Ellen Verheul and Remco van de Pas

Imagine yourself as a doctor in, let’s say, a Zambian district hospital. There is only one other doctor, busy with her management tasks. There is so much to do, that you don’t know where to start. Would you treat as many patients as you can? Would you educate the few nurses, so they can improve their performance? Would you assist the district director in his search for donor funding to pay extra staff? Would you support a Zambian organization that is lobbying its government to invest more in health workers? Would you lobby to recruit more health workers? Would you speak up when you saw Dutch hospitals recruiting health workers from countries with severe shortages?

 

In 1979, medical students at the Free University of Amsterdam that asked themselves similar questions formed the Werkgroep Medische Ontwikkelingssamenwerking (Wemos). They realized that many diseases that doctors were treating were linked to poverty, which they believed was in fact a political issue. The students discussed what this insight meant: should they go abroad and try to improve health care from the inside out? Or should they stay at home and strive to change the politics behind health problems in developing countries? Similar discussions started in Groningen, Utrecht and Nijmegen. In 1982 Wemos organized its first international congress about health and politics in developing countries. More than 1 000 participants debated theoretic and practical issues. The Alma Ata declaration -still fresh at that time- provided both an important source of inspiration and practical strategies to make a real impact on people’s health.

 

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC) in Alma Ata (Kazakhstan) in 1978. It expressed the need for urgent action of all governments, all health and development workers and the world community to protect and promote the health of people worldwide. It was the first international statement that underlined the importance of primary health care and was accepted by the WHO and all countries.

 

Wemos became a professional advocacy organization, collaborating with several international networks. Their mission has always been bilateral; firstly the lobby that aims governments and agencies to do no harm and avoid policies that, often unintentionally, have a negative impact on health. Secondly, the intention to challenge donors to improve aid and stimulate independency of developing countries is important.

Still relevant

The world has changed in many ways since 1982, but many issues are still relevant. Although on average the world has become a healthier place with less infant and maternal mortality, health inequities have grown between and within countries. For example, funding for health has increased considerably since the year 2000. Figures show that most of the extra money went to HIV/AIDS-programmes. Although HIV/AIDS is a major cause of mortality in several countries, it is certainly not in all countries. Therefore, it is important to advise donors to allow governments to invest in health problems most prominent in their countries. Furthermore, there should be more attention for evidence-based interventions that strengthen health systems comprehensively.

Budget monitoring

Governments of developing countries insufficiently invest in health. In order to invest in health more adequately, the Budget Monitoring project

was started in Bangladesh, Bolivia, Kenia and Zambia in 2007. Main activities include training to improve policymaking, lobbying strategies and

empowerment of involved organizations. In Bangladesh, community budget clubs lobbied for more money for health care. In Kenia, accomplishments

of the government to improve, for instance the access to health care are closely monitored. Also information about health in households is collected

to strengthen their lobby. In Zambia, a national NGO together with WEMOS promotes the voice of the local population in the process of improving

health and more efficient investments in health care. Achievements of these programmes are very promising.

Nearly all countries have signed up to the right to the highest sustainable level of health of their citizens. For Wemos, advocating for this right for people in developing countries has become the central mission. The right to health obviously does not mean the right to be healthy, but the right to have access to health care and other health determinants. Governments have the duty to protect, respect and fulfil the right to health of their citizens, and rich countries have the duty to support developing countries in fulfilling their obligations.

 

This year, IFMSA-NL celebrates its thirtieth birthday. Wemos will do so next year. More than ever, there is a need for medical students and doctors to understand the underlying causes of every-day health problems. To recognize that health is more than a medical issue and to help motivate policy makers and politicians to take action.

 

 

About the authors

Ellen Verheul and Remco van de Pas are coordinators of Wemos programmes in Bangladesh and Zambia, respectively.

Further reading

• About the health workers crisis: Greener pastures for health workers, ten questions to Wemos.
• Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health, World Health Organisation, Geneva, 2008.