Margaret Chan: "the market does not solve social problems"

There has been a flurry of activity here in Maputo, as we prepared for the large annual meeting between the Ministry of Health and its development partners to review the performance of the health sector in 2008. I took my camera along to the big meeting on the 3rd April, so that you can get a sense of the level of attention this meeting draws. However, for now I just wanted to touch on one issue - how we protect health and social welfare in a time of economic crisis.

One of the issues raised in the meeting with the Ministry of Health was the need for collective efforts to protect investments in health. There is considerable evidence that poverty pushes people in to poverty, and a real danger that in times of economic downturn - levels of poverty will increase, and the numbers of people excluded from health care rise, because they either can't afford the cost of care, or can't afford the associated costs of getting to hospital and of lost employment.

I would like to direct everyone who is interested in this subject to a very powerful speech by Margaret Chan, the Director General of the World Health Organisation. It is a heart felt statement, with a clear message that "the market does not solve social problems".

Margaret Chan, World Health Organization

"Collectively, we have failed to give the systems that govern international relations a moral dimension. The values and concerns of society rarely shape the way these international systems operate. If businesses, like the pharmaceutical industry, are driven by the need to make a profit, how can we expect them to invest in R&D for diseases of the poor, who have no purchasing power? In far too many cases, economic growth has been pursued, with single-minded purpose, as the be-all, end-all, cure-for-all. Economic growth, as many believed, would cure poverty and improve health. This did not happen."

Whilst the resources generated by economic growth and the employment created lifts millions out of poverty, if we want to address inequality, and ensure that the poorest do not fall further behind, then we need social policies which target the poor and vulnerable. In our meetings with the Ministry of Health in Mozambique, which is committed to trying to reduce inequality, this is an important area of discussion. We want to try to ensure that investment in health is protected in the economic crisis, and people who are sick can access essential services, irrespective of their ability to pay.


  1. Albert @ Open Budget Blog

    Thanks for the thought provoking post. Given the poor ability of many African countries to deliver on health and other social services - how useful is the market - government distinction? Can't National Health Insurance schemes and the like help engage the market in the delivery of health to the poor? Isn't delivery more important than one's ideological position on 'the market'?

    Open Budget Blog

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  2. Neil Squires

    Thanks Albert. DFID's position is to support the governments policies, which at present in Mozambique include free services for mothers and children. We have done some work to look at the cost of extending free primary care services to all people and that may help. At present, the number of salaried workers in Mozambique is so low that National Insurance contributions would not add a huge amount to the health budget - but the primary objective is still to finance the health services from government revenue's as well as donor financing. Private health insurance schemes have not really been considered, as outside of the major cities there is little formal private sector health care to speak of - and to spend time developing an insurance scheme would possibly distract attention from the more immedate needs of identifying and addressing the barriers for poor people to access services. These barriers can include things like the cost of getting to a health facility. There are still some people in Mozambique who have to walk more than 50km to reach a health centre. Our approach is to help the government make decisions based on evidence of what work - and then to support government to implement its own policies. We try not to push any ideological position, but we do have a stong belief that cost should not be a barrier to accessing health care - so the principles which govern the UK's national health services, that it should be free at the point of use, shape our thinking. Best wishes

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  3. Albert

    Couldn't agree with you more with regard to Mozambique. This position just gets a little problematic when one exports it to other contexts without being sensitive to changes in circumstances. You would have seen the controversy around the recent Oxfam report, for example:

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  4. Tom Fawthrop

    Dear Neil,

    The major source of free medical care in Africa, would appear to come from the myraid Cuban medical teams that provide extensive health-care in roughly 25 countries spread across all parts of Africa with a current total of some 2000++ medical staff.

    Has DFId ever considered that in the health sector that should work more closely with Cuba's efforts?

    Imagine how much more the Cubans could achieve if the poor country but rich in human resources could team up with the countries with the cash to enhance health rights across the continent.Cuba has made several offers in the past but not much response from western agencies.


    Tom Fawthrop
    Eureka Films
    director of TV documentary on the
    Cuban health system

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