International Conference Be-cause health 23 & 24 March 2023
Thursday 23rd March – parallel sessions 03:15 – 04:15 pm (CET)
Interrogating myths and taboos in the Universal Health Coverage (UHC) discourse: amplifying evidence from the majority world
The first decade of experience in many (high-income) countries shows that UHC initiatives have led to further commodification and commercialisation of health care, and worsened equity in access and weakened public services without the ability to regulate the private sector.
UHC progress has stalled in part because of the (economic) impact of the Covid-19 pandemic, financial austerity, and other crises but mainly because of the faulty premises (myths) in UHC discourse and policies that undermine public health care systems in favour of the private health sector. This trend is a transnational problem, as even high-income countries are struggling to sustain the capacity and quality of their public services (e.g. the latest Nurse strike in the United Kingdom) in light of rampant privatisation and under-funding of existing public services.
Drawing lessons from multiple countries, this session will clarify how the mainstream UHC discourse has deepened commercialisation of health service provision. It will discuss how some of the myths are amplified in the UHC discourse despite a lack of evidence, while other more viable forms of (public-sector oriented) progress, have become a global taboo, been attenuated, or have altogether been excluded in the UHC discourse. This adversely affects health equity and financial protection, values which are in theory widely accepted.
- Speakers: Sulakshana Nandi, Jamie Dasmariñas, Thiagarajan Sundararaman, Mario Esteban Hernandez Alvarez
- Moderator: Remco van de Pas
Unspoken Truths: commercialisation of health undermines human rights
The subject of this organised session is “unspoken truths” around the pervasive and continuous spread of commercialisation of health. In the work to promote and develop strengthened public health systems that put people first, researchers, advocates, practitioners, and activists must confront the insidious motivations driving commercialisation of health, health care, and health products. Doing so, with a strong evidence-base gathered from lived experiences–as well as a perspective grounded in international human rights law and standards–is necessary to deconstruct the logic behind this widespread trend. Only then can stakeholders push decision makers to advance public health policy that is proven to be more effective, equitable and works towards achieving the right to health.
This session will focus on several “unspoken truths” that drive the commercialisation of health: the totem of health privatisation and private sector profiteering in the health sector; the “real costs” of health commercialisation; the need for transparency around direct foreign investments (DFIs); ways by which private sector engagement undermines health care quality, equity and rights; and the need to strengthen regulation of private actors. Panellists will provide evidence from country case studies and related worldwide data that demonstrate how these factors are proliferating in the context of the health sector, lead to worse health outcomes, and erode the right to health.
This session provides insights as to how private sector solutions to public health challenges have proven antithetical to human rights and public interest. The session also amplifies the voices and experiences of affected communities and equips advocates and activists with evidence of the harms of commercialisation in the health sector. Finally, the session will explore evidence-based solutions and steps that must be taken to curb commercialisation of health, challenging us all to speak truth to those taboos that powerful decision makers rely on us remaining quiet about.
- Speakers: Shweta Marate, Ravi Ram, Katharina Anne Berza, Elias Kondilis
- Moderators: Leigh Haynes, Anna Marriott
The opportunities and limitations of digital health: between optimism and pessimism
A powerful paradigm within the global health community is that digital health and its accompanying solutions have an important role to play in improving health systems to the point of considering only their advantageous side. This position has been further confirmed during the COVID-19 pandemic where many case tracking and surveillance tools have been developed by technology companies. However, digital health care cannot be a panacea for access to health care for all, especially in low-resource contexts. Digital health solutions should consider the local contexts, including the levels of digitalisation of economies and societies, which is key to ensure they can positively contribute to the reduction of inequalities and access to health care. In this panel, we will hear from e-health entrepreneurs and experts who are notably developing and supporting the implementation of e-health solutions in LMIC’s as well as analysing their impact on the health system. They will share their experiences of how they have considered both the limitations and opportunities of digital technologies to facilitate access to affordable and quality health care. They will also tell us about cases of failure and the difficulties in scaling their solutions.
- Speakers: Steven Serneels, Jean-Pierre Noterman, Franck Nziza, Farah Beniacoub
- Discussant: Taofeekat Adigun
- Moderator: Mireille Ntchagang
Coloniality and power imbalances in vaccine equity, programme evaluation, and health education
Health equity and healthcare for all has become a key landmark goal in global health theory, policy, and practice. While national and international stakeholders are struggling to find solutions to extend access to the highest standard of health, they are confronted by structural barriers sustained by enduring power asymmetries. These power imbalances are reinforced by (post-)colonialism, supremacist ideologies and practices, racism, patriarchy/misogyny, xenophobia, and others, which are embedded in today’s global health theory and practice.
In this session, the issue of coloniality is addressed in several aspects of global health:
- ‘Vaccine equity’: a step towards decolonisation or power imbalances perpetuated?
During the COVID pandemic, the WHO set a target of reaching 70% global Covid vaccination coverage worldwide. This target had the objective to reach vaccine equity and was seen as a decolonising instrument. However, it is a policy imposed by global health institutions on all countries. In LMICs (this session will focus mainly on African countries), this strategy did not match the countries’ needs. It is time for these countries to choose and their own health priorities and act accordingly.
- Power relations in health programmes and policy evaluations in Burkina Faso
Every programme and policy evaluation raises political issues and power dynamic issues. In the Burkinese health context, these evaluations are practised but at the convenience of the funding organisations and usually at the will of the “development industry”. This qualitative study of 40 semi-directed interviews from 5 evaluation processes proposes to provide an understanding of evaluative practices in health administration in Burkina Faso.
- The terrible “C word”: Addressing coloniality and hegemonic structures in health education.
Power structures are often perpetuated through health education that instils eurocentric perspectives and methodologies. While public health academics have long called for the decolonisation of health education, there is limited evidence of such initiatives in European higher education institutions. A student-led project was launched within the University of Ghent to examine and address hegemonic structures in health education with 3 objectives: (I) explore power imbalances in health education, (II) co-develop (with a co-creation approach) recommendations to dismantle the power structures, and (III) assess the feasibility of implementing these recommendations.
- Planetary health education and capacity building for healthcare professionals-context of decolonisation and health equity
Planetary Health (PH) has a strong mission to deal with the environmental threats to public health: these treats must be discussed in a more organised and sustainable way within the global public health and healthcare disciplines. The role of education is central to this aim by developing the basic and contemporary understanding of PH as well as by advancing self-reflection of the wider society and a recognition of the instrumental contributions of others. Incorporating PH in the education system for all disciplines is a crucial footstep to obtain this change. To be an inclusive and result-oriented, holistic model, individual and community-level, formal and informal, professional education is needed to ensure equitable and justifiable climate education. There is a noticeable lack of knowledge and resource equity between the Global South and North. The majority of the available PH courses and discussions of curriculum development have emerged from high-income countries and is limited to few professions (doctors and nurses). We conducted a scoping review to identify potential resources describing PH education and existing education programmes for HCPs.
- Speakers: Elisabeth Paul, Mohamadi Zeba, Danielle Fernandes, Muhammad Asaduzzaman
- Moderator: Charles Ddungu
Thursday 23rd March – parallel sessions 04:30 – 05:30 pm (CET)
The not so voluntary “voluntary family planning”? Reproductive coercion in past and present
Sexual and Reproductive Health and Rights (SRHR) programmes and policies worldwide find their origins in European and United States’ elites’ homegrown concerns about population control in the 19th to early 20th century. They were built on a Malthusian world-outlook of fear of ‘exponential population growth’ and hence ‘overpopulation’ and ‘scarce resources’ if the growth of certain populations, (read the poor), was not kept in check. This world-outlook has informed coercive top-down policies of population control through forced family planning, abortion, and sterilisation programmes in the 1960’s up until the 1990’s.
With the 1994 International Conference on Population and Development in Cairo (ICPD), under pressure from women’s rights groups from around the world, a drastic turn was taken. Women’s individual reproductive rights were recognised as human rights and the United Nations (UN) member-states agreed to end the harmful policies of population control. Black feminists, eco-feminists and reproductive justice feminists have increasingly come to question this assumed defeat of population control as a driver of family planning programmes. They critique ‘populationist’ policies and programmes that “aim to produce female subjects who empower themselves, promote economic development, and reduce environmental degradation by controlling their fertility” (Bhatia et al., 2019). They worry that these policies and projects emphasise strategies of individual optimisation predicated on correct ‘management’ of bodies, fertility, and reproduction (Bhatia et al.). Feminist research has also started to uncover how contemporary family planning and sterilisation programmes continue to suffer from diverse types of direct or indirect coercion, informed by population-control and/or climate change and/or security concerns of implicated states and donors.
With this panel, we seek to build our understanding of why and how contemporary programmes of voluntary family planning continue to suffer from population control concerns, can lack in voluntariness, and might involve direct reproductive coercion while resisting to pay attention to addressing infertility concerns in the populations they aim to serve. The discussion will also engage with viable alternative perspectives, drawing on insights from the reproductive justice movement and intersectionality.
Financial Justice for Pandemic Prevention, Preparedness, and Response
Financial injustices and ill-conceived economic policies have stood in the way of increasing domestic public resources for investments in health for many years, with significant negative consequences for the right to health of millions. Yet, in the global health community these health justice issues are generally considered to be out of the scope of the sector’s discourse and health actors’ interventions. Raising them in global health and health financing discussions is a taboo and often met with little or no response. Existing and proven solutions for changing the current dysfunctional scenario and working towards economic justice, are side-lined in the name of innovative financing mechanisms. This furthers the commodification of healthcare delivery the and the leveraging of the private sector in health. Clear evidence on the need for increasing public – not private – finance for health equity tend to remain ignored, despite the multiple lessons the world had to learn with COVID-19.
After three years of the pandemic, and in the current context of polycrisis, we cannot help noticing that instead of joining forces to end illicit financial flows and cancel debts, for example, global health actors are seeking to fill funding gaps in global health by again following what can be labelled as ‘false gods’. These include using scarce public funds to attract private investments, privatising health services or offering piecemeal responses that do very little to meet people’s needs. More recently, the international community engaged in supporting pandemic prevention, preparedness, and response (PPR) but has only been able to come out with yet another global fund that is bound to reproduce well known dynamics of uncertainties and donors’ dependence.
With its Financial Justice for Pandemic Prevention, Preparedness, and Response report, the Geneva Global Health Hub (G2H2) aims to break this taboo and urge global health actors to pursue economic and climate justice because it is impossible to achieve global health equity, without such eco-social justice.
The choice of the selection committee: three additional presentations
1. Advancing publicness, regulating commercialisation of health systems: Lessons for global health from the COVID pandemic in India
The COVID pandemic generated unprecedented healthcare needs and challenges, especially in countries like India with highly privatised healthcare systems. The pandemic situation forced states as well as social actors to develop innovative strategies to ensure access to life-saving care for the population. In doing so, they considerably expanded the ambit of public systems and actors, while attempting to regulate the profit-driven behaviour of commercial private providers. Though the results of these diverse and unique efforts were mixed, valuable lessons emerge regarding how to deal with widespread commercialisation of healthcare to protect public interests, within a larger framework of ensuring universal availability of healthcare. Unpacking concepts like co-production of healthcare, interventionist regulation, social accountability of private healthcare providers, social embeddedness of healthcare, and market-reshaping public engagement of private providers can help to elaborate an integrated framework of ‘advancing publicness of health systems’, which is much needed in the present era of commercialisation.
2. “Changing power equations for inclusive health” – Experiences from 5 districts of West Bengal, India
Indian healthcare has been considered “urban-biased, top-down, and elite-oriented” following colonialism. Despite national health programmes to overcome them, institutional and political residual impacts can be seen at the policy and operational level as well as in institutional and practice-based medical cultures. The market preferred biomedical disease procedures over developmental ones. It privatised Indian healthcare, creating severe health inequalities that prevent the vulnerable from receiving care or being healthy.
The Basic Health Care Support programme (BHCSP) was developed by the West Bengal Voluntary Health Association (WBVHA), with MEMISA and the DGD Belgium, and covers 1.5 million people in five districts. This program offers some insight into how a health programme could challenge inherited health colonialism, shift the power equation in the community, and empower the population, especially the marginalised, to confront health disparities and access health services.
BHCSP challenged the healthcare system’s social and political power, connections, and vested interests that have perpetuated power imbalances and created disparities. The programme allowed marginalised people to access services and participate in health and life decisions.
The programme used two popular frameworks, “Power Cube” and “Expressions of Power,” to explain how it worked with vulnerable communities to confront and change power relations to strengthen the local health system and implement an inclusive health programme. Groups, mentoring, capacity building, connecting with authorities, inviting them to share platforms and coordinated actions, and networking empowered the vulnerable. BHCSP advocated with those in “power” and empowered the “powerless.” It established forums where health professionals, civil society organisations, and institutions address health issues affecting all, especially the excluded. These multi-level forums encouraged the powerful and powerless to collaborate on people-centred health policies and programmes, helped local communities organise and voice health demands, and held health professionals accountable while implementing national and state-level health programmes.
3. Reflections on the definition of Medicalised Female Genital Mutilation/Cutting (MFGM/C)
In 2015, the international community set a goal to end Female Genital Mutilation/Cutting (FGM/C) by 2030. However, ending the practice by the 2030 deadline, appears to be under threat from emerging trends in FGM/C, notably the increase in cases of the Medicalization of FGM/C (MFGM/C).
In this paper we unpack the current definition of MFGM/C from the WHO which shows us that the definition of MFGM/C rests primarily on who performs the practice: if the procedure is performed by a healthcare professional, the practice is deemed to be medicalized. By discussing case studies of MFGM/C in higher MFGM/C prevalence regions, we demonstrate that this definition lacks detail and clarity to discuss the nuances within (M)FGM/C. We argue that it is important to gather more information on MFM/C, specifically on what is cut as well as where and how MFGM/C is performed, in addition to by whom the practice is performed.
With this paper we aim to induce a discussion on the development of a broader definition of FGM/C including traits of medicalisation rather than approaching MFGM/C as a separate practice of FGM/C. This is to both capture the variety within the practice, whilst recognising that MFGM/C is a form of FGM/C and thus a violation of human rights. We argue that the development of a comprehensive, detailed and realistic MFGM/C framework can assist policies in tackling MFGM/C and to contribute to ending the practice.
- Speakers: Ketaki Das, Biswanath Basu, Aloysius James, Nina Van Eekert, Abhay Shukla
- Moderator: Karel Gyselinck
Friday 24th March – parallel sessions 03:30 – 04:30 pm (CET)
Race, Ethnicity and (Global) Public Health: Making the Blind Spots Visible (English only)
The subject of our work is health research and data on racially minoritised groups. In particular, the implications of this research and data on addressing racism and racial disparities in public health practice and policies in Europe. This subject aligns well with the conference theme, as the racism is rarely addressed in health research and public health practice and policy. This acts as a structural barrier that (re)produces racial health disparities and thus hinders health equity, access to quality healthcare, and the exercise of the right to health. Given that the socially constructed concept of ‘race’ and its related terminology are rarely discussed, and mainly avoided, in most Health research outside of North-America and the United Kingdom, we see this as a relevant topic for a conference focusing on taboos in Global Health.
- Speakers: Theo Cosaert, Clara Affun Adegbulu, Marie Meudec, Eskedar Mekonnen
- Moderator: Charles Ddungu
The early days of integrating mental health care into primary health care in Burundi
Patients suffering from mental disorders, including epilepsy, are often stigmatised, both by their communities and by some care-givers. Often times due to a lack of knowledge of these pathologies, these people find themselves as outcasts, excluded, and often plunged into poverty. The intervention of the MEMISA Consortium (Enabel, Louvain Coopération, Medics without Vacation, MEMISA) in Burundi aims to facilitate their care and better integration into the community.
Since 2019, this consortium has been supporting the Burundian Ministry of Health in its policy of integrating mental health care into the existing health care system, particularly in direct primary care.
To do so, an intervention targeting caregivers and community health workers was tested in the form of action research. This session will present this research and its initial results. Speakers will discuss the following three themes before opening the floor for discussion:
- A challenging mental health care pathway for patients in Burundi: Can the integration of front-line support facilitate this care?
- Barriers and facilitators to accessing care for patients with mental illness: a qualitative study in the provinces supported by the MEMISA consortium in Burundi; and
- Community health workers for closing mental health care in Burundi: acceptability and feasibility
- Speakers: Edouard Nkurunziza, Belyse Munezero, Alain Ndayikunda, Manassé Nimpagaritse
- Moderator: Aline Labat
Decolonising SRHR by programming from below. Challenges and ‘lessons learned’
Different stakeholders in Belgium’s international cooperation are invested in advancing sexual and reproductive health and rights (SRHR) in low- and middle-income countries. They are seeking to advance maternal health, access to abortion, comprehensive sexuality education, the sexual violence response, and the prevention of female genital mutilation/cutting.
The ways in which we understand and conceptualise SRHR traditionally starts from a European, high-income country point of view. However, decolonising cooperation on SRHR and making progress on the ground requires us to decentralise and question whether we are listening to the communities and the individuals we work with. Programmes risk failure if we do not understand people’s needs, local knowledge and points of view, and if we forgo people’s agency. While the joint reflection on how to decolonise SRHR has only just started, some organisations have already taken concrete practical steps that could inspire possible trajectories into decolonising SRHR. They can help us rethink how programmes can be designed and implemented in a decentralised way and/or with a culturally sensitive approach.
In this session, we want to engage in a conversation with different partners from Belgian organisations to share these concrete experiences, draw lessons learned, and see how these could be used for future international cooperation on SRHR.