Free and Public

David vs Goliath: How the richest governments block the poorest nations from using their rights under international law

It is all too technical. It cannot be a media story. It is about acronyms like TRIPS and the negotiation was taking place in an obscure place called the TRIPS council in Geneva. Therefore the injustice practiced by the richest nations against the poorest ones goes unnoticed except by dedicated NGOs who are worried about the poorest people in this world. So what is this story about?

In 1995, the World Trade Organisation (WTO) was created and with it, the Trade Related Aspects on Intellectual Property Rights (TRIPS) which dictated that all WTO members adopt Western-style intellectual property standards irrespective of a country’s status of development or industrial progress. Luckily the TRIPS negotiators realised that the poorest nations – the least Development Countries (LDCs) – do not have the capacity to implement such complicated regimen so they were granted a “waiver” or a transition period until 2006, after which they were to implement the agreement.

Needless to say that by 2006 LDCs did not have the capacity to implement  -let alone to benefit from – TRIPS. So the WTO granted them another extension till 2013. This extension will expire by the end of this month. Given that the LDCs still do not have the capacity to implement TRIPS, Haiti, on behalf of the LDCs applied to the TRIPS council for an extension as they are entitled by the agreement itself. Rather than having yet another extension for an arbitrary number of years, the LDCs requested unconditional extension until a country develops enough to cease to be an LDC. The proposal was unequivocally rejected by the richest nations.

During the negotiation of the LDCs’ request, the US and EU took a very tough and inflexible position. Firstly they tried to impose a conditionality that requires LDCs to maintain existing levels of TRIPS compliance, even if these work against their development needs. Such conditionality is not required by the TRIPS agreement itself !

The US and EU also pushed hard for a limited extension of only five to seven and a half years. Such a short extension would not allow LDCs to develop the basic prerequisites (e.g. qualified personnel, a scientific and technological base, a functioning market, and regulatory systems) that would enable them to implement, let alone to benefit, from the TRIPS Agreement.

Citizens of LDCs, most of which are in sub-Saharan Africa, are the most vulnerable people in the world. More than half lives on less than $1.25 per day. The early implementation of TRIPS agreement would have a grave impact on access to medical technologies, educational resources, seeds and climate change adaptation technologies.

I personally think that it is shameful that the US and EU oppose the reasonable request of the LDCs and put undue pressure on them to accept the US/EU conditionalities that work against the interests of ordinary people in countries such as Niger, Somalia, and Malawi.

Mohga Kamal-Yanni is a Senior Health and HIV Policy Adviser at Oxfam GB

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Is this a real U-turn? World Bank president speaks at WHA

In an inspiring speech at the 66th World Health Assembly of the World Health Organisation, the President of the World Bank Jim Yong Kim said: “Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services.  This is both unjust and unnecessary.”

Twenty years after the infamous World Bank “Investing in Health” report that set the path towards implementation of user fees and privatisation of health care, no less than the President of the World Bank dares to criticise user fees. The evidence is now very clear that health user fees punish poor people and prevent them from accessing life-saving treatment, especially women and marginalised groups. It is about time to abolish user fees globally. Yet to do so successfully, countries need financial and technical support from the WHO and the World Bank as well as from other donors. The World Bank’s advice and technical assistance at a country level will continue to be a decisive factor in supporting countries to move towards Universal Health Coverage (UHC) and determining whether or not the World Bank meets its commitments.

And it is not just poor people who face problems with payment for health care. People living above the poverty line and the so-called lower middle class are also badly affected.  According to WHO estimates, every year 100 million people are pushed into poverty and 150 million more suffer economic hardship due to the cost of health care.

For me personally these are not just dry statistics. The numbers represent people that I know very well: family, friends, and neighbours – many of whom have chronic illnesses that require life-long health care which drain the family income and assets

In his speech Jim Kim outlined five specific ways in which the World Bank will support countries to realise UHC: enhancing analytic work and support for strengthening health systems; helping countries to reach the Millennium Development Goals 4 and 5 on maternal and child mortality; developing a monitoring framework for UHC coverage in collaboration with the WHO; intensifying work on the science of delivery; and stepping up efforts to improve health through action in other sectors that impact on health.

These are welcome commitments. However, as the English say: “the proof of the pudding is in the eating”, which means you have to eat the pudding to know what is inside it. The challenge for the President and his team is now to translate these words into practical measures that bring real benefit to poor people. Still, Jim Kim and the health team behind him represent a breath of fresh air at the World Bank.

Evidence  from countries which have achieved or are on their way to achieving UHC, shows that universal coverage cannot happen without major, scaled up public investments in health. Jim Kim highlighted the case of Thailand where the state financed health care expansion against World Bank advice. It is not surprising that the Thai delegate at WHA said that UHC is possible to achieve. Evidence also shows that to reach the poorest and most vulnerable people, governments should expand public delivery of health services. This is clearly the message from the successes in Ethiopia where 30,000 health workers were trained in just 3 years – against the advice of donors!

One important lesson from countries such as Thailand and Ethiopia is that policies to achieve UHC should not be defined by the existing low government health budgets. Such approaches will automatically lead to designing financial systems that place the burden of payment on patients. Countries need help to reform their tax systems to build a fair and progressive system where not only well-off people pay their share but also foreign companies pay their tax duties.

I was inspired by Jim Kim’s speech and his personal commitments to UHC and poverty eradication. Now I am watching to see what it means for my family, friends and neighbours who so desperately need access to free, quality health care.

Mohga Kamal-Yanni is a Senior Health and HIV Policy Adviser at Oxfam GB

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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.