Pro-poor health system up the creek

View(s): 271

The week was to focus on a No-Confidence Motion (NCM) in Parliament against the Health Minister, but it got side-tracked by a foreign television channel that deftly timed the release of a ‘documentary’ on the 2019 Easter Sunday bombings. The old wine packaged in a new bottle took a section of Parliament on both sides of the House by storm. Blinded by the fog of parochial politics, some naively fell for the trap to call for an international investigation and thereby help open the door (that successive Governments have kept shut) for the UN Human Rights Commission (UNHRC) to pursue demanding an international investigation on allegations of human rights violations in Sri Lanka, especially against its Armed Forces. Currently, the ‘Accountability Project’ of the UNHRC, its Prosecutorial office investigating human rights in Sri Lanka is forced to work from Geneva.

This is different from seeking foreign assistance, which has already been done when the US/FBI was here soon after the bombings. Clearly, there has been a deficiency, even a possible coverup in the local investigations, but to invite an “international investigation” only plays into the hands of a wider agenda fanned by a section of the Diaspora targeting Sri Lanka.

The outcome of the NCM on the Health Minister, on the other hand, was a foregone conclusion. It was defeated. The perennial question therefore is how much this Parliament continues to reflect the views of its own constituency.

Sri Lanka’s State-run public health system, once lauded worldwide as ‘pro-poor’ and the best in South Asia, today sends away the poor from Government hospitals clutching lists of medication that the State cannot give them anymore. The problem extends beyond funding to lethargy, apathy and corruption.

The health budget today is far bigger than before the economic crisis, supplemented by the Indian credit line, as well as funding from the World Bank and the Asian Development Bank. The National Audit Office in a special report found the dollar crisis was just one reason for the shortage of medical supplies. Others include outdated computer systems, lack of coordination and disregard for procurement schedules.

“Emergencies” that allow the Health Ministry to override procurement procedures are ‘manufactured’ to place orders at inflated costs. Suppliers and agents are greasing the palms of officialdom big-time, or using their political influence to get waiver after waiver from the regulator to dump untested medicines on the unsuspecting poor.

The Health Minister’s visit to India at the invitation of a supplier was telling. Containers of drugs given as gifts from well-meaning donors abroad rot in the port. Unwanted medicines are imported purely for the kickbacks on offer. A software system linking all hospitals to track medical needs is not working properly.

Where does the buck stop then? Is it not with the Health Minister—or is it with the President? A reshuffle by the President appears to be the least he can do to restore a semblance of confidence, not among the Minister’s parliamentary colleagues who voted against the NCM, but of the people, especially the young doctors who cringe at the way the health sector is handled and apply for jobs abroad in sheer disdain.

Global summits and the world’s poor

Next week’s summit of the Group of 77 and China (G77) in Cuba is a fresh campaign by the ‘Global South’, the economically poor nations, to band together to bridge the North-South divide separating the ‘haves’ from the ‘have nots’ of this world. It comes on the back of the G20 summit in India of the ‘haves’ and the emerging ‘haves’.

G77 now has 134 member states and China. The theme of the summit is; ‘Current Developments on Challenges – the role of Science, Technology and Innovation’. The thrust is to play ‘catch up’ with the inexorable currents of the digital explosion that is sweeping the world.

It has identified what they call the “unjust international economic order” and the global financial architecture which is heavily weighted in favour of the North against the South.

Calling for unity and activism by the Group, the issues that have been listed out for joint action have a direct bearing on Sri Lanka’s ongoing complexities. These range from the growing burden of external debt; fragility of health and education systems that have got disrupted; geopolitical tensions; food and energy security; the digital gap; adverse effects of climate change and the like, some of them the direct outcome of the post-Covid world.

The private sector in the G77 member states will be called upon to join the state sector in this joint effort. Similar to its one-time patron, Russia, and its fellow traveller China, Cuba too has relaxed its state monopoly and is ready to acquire foreign investment and technology. It has recognised global Intellectual Property rights with calls for its liberalisation (as was seen when giant Western pharmaceutical companies fought over patents while people were dying of the pandemic). The former gung-ho anti-imperialism policy is tempered with calls to work within the UN system in redressing these imbalances.

Sri Lanka has for long given only step-motherly treatment for this area. Technology is part of the Ministry of Education and was allocated Rs. 11.5 billion out of the Education vote of Rs. 232 billion. These are allocations, not the actuals spent. It betrays the priority given to science and technology.

The G77 has identified what the future need be. The Government will have to see how to be inclusive of this global trend both domestically, and externally, by providing its support to collective action as it once did, as a frontline member of the Non Aligned Movement.

The theme of the United Nations General Assembly (UNGA) is also on similar lines; i.e. to see how the poor countries can be financed to face the challenges of today from debt to climate change and to meet the UN’s Sustainable Development Goals. All these summits are steps that will lead up to a ‘Summit of the Future’ in New York next April. Sri Lanka that was a basket case only last year, has all the makings of being a success story by next year if all goes well.