By Alex Vass | BMJ Save the Children
Increasing foreign investment in the health sector is a "poisoned chalice" for many countries and risks weakening their public health systems, an international children's aid charity has said.
Save the Children's warning comes as private sector investment in health services, such as private health care and health insurance, is being encouraged under the General Agreement on Trade in Service (GATS), which is designed to liberalise international trade. Eighty three countries have now signed agreements that will allow foreign investment in at least part of their health services. But in a report published this week Save the Children said that "liberalisation of trade in health services is the wrong model to follow if countries wish to develop a strong public health system for all their people."
Trade in health, the report warned, offers meagre economic benefits to developing countries and diverts resources away from public health systems that are already over-stretched. In particular, investment in private health systems that cater to foreign customers encourage staff away from the public sector. This exacerbates shortages of trained staff and lowers the quality of staff in the public health system.
Trade in medical staff from poor to rich countries is already a problem. Developing countries supply more than half of all migrating doctors: 100 000 doctors of Indian origin are settled in the United States and United Kingdom alone. And although there are 4000 physicians in Kenya, 700 Kenyan doctors are working abroad.
Save the Children has called for a thorough evaluation of the impact of trade liberalisation. Until that time, developing countries should "avoid making further liberalisation commitments on basic services under GATS," the charity suggested. It has also called for countries to be allowed to reverse trade liberalisation agreements without incurring penalties.
Full details of the report, The Wrong Model: GATS, Trade Liberalisation and Children's Right to Health, are available from www.savethechildren.org.ukBy Alex Vass:
