Promoting Health in Trade agreements. Brief on a research and training workshop

Transcription

1 Promoting Health in Trade agreements Brief on a research and training workshop With EQUINETA Tanzania June Dar es Salaam, Tanzania Report produced by CHP/ SEATINI /TARSC With support from: SIDA and IDRC (Canada) EQUINET Training Workshop Report

2 Promoting health in Trade Agreements Dar es Salaam Tanzania June 1. BACKGROUND The workshop on Protecting health in Trade agreements held in Tanzania in June 2005 was held within an EQUINET programme with Centre for Health Policy South Africa and SEATINI Zimbabwe that aims to build capacities in state, legislative and civil society institutions to know, understand, analyse and promote public sector equity oriented health systems within trade and investment policies and agreements. The training courses aim to enable participants to be able to carry out assessments nationally of the key trade and investment agreements that impact on health and identify options for promoting public sector equity oriented health systems within current trade and investment policies and agreements. The workshop thus aimed to cover An introduction to trade and health that outlines major issues affecting the region An outline of health systems, their major components of health systems and the challenges posed by commercialisation. An introduction to outline of the global major trade systems and the World Trade Organisation and how it agreements that impacts on health, and the options for protecting and promoting health within these trade agreements An outline of two major trade agreements - TRIPS and GATS - that impact on health, and the options for protecting and promoting health within these trade agreements A guideline for audit of the impact of trade agreements on health systems An introduction to analyzing and understanding the health systems context in which policy is developed, designed and implemented. After the workshop, EQUINET through SEATINI and CHP is supporting country level follow up activities to identify and deepen understanding and evidence on priority trade and health issues identified at the workshop. National level activities will be reported back at a regional meeting to be held later in A training manual developed for the course provides the content of the work covered and is not repeated here. This brief highlights the major issues raised and the area proposed for follow up study. The del;egates to the meeting are shown in Appendix 1 and the programme in Appendix 2. 1

3 2. PROCEEDINGS The first workshop on trade sensitive health policy run by Centre for Health Policy, Southern and East African Trade Information and Negotiations Initiative (SEATINI) and EQUINET with support from SIDA and IDRC was held at the Courtyard Hotel in Dar-es-Salaam from June The workshop was hosted by EQUINETA in Tanzania. The meeting was opened by Professor Gabriel Mwaluko (EQUINETA). Dr Rene Loewenson TARSC / EQUINET introduced the relevance of trade to health systems. The workshop then followed the plan set out in the training materials on health systems and regulation, on trade agreements and on the linkages to health systems issues. The meeting presentations and discussions continually flagged the links to developments in international trade debates to the challenges facing equity and health systems on sub-saharan Africa. Participants were encouraged to participate in discussion through group-work exercises focusing on the application of health systems frameworks to the Tanzanian health system. On day 2 Riaz Tayob provided an overview of developments in international trade agreements followed by an overview of GATS and TRIPS and its relevance and challenges posed to the attainment of equitable health systems. In the afternoon participants used the opportunity to in groups to review the audit framework presented in the training materials that was used to shape the county-level study. On day 3 Haroon Wadee provided an introduction to policy analysis. This fed into discussions around the audit and proposed strategies to mobilise and win support in promoting equitable health systems under increased commercialisation under the WTO trade agreements. 3. FOLLOW UP WORK IDENTIFIED The group discussions highlighted major areas for possible follow up of the training work and audit. These included The segmentation within the health system arising from various forms of fee charges and exemption systems and the implications for commercialization of health systems Protection of Rights of Access to Essential Medicines under Trade and Market Policies in Tanzania Trade and market pressures for and responses to Health worker migration 2

4 These issues were further reviewed and the second, Protection of Rights of Access to Essential Medicines under Trade and Market Policies in Tanzania identified as the focus area for follow up research by the Tanzania country team with mentoring input from CHP and SEATINI. In addition EQUINET will convene a Regional Workshop for interaction between Southern African countries. A country-level team was identified to take forward the country-audit. Dr Robert Mhamba of the Institute for Development Studies (University of Dar-es-Salaam) agreed to take the lead with support from a steering-committee made up of a range of participants. The details of the audit process were to be finalised subsequently between EQUINET and IDS (for Robert Mhamba). The terms of reference for this work were finalized the following day. The study terms of reference were agreed as to examine and analyze how, through GATS, national policy options that supports equity in health are threatened. More specifically the study will examine how we can protect rights of access to essential medicines under trade and market policies. The study among others, will seek to answer the following questions: 1: How will the health system look if the current market orientated reforms are implemented fully under the WTO and international agreements and in terms of the current orientation of reforms? This areas of work will examine the national health policy objectives and reforms on access to medicines? how reforms and trade agreements are affecting access to medicines? What this implies for national policy objectives? 2 Who are the actors/institutions involved in access to medicines and their policy positions on national policies, reforms and trade pressures on access to medicines. 3: Where policy on access to medicines is being made, by whom and what this means for options to promote national policy objectives? The study will focus on identifying measures to protect national policy objectives on access to medicines in trade agreements and reforms. The study will review and consolidate information from secondary data sources and from key informant and focus group discussions with the relevant stakeholders in the health sector, and the civil society. The team involves the Institute of Development Studies, Muhimbili College of Health Sciences and a steering group involving institutions represented at the meeting and government representatives. 4. EVALUATION AND CLOSING 3

5 The delegate evaluation of the meeting was on the whole positive with suggestions for improvement in terms of organization of assignments, local content of materials, local presenters and inputs from key institutions in Tanzania on trade and health issues. As the meeting was a pilot to field test the training these comments were noted for integration into the next round of country training. Participants found the material and the input sessions both useful and relevant. Concerns were also raised that a venue outside the city would have enabled more consistent attendance for the duration of the workshop. It is noted that the resources for the meeting did not enable a residential programme. Delegates also noted the need for stronger presence of government delegates at the meeting from both health and trade officials. This fed into a reflective process which culminated in the changed format for the next workshop. It was agreed that future workshops would integrate presentations by actors from ministries of trade and health and civil society. It was also proposed that a more active process of dialogue be held with parliamentarians and senior policymakers before such workshops are held. These lessons were incorporated into the subsequent country workshop in the programme. 4

6 APPENDIX 1: Delegates List Name Gabriel Mwaluko Dr Phare Mujinja Mangi Ezekiel Joseph Njau Veronic Oulette Isabella Max Peter Kamuzora Robert Mhamba Mwajumah Masaiganah Justin Nyamga Rene Loewenson Elizabeth Senwaiko Tata Mustafa Mary G Materu Andrew Mushi Jennifer Rockwitz Jiang Alipo Audax Rukonge Akida Khea Riaz Tayob Haroon Wadee Institution TANESA Muhimbili College of Health Science Muhimbili College of Health Sciences Ifakara HRDC University of British Columbia, Canada SWAT IDS University of Dar es Salaam IDS Unviersity of Dar es Salaam TARSC Tanzania; PHM East Africa Christian Council of Tanzania TARSC/EQUINET Kimara Peer Educators Kimara Peer Educators COUNSENUTH TANGO TANGO UNA-TANZANIA ACTIONAID (Tanzania) Tanzanian Food and Drug Administration SEATINI Centre for Health Policy 5

7 APPENDIX 2: Programme June 28 June 29 June Opening GM, EQUINETA Participant introductions and introduction to module objectives and timetable Plenary review of group work/clarification of day 1 (15 minutes) (HW/RT) Tea break Overview of health equity and EQUINET - (RL) Introduction to trade and health: Module 1: Overview of trade and equity and health systems (RL) Introduction to health systems Module 2: What is a health system (HW) Overview of trade systems and agreements Module 4: Intro to WTO and trade (RT) Tea break GATS and TRIPS Module 5: GATS and TRIPS (RT) Discussion Group work on trade agreements As in Module Plenary review of group work/clarification of day 2 (15 minutes) (HW/RT) Analysing policy: Module 7 (HW) Tea break Group work and plenary on policy analysis: Exercise and feedback on policy analysis Group work: Proposals for follow up country audit Outline of objectives, areas of investigation, methods and proposed indicators for country audit and follow up on trade and health Health financing: Module 3: Introduction to health financing Exercise on health financing (HW/RT) Tea Plenary discussion of group work Comparing health financing Introduction to regulation (Input Session) Module 3: regulation of health systems (HW) Homework Exercise on regulation LUNCH Plenary report and discussion of group work (HW/RT) Tea Auditing trade impacts on health (Input Session??) Module Group work on trade impacts and health Priority areas for follow up, areas for audit Homework apply audit framework to priority area Feedback and discussion of group work Tea Plenary discussion of logistic, communication and resource issues (HW/RT/ RL) : Evaluation Of course and course materials Closing 6

8 Equity in health implies addressing differences in health status that are unnecessary, avoidable and unfair. In southern Africa, these typically relate to disparities across racial groups, rural/urban status, socio-economic status, gender, age and geographical region. EQUINET is primarily concerned with equity motivated interventions that seek to allocate resources preferentially to those with the worst health status (vertical equity). EQUINET seeks to understand and influence the redistribution of social and economic resources for equity oriented interventions, EQUINET also seeks to understand and inform the power and ability people (and social groups) have to make choices over health inputs and their capacity to use these choices towards health. EQUINET implements work in a number of areas identified as central to health equity in the region: Public health impacts of macroeconomic and trade policies Poverty, deprivation and health equity and household resources for health Health rights as a driving force for health equity Health financing and integration of deprivation into health resource allocation Public-private mix and subsidies in health systems Distribution and migration of health personnel Equity oriented health systems responses to HIV/AIDS and treatment access Community Voice and agency in health systems Monitoring health equity and supporting evidence led policy EQUINET is governed by a steering committee involving institutions and individuals co-ordinating theme, country or process work in EQUINET: Rene Loewenson, Godfrey Musuka TARSC Zimbabwe; Firoze Manji Fahamu UK/SA; Mwajumah Masaiganah Peoples Health Movement, Tanzania; Itai Rusike CWGH, Zimbabwe; Godfrey Woelk University of Zimbabwe, TJ Ngulube CHESSORE Zambia; Lucy Gilson, Centre for Health Policy South Africa; Di McIntyre University of Cape Town HEU South Africa; Gertrudes Machatini, Mozambique; Gabriel Mwaluko Tanzania Adamson Muula, MHEN Malawi; Patrick Bond Municipal Services Project; A Ntuli Health Systems Trust, South Africa; Leslie London UCT School of Family and Public Health South Africa; Yash Tandon/ Riaz Tayob SEATINI, Zimbabwe For further information on EQUINET please contact the secretariat: Training and Research Support Centre (TARSC) 47 Van Praagh Ave, Milton Park, Harare, Zimbabwe Tel / Fax admin@equinetafrica.org Website: 7