The first speech was given by Elisabet Jané, member of the HLSP Consulting Group, based in London and Barcelona. Jané began her allocution by questioning the results of the activities of international cooperation organisations in health matters in developing countries.
Jané highlighted the importance of health interventions for three main reasons: they provide effective responses to specific difficulties; they represent a very important part of the spending of any country; and, finally, they are extremely valued by people, particularly in situations that are considered to be serious. Jané then asserted that external cooperation in health matters has failed in its activities for a number of reasons. On the one hand, she highlighted the determining factors for health and, on the other, the features of the cooperation itself as the main causes of this failure.
Thus, negative indicators and phenomena such as famine; access to drinking water and sanitation; the lack of freedom; unemployment; and violence have increased, resulting in worse health conditions in the populations of developing countries. These factors depend at the same time on a whole series of related factors, known as health determinants, which condition the development of the factors themselves. These include increasing inequalities, low production prices, commercial protectionism by the rich countries, and freedom of action of financial capital.
Speaking about the features specific to international cooperation in health issues, Jané noted a number of aspects. First, she highlighted the multiplicity of criteria (type of illness, intervention groups, field of intervention) of the different cooperation agencies that might be working in one area. She then highlighted the different components that make up each project: among others, infrastructure, strategies and policies. She then emphasised the fact that each agency develops its own projects independently, and does not coordinate with other agencies, providing a response to a specific situation. In this sense, Jané asserted that many projects are often determined by what the agencies offer. This fact determines that the planning and assessment mechanisms of the agencies are independent and that, in many cases and in a single area, studies of a specific illness may be duplicated. Nevertheless, Jané stressed the importance of cooperation agencies in health activities in developing countries, given that, in may cases, the resources that these contribute to health spending can reach up to 35% of the local health ministry budget, as is the case in Nicaragua.
During his intervention, English paediatrician Albert Aynsley-Green presented the child attention programme that the government in his country is developing. This programme aims to cure children and adolescents from a perspective that goes beyond physical health, given that it focuses mainly on the environment and education of these children. Aynsley-Green considered children to be the most important resource of any nation and, for this reason, he believed it essential to invest in healthcare for children. Aynsley-Green gave a historical overview of the healthcare situation of infants, noting that, with the passing of time, the condition has improved, but not enough. He added that children and adolescents currently suffer from a number of shortages, in that they are not given sufficient value and, therefore, neither is parenthood. In this sense, he illustrated this fact with the appearance of a new term to designate young women with a high level of education and acquisitive power who do not have children: the Anti-baby party. The paediatrician believed that, with regard to children, there is a certain amount of ambivalence among the adult society. Thus, either all necessary care is provided, or children are demonised.
As to government activities, Aynsley-Green considered that there is a lack of political commitment to understand and respond to the real needs of infancy and to place infancy at the heart of healthcare activities.
The Director of the TCE Health Programme, Snorre Westgaard, presented the experience of the development of the health programme in Zimbabwe. The aim of this programme is to combat AIDS, and it is applied in developed countries that suffer from the epidemic. Westgaard noted a number of essential elements in community healthcare. The most important aspects of health activities are the initial idea, the strategy, the tactics, the action plan and the methodology used to apply the measures. Westgaard thought that the creation of a mass movement concerning any form of healthcare was of great importance in order to bring about changes in behaviour, mobilise the entire public and maintain the commitment of their leaders. As to the community receiving the healthcare, the most important aspect is accessibility to the test and the treatments, which have to be free for all those requiring them.
During his intervention, the Chair of the International Health Department at the Karolinska Institute, Sweden’s Staffan Bergström, set forth on the one hand the main problems affecting the management of human resources in healthcare and, on the other hand, the strategies to manage these resources. As to the problems, Bergström highlighted the shortage of availability of professionals and increasing demand as the main challenges to be met. In this sense, the main causes of shortages in terms of professionals are the brain-drain from developing countries to developed countries and the high percentage of professionals who die of AIDS. The growing demand is a result of the decline in health among the populations of developing countries and the desire to achieve the Millennium Goals. Bergström considered that the shortages could be resolved with the training of professionals to an average level, not doctors, who would carry out simple healthcare interventions which, in developing countries, would considerably help to reduce mortality.
Joaquin Lejeune, Director of the Electromedicine Department at the Virgen de la Macarena University Hospital in Seville, discussed the problems in identifying the appropriate technology for every need. Lejeune highlighted that, often, the technology acquired, whether in the form of new equipment or second-hand equipment, is not governed by the real needs of the health centre; nor is the availability of resources to deal with the future costs of the equipment taken into account. Thus, in Latin America, 50% of the electromedical equipment does not work and, in Sub-Saharan Africa, 47% of the equipment can not be used.
In the majority of cases, these facts are a result of the shortage in terms of technical service, which would guarantee the supply of spare parts or technicians able to deal with the maintenance of the equipment. Lejeune attributed this to a lack of realism at the time of acquiring or accepting donations in the form of equipment, and proposed two solutions to manage health technology. On the one hand, he stressed the importance of good organisation when acquiring equipment, using it and improving controls. On the other hand, he emphasised appropriate training of staff to obtain the maximum yield of the benefits of the equipment. Finally, Lejeune proposed that the countries receiving donations of electromedical equipment should draw up lists of technology requirements in order to make sure that the donations are suitable.
Public and Private Healthcare Collaboration
The Vice-President of Uganda, Gilbert Bukenya, considered that the shortage of resources was the main impediment to developing countries being able to carry out extensive health policies throughout the population. Among the main resources missing, Bukenya highlighted trained professionals and technology. In order to deal with this lack of resources, he proposed two means of generating resources for developing countries. First, he spoke about national internal resources, although he considered these to be limited, given the scant ability of the governments to collect taxes or set up sustainable social security systems. Bukenya considered that the majority of resources have to come from abroad, from countries with a high income and international finance organisations such as the Global Fund, or loans from the World Bank. Like the other speakers that day, Bukenya emphasised the importance of human resources, and denounced the little training to which they have access. In spite of everything, Bukenya warned about the risk related to foreign donations, in that they can distort national sector priorities and encourage vertical coordination structures. Eric Buch, a health consultant at the New Partnership for Africa’s Development (NEPAD), presented the objectives and activities that this organisation carries out in Africa. The programme acts as a strategic framework for overall renovation in Africa, and has four main objectives: to eradicate poverty; to place African countries, individually and collectively, in sustainable growth and development conditions; to put a stop to the marginalisation of the African continent in the process of globalisation; and to accelerate the empowerment of women. Buch went on to highlight the priorities that govern the interventions carried out by NEPAD. The first is the priority of establishing the conditions of a sustainable form of development, ensuring, among other things, peace and security, good governance, regional cooperation and capacity-building. The second priority referred to the changes in policies and a greater investment in agriculture; human development through health, education, science and technology; and infrastructures, including Information Technology (IT). The third priority, according to Buch, was to optimise the internal resources of countries and to collect foreign investment. Buch concluded by highlighting the relevance of small-scale initiatives in health matters.