under control, we must consider measures to strengthen the state institutions especially the health service in order to effectively deal with health threats in the region.

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اليوم العالمي للالتهاب الكبدي: احتفاءً بعلاج جديد أو مواساة لمن لا يستطيع شراءه ؟

World Hepatitis Day: Celebration of a new cure or commiseration for those who can’t afford it?

مهجة كمال ي
Translated into Arabic by Nagy Kamal Yanni

قليلاً ما نسمع عن دواء جديد يشفي فعلا ًمن مرض خطير. لكن في هذا العام يأتي اليوم العالمي للالتهاب الكبدي مع الأخبار المثيرة عن دواء سوفوسبوفير الجديد لعلاج التهاب الكبد سي. ويحقق الدواء نسبةشفاء عالية-أكثر من 90٪ ويستخدم في شكل حبة واحدة يوميا لمدة 12 أسبوعا بدون حقن. متفوقاً عن العلاجات الحالية التي تعتمد على مزيج من ريبافيرين عن طريق الفم يوميا مع حقن الإنترفيرون أسبوعيا لنحو 48 أسبوعا. وفعالية هذه الأدوية القديمة أقل بكثير من 90٪، كما ان لها آثارا جانبية مؤلمة بالإضافة للمتاعب المرتبطة بالحقن أسبوعيا.

فهل يمثل هذا العلاج الجديد أخباراً سارة؟ للأسف هناك مشكلة كبيرة- فالدواء ليس في متناول الجميع، حتى في البلدان ذات الدخل المرتفع . فطبقاً للسعر الحالي -1000 دولار أمريكي للحبة الواحدة- قد تضطر الميزانية الأمريكية لدفع أكثر من 300 مليار دولار لعلاج كل المصابين والذي يقدر عددهم ب 3 ملايين شخص
. فعلى سبيل المثال، فإن ولاية اوريجون ستتكلف 360 مليون دولار لعلاج سكان الولاية المصابين بالمرض مما يستنزف برنامج الولاية الطبي (377 مليون دولار) والمخصص للصرف علي جميع الأدوية لحوالي 600 ألف مواطن أعضاء في برنامج الولاية لعام 2013 . ونظرا لغلو سعر سوفوسبوفير، فقد قررت بعض شركات التأمين الامريكية تقنين العلاج وأعطوا تعليمات لأطبائهم بألا يقدموا الدواء لجميع المرضى الذين في حاجة إليه – وأن يصفوا الدواء فقط لحالات محددة جدا.

أما الوضع في أوروبا فهو ليس أفضل منه في أمريكا، فتكلفة العلاج لمدة 12 أسبوعا هي 50 ألف يورو (حوالي 68 ألف دولار). حتي أن وزيرة الصحة الفرنسية حذرت من أن مثل هذه التكلفة العالية سيكون لها تأثيراً سلبياً على نظام الضمان الاجتماعي الفرنسي، ودعت الاتحاد الأوروبي للتفاوض بشكل جماعي للوصول لأقل الأسعار

وإذا كانت التكلفة هي مشكلة رئيسية في البلدان الأكثر ثراء، فإن تأثير ارتفاع سعر العلاج في البلدان المتوسطة الدخل والمنخفضة الدخل ستكون له عواقب وخيمه. حيث يعيش فيها غالبية المصابين بالتهاب الكبد سي – 80٪ من المصابين. والبلاد التي لديها معدل انتشار العدوى أعلى من 10٪ هي: مصر في 14٪، الكاميرون 13.8٪ ، بوروندي 11.3٪، ومنغوليا 10.7٪ .

وغني عن الذكر أن هذه الدول لا تستطيع تحمل الأسعار الحالية المغالي فيها. وقد دخلت شركة جلياد في مفاوضات مع الحكومة المصرية لتقديم كورس للعلاج مدته 12 أسبوعا بسعر900 دولار لكل مريض يتم علاجه في المستشفيات الحكومية . وإذا كانت نسبة الإصابة في مصر هي 14٪ من السكان البالغ عددهم أكثر من 82 مليون شخص، فإن العدد المحتمل للمصابين بالتهاب الكبد C في مصر قد يصل إلي 11.5 مليون شخص . وبهذا فإن علاج حتى 5 ملايين مريض فقط قد يكلف مصر ما يعادل تقريبا ثلثي ميزانية الصحة الإجمالية (4.5 مليار دولار أمريكي من إجمالي 7.22 مليار دولار أمريكي لعام 2014/2015) . وهذه التكلفة بالإضافة إلى نفقات الأدوية الأخرى (ريبافيرين وبجيلاتد انترفيرون) وهي التي يجب استخدامها مع السوفوسبوفير للوصول إلى نسبة شفاء 90٪ للنمط الجيني رقم 4، وهو نمط التهاب الكبد C المنتشر في مصر.

ومع ذلك فإنه ليس من المحتم أن يكون سعر الدواء بهذا الغلو وذلك لسببين. السبب الأول هو أن باحثون في جامعة ليفربول أجروا دراسة عن التكلفة الحقيقية لعدد من الأدوية الجديدة المضادة للفيروسات والتي تشمل سوفوسبوفير وقد تضمنت الدراسة بحث تكاليف المكونات الصيدلانية الفعالة للدواء وتكلفة تصنيع الأدوية. وقدرت الدراسة أن تكلفة دورة علاج مدتها 12 أسبوعا مع مزيج من السوفوسبوفير والدكلاتاسفير sofosbuvir وdaclatasvir هو 78 دولار أمريكي للشخص الواحد .

والسبب الثاني هو أن الأدلة تشير إلى أن أسعار الأدوية تنخفض بواسطة منافسة الأدوية الجنيسة . فقد كان ثمن علاج فيروس نقص المناعة البشرية في عام 2000 مرتفعاً جداً وذلك في ذروة حملة احتجاج شعبي ضد ارتفاع أسعار الدواء، وكان من الصعوبة بمكان إقناع أي حكومة أو جهة مانحة بدفع تكاليف العلاج، وبذلك تُرِك الملايين من الناس في البلدان الفقيرة للموت .فقد كان سعر العلاج الثلاثي لفيروس نقص المناعة البشرية حوالي 10 ألاف دولار أمريكي لكل مريض سنوياً. ومن الواضح أنه لا يمكن أن يتحمل المرضي ولا الحكومات، ولا الجهات المانحة في ذلك الوقت مثل هذه النفقات. ولكن بفضل منافسة الشركات الهندية بالأدوية الجنيسة، فقد انخفض سعر العلاج الثلاثي بين ليلة وضحاها إلى 360 دولار لكل مريض في السنة أي بمعدل دولار أمريكي يوميا. وقد أدى استمرار المنافسة إلي السعر الحالي للعلاج الثلاثي وهو حوالي 100 دولار لكل مريض سنويا.

وبعد تطبيق اتفاقية “الجوانب المتصلة بالتجارة من حقوق الملكية الفكرية (تربس)” في جميع البلدان تقريبا، بما في ذلك تلك التي لديها القدرة التصنيعية مثل الهند، فقد أصبحت منافسة الأدوية الجنيسة أكثر صعوبة. ومع ذلك، فإن اتفاقية التربس تتضمن بعض المرونة، والتي يمكن أن تستخدمها البلدان للمساعدة في خفض الأسعار. فعلى سبيل المثال، يحتوي قانون براءات الاختراع في الهند علي بند بشأن “المعارضة قبل منح براءة الاختراع”، والذي يسمح لأي مجموعة مهتمة بالطعن في طلب البراءة قبل منحها. وقد استخدمت منظمات المجتمع المدني هذا البند للطعن علي طلب براءة الاختراع لدواء سوبوسبوفير. وبالتالي فإنه حتي الآن لم تمنح الهند براءة الاختراع للدواء (وينتظر القرار النهائي حكم المحكمة).

ويمكن للحكومات استخدام مرونة الترخيص الإجباري -وهي أداة قانونية هامة في اتفاقية النتربس-وذلك لضمان أسعار معقولة من الأدوية الجديدة. وقد استخدمت الهند الترخيص الاجباري لدواء سورافينيب (نيكسافار) sorafenib (Nexavar) لعلاج سرطان الكبد والكلى فانخفض سعره من حوالي 5500 دولار أمريكي في الشهر إلى 175 $ في الشهر . وفي عام 2008، أصدرت تايلاند تراخيص إجبارية لثلاثة أدوية لعلاج السرطان، مما أدى إلى انخفاض كبير في الأسعار. فعلى سبيل المثال، تم تخفيض سعر القرص الواحد من عقارلتروزول letrozole 2.5 ملج من السعر الأصلي لشركة نوفارتيس وهو 7،35 دولار إلي من 0،19 الي 0،22 دولار- أي أقل 30 مرة من السعر الأصلي .

ومن الواضح أن شركات الأدوية والبلدان الغنية التي تدعمهم لا تفضل استخدام الحكومات لمثل هذه الأدوات القانونية الموجودة في اتفاقية التربس. فعندما أصدرت تايلاند التراخيص الإجبارية لأدوية علاج فيروس نقص المناعة البشرية وأمراض القلب والأوعية الدموية، والسرطان، فإنها وقعت تحت ضغط هائل من كلا من الولايات المتحدة والاتحاد الأوروبي حتي تتوقف عن استخدام الترخيص الإجباري . وفي العام الماضي كانت هناك ضغوط كبيرة من قبل الشركات الأميركية والكونجرس علي حكومة الولايات المتحدة لكي تتخذ إجراءات صارمة ضد الهند بسبب نظام الملكية الفكرية الهندي .

وتقع المشكلة الأساسية المؤدية لارتفاع أسعار الأدوية الجديدة في نظام قواعد الملكية الفكرية التي تتيح للشركات الكبيرة احتكار أسعار الأدوية، وبالتالي تمنحهم القدرة على التحكم فيها. وعلاوة على ذلك، فإن تمويل البحث والتطويرR&D) ) للأدوية لا تزال تمليها المصالح التجارية بدلا من الاحتياجات الصحية العامة في جميع أنحاء العالم. وتضغط شركات الأدوية بشراسة لحماية الملكية الفكرية ولجعلها أكثر صرامة باعتبارها السبيل الوحيد لتحفيز البحث والتطوير وللتأكد من أن هذه الشركات قادرة على المحافظة على احتكارها للتحكم في الأسعار.

وقد أعطى سعر الدواء الجديد التهاب الكبد سي المزيد من الزخم إلى الحركة العالمية المتصاعدة ضد ارتفاع أسعار الأدوية الجديدة الفعالة في مكافحة الأمراض ابتداء من السرطان إلى التليف الكيسي cystic fibrosis وطالما استمر ربط تكلفة البحث والتطوير بتسعير الأدوية، فسوف تستمر شركات الأدوية في تسعير الأدوية بما يحقق لها أقصى قدر من الأرباح، حتى لو كان ذلك يعني انخفاض إتاحة الأدوية للأشخاص الذين هم في حاجة إليها.
وتلك هي مهزلة الصحة العامة.

إن سعر الأدوية الأكثر فعالية والتي يمكنها علاج التهاب الكبد سي اليوم، يسلط الضوء على الحاجة الماسة للفصل بين تمويل البحث والتطوير وسياسات التسعير، وإلي الحاجه الماسة لإيجاد سبل جديدة لتمويل البحث والتطوير لإتاحة الأدوية الفعالة بأسعار في متناول جميع المحتاجين إليها.

المراجع

[1]http://www.bloomberg.com/news/2014-04-08/express-scripts-raises-pressure-on-gilead-for-drug-price.html

[2]http://www.washingtonpost.com/blogs/wonkblog/wp/2014/07/24/the-drug-thats-forcing-americas-most-important-and-uncomfortable-health-care-debate/

[3]http://news.yahoo.com/eu-nations-join-forces-against-exorbitant-hepatitis-c-193456820.html

[4]Lavanchy D.( 2011) Evolving epidemiology of hepatitis C virus.Clin Microbiol Infect.;17(2):107-15

[5]http://www.reuters.com/article/2014/03/21/hepatitis-egypt-gilead-sciences-idUSL2N0MI1ID20140321

[6]http://countryeconomy.com/demography/population/egypt

[7]Forthcoming: New effective hepatitis C medicines must reach all patients. PLOS

[8]http://cid.oxfordjournals.org/content/early/2014/01/06/cid.ciu012.full.pdf

[9]http://www.pharmatimes.com/article/13-03-05/Bayer_loses_appeal_in_Indian_compulsory_licence_case.aspx

[10]http://www.moph.go.th/hot/Second_white_paper_on_the_Thai_CL_%5bEN%5d.pdf

[11]http://www.wcl.american.edu/pijip/documents/mandelson07102007.pdf

[12]http://www.ip-watch.org/2013/06/20/170-members-of-us-congress-pressure-india-on-ip-rights/

[13]http://online.wsj.com/articles/costly-drug-vertex-is-denied-and-medicaid-patients-sue-1405564205

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Have pharmaceutical companies changed?

TAKE 1: CLACKET FIRST TIME OF PHARMA FILM

It is 1996 and the scene is starting with the plight of HIV hitting the news. By 2000, it was clear for all to see that the medicines available to treat this deadly disease are in the North while the disease is most prevalent in the poorer countries in the South. It was estimated that one in five South Africans was infected.

Yet 39 multinational pharmaceutical companies decided to take Nelson Mandela’s Government to court over an Intellectual Property Bill that tried to prevent patents from hindering access to medicines. Thanks to a global public campaign and patients’ advocacy, the companies were forced to withdraw their case in 2001.

Talk to “big pharma” and they will tell you that the South Africa court case was a landmark in their history. Some even say that such a thing would not happen again. One cannot help a cynical smile when remembering that in 2006 Novartis took the Indian government to court over the claim that India’s intellectual property law is not TRIPS  compliant. Needless to say Novartis lost its case. At least this time other companies watched from a distance without giving public support for Novartis.

TAKE 2: CLACKET SECOND TIME OF THE SAME FILM

It is 2014 and the scene is of a world waking up to the growing plight of non-communicable diseases. The latest WHO report estimates that cancer cases are expected to soar by 70% over the next 20 years . Although the big talk is still about prevention (which of course is critical), very few are talking about treatment. In the current debates on post MDGs cancer is hardly mentioned and in the discussions on Universal Health Coverage one rarely hears about how to make detection and treatment (surgery, radiotherapy and medicines) available and affordable. 

Roche markets a drug for cancer (Avastin) which was discovered to also cure a type of blindness affecting older people. So Roche patented another form of the drug (Lucentis) as specific treatment for the eye condition. The catch is that one injection of Avastin costs $50 while a Lucentis injection costs $2,000. Another example that recently hit the headlines is that of a new medicine to treat Hepatitis C (made by Gilead) but alas it costs $1,000 per day.

Needless to say that access to affordable medicines for HIV and other infections remains an “unfinished” agenda – the debate on medicine price is just as important today as it was in late nineties and early 2000s.

And now back to South Africa again. In February this year, a leaked document shows that the Innovative Pharmaceutical Industry Association of South Africa (IPASA) and its sister organisation in the US (PhRMA), hired a PR company to conduct a covert campaign against the South African government. The campaign intended to delay and undermine the Government’s new Intellectual Property Bill which seeks to use internationally agreed legal instruments such as the TRIPS flexibilities included in the Indian law, to enhance access to more affordable generic medicines in South Africa.

But the pharmaceutical industry does not want the South African government to take such actions to protect public health. IPASA made a submission to the DTI on the Draft National Policy on Intellectual Property in support of the current status quo.

The South African Department of Health condemned the recently leaked pharmaceutical industry strategy. The Minister of Health described the proposal as a “genocidal conspiracy of satanic magnitude”, accusing pharmaceutical companies of “conspiring against the state, the people of South Africa and the populations of developing countries” – and of planning what amounts to “mass murder”.

SO HAVE PHARMACEUTICAL COMPANIES CHANGED?

I cannot answer this question any better than the honest statement given by Marijn Dekkers, CEO of Bayer who said in reference to Bayer’s medicine Nexavar for the treatment of liver and kidney cancer: 

“ .. we did not develop this product for the Indian market, let’s be honest. We developed this product for Western patients who can afford this product, quite honestly. It is an expensive product, being an oncology product.”

These simple words tell us the whole story of multinational pharmaceutical companies’ approach to access to medicines: that they are about maximizing profits and not about contributing to advancing public health. All their talk of “putting patients at the front of our business” is just talk for public consumption to improve their PR image. The business model of multinational pharmaceutical companies – founded on maximizing profit – dictates the Research & Development agenda and the pricing and marketing pathways. Companies still refer to compulsory license, a legal instrument under TRIPS, as “essentially theft.”

We must always remember that it was this industry –chiefly Pfizer- which lobbied and succeeded in designing a global Intellectual Property system (TRIPS) and fought hard against the flexibilities and instrument included there for countries to use to protect their citizens.   It is pharma that continues to lobby for stricter Intellectual Property rules in free trade agreements that further tie the hands of governments so that companies’ monopoly is extended.

So what has changed apart from adopting new tactics? Well at least some companies remembered – and perhaps did not want to repeat – the old South Africa saga and started to withdraw from the IPASA campaign plan. The Danish company, Novo Nordisk dissociated itself from IPASA and more recently Roche followed suit.

The big question remains though: when will multinational pharmaceutical companies realise the failure of their Intellectual Property-dependent business model and seek alternatives?

Dr Mohga Kamal-Yanni is a Senior Health Policy Advisor at Oxfam GB

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Working for the Many – what role for public services in fighting inequality?

The extreme gap between the rich and the poor has become headline news in countries around the world, with consensus from actors as diverse as the Pope, Christine Lagarde and President Obama that we need solutions to reverse the growing divide between the haves and the have nots.

In February 2014, backing a new IMF discussion paper, Christine Lagarde Director of the IMF underlined that ‘making taxation more progressive’ and ‘improving access to health and education’ have a key role to play in tacking inequality.  Oxfam has worked for decades to promote universal access to quality health services, and in our new report ‘Working for the Many’ we consider evidence of how public services – especially health and education – impact on economic inequality.

The evidence bears out Christine Lagarde’s claim – the case to invest more in free public healthcare as one of the weapons to tackle extreme inequality is compelling.

First we consider a 2012 OECD study which quantifies the value of public services – the vast majority of which is health and education – to each quintile of the population, by converting that value into ‘virtual income’.  The data shows that in OECD countries public services are worth the equivalent of a huge 76 per cent of the post-tax income of the poorest group, and just 14 per cent of the richest. So whilst public services benefit rich and poor equally in absolute terms, so that everyone is a winner, these services are strongly redistributive and help to mitigate the impact of today’s skewed income distribution by benefiting the poorest far more.

In fact, across OECD countries the virtual income gained from public services reduces income inequality by an average of 20 per cent.  Similar calculations across six Latin American countries show the same impact – virtual income from health and education reduce income inequality by between 10 and 20 per cent.

Evidence from studies done across Asia, and more than 70 developing and transition countries shows the same underlying patterns in the world’s poorest countries.  A 2007 study of healthcare systems in eight Asian countries and three Chinese provinces and regions shows that in all but one, healthcare had the same equalizing effect through progressive distribution of benefit. The more these governments spent on healthcare, the more progressive the distribution of income was and the more the healthcare system addressed economic inequality. This mirrors findings in the OECD study, that countries that increased public spending on services throughout the 2000s had an increasing rate of success in reducing income inequality. But those countries that cut spending during that time showed a marked decline in the rate of inequality reduction.

Whilst public services provide everyone with ‘virtual income’ and fight inequality by putting more in the pockets of the poorest; user fees and private services have the opposite effect.

User fees take money out of the pockets of the poorest and undermine the inequality-reducing potential of services.  Health user fees cause 150 million people around the world to suffer financial catastrophe each year.  That is approximately two per cent of the global population.  And since Malaysia privatized portions of its health services and introduced user fees in the 1980s, out-of-pocket spending has risen, representing one-third of total healthcare spending in the country in 2009. A recent study in the USA showed that the poorest 20 per cent spend 15 per cent of their income on healthcare, compared to the richest 20 per cent for whom healthcare amounts to just 3 per cent of income. But despite this significant cost to the poorest, they still don’t get all the cover they need.

Private provision of healthcare further skews the benefit towards the richest.  In three of the best performing Asian countries that have met or are close to meeting Universal Health Coverage – Sri Lanka, Malaysia and Hong Kong – the private sector is of negligible value to the poorest quintile of the population, and the benefits of private healthcare services are strongly regressive. They serve the richest far more than the poorest. Fortunately in these cases the public sector has compensated and allowed universal and equitable access to be achieved.

More recent and detailed evidence from a 2013 study of the Indian healthcare system finds that amongst the poorest 60 per cent of Indian women, the majority turn to public sector facilities to give birth, whilst the majority of those in the top two quintiles give birth in a private facility.  Finally, comparable data from across 15 countries in sub-Saharan Africa reveals that just three per cent of people from families living in the poorest quintile sought care from a private doctor when sick.

Fees take more away from the actual income of the poorest people, and private services benefit the richest first and foremost.  If governments are serious about closing the gap between rich and poor, and achieving Universal Health Coverage, the evidence points them towards free public services.

Read the full paper, ‘Working for the Few: Public Services Fight Inequality’

Emma Seery is Head of Inequality Policy and Campaigns for Oxfam GB

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Waiting for a second chance in Georgia

Maya says: "I don’t want to die and leave my daughter alone. That’s my biggest fear. She’s been through so much she deserves to have a better life." Maya Giorgadze, 47, is a single mother, from Gori, Georgia. She has a 15-year-old daughter, Dea. Maya was diagnosed with breast cancer and had a lumpectomy but cannot afford follow up treatment. Photo: Justyna Mielnikiewicz. Oxfam

Giorgi’s shy innocent face stares out of a billboard in Tbilisi. The words ‘I have a right to live’ are printed across the frame. A famous Georgian journalist tenderly holds Giorgi’s hand, urging the country to hear their urgent call to action. 13-year-old Giorgi has just a few critical months to find a bone marrow donor to save his life.

Giorgi is part of a campaign run by leading Georgian journalists, and supported by Oxfam, to ask the Government to urgently invest in the healthcare sector, and save the lives of children affected by leukaemia. For Giorgi, the journalists’ crusade is his last hope. Giorgi’s mother, Jakhia, explains,

“We have no money. We only receive 125 lari (£48) per month from the state, which is barely enough to feed my family. We have nothing to sell, and I don’t know how we’ll cope,” she says wiping away tears.

Although the Georgian government provides chemotherapy and medicines to children affected by leukaemia, there are currently no facilities in the country to facilitate bone marrow transplants and no database to find donor matches. Giorgi’s mother may be forced to seek refugee status abroad to pay for her son’s transplant which costs around 100, 000 euros (£85, 000)– an insurmountable amount for the majority of Georgia’s population.

Giorgi’s story is representative of hundreds of people across Georgia who are struggling to access affordable health care. The health system in Georgia requires families to take drastic measures to save their children’s lives.

In Gori, the former home of Stalin, Maya, a young single working mother largely dependent on social benefits, is unable to afford the cost of her post cancer treatment. Rising food prices are also having an impact on her family and pushing health care even further out of reach. Maya looks sadly out of the window of her small dilapidated ex Soviet apartment, which she shares with fourteen other families “Sometimes I go to bed hungry at night so I can pay for medicine for my daughter.”

Elsewhere, people like Elguja, who used to be an actor, have no choice but to buy low quality cheap medicines. Elguja who turned blind at 22, says, “My pension is 125 lari (£48) each month but medicine costs 100 lari (£38). I have to buy cheap medicines but it makes my asthma worse. You can’t imagine what it’s like when you can’t breathe, especially at night.” Elguja often has pain in his eyes but cannot afford the high costs of eye medication. “I miss being able to see people’s eyes on stage,” Elguja wistfully remembers, “The eyes are the window to the soul,” he waves his walking stick like a wand as if he is playing the part of a blind man in a play.

For Giorgi, Maya, and Elguja, the new Government’s pledge for universal free healthcare for Georgia’s population, and the promise to establish a transplant centre for children affected with leukaemia offers hope. Oxfam is working to raise awareness amongst young people about their health rights and have a say in the future health care system. For young Madea, who is taking part in the project, it gives her a chance to have a voice, “Healthcare is the most important thing, especially for children as they are the future of the country. We often have meetings with municipality representatives to have a say in the healthcare system and lobby for changes.”

Meanwhile, Giorgi’s message ‘I have a right to live’ remains on billboards across the capital, a stark reminder of the urgent need for healthcare reform in Georgia. I hope that Oxfam’s campaign gives Giorgi, Maya and Elguja a second chance.

Caroline Berger is the Oxfam Regional Digital Media Coordinator for the CIS

 

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Global Health Check is edited by Anna Marriott, Health Policy Advisor for Oxfam GB, and welcomes contributions from different authors. If you would like to write an article for this site or if you have any queries please contact: amarriott@oxfam.org.uk.