RESULTS Urges World Leaders to Adopt Innovative New Funding Mechanism for Health

RESULTS UK has joined with Stamp Out Poverty, the International HIV/AIDS Alliance and more than 100 other health and development organisations in urging world leaders to institute a Currency Transaction Levy (CTL) to meet the United Nations Millennium Development Goals for Health.

World leaders speak out for free healthcare at the UN

This week has seen really exciting developments in the campaign to remove user fees for healthcare in the developing world. At a summit in New York world leaders including Gordon Brown and Margaret Chan, Director-General of the World Health Organisation, pledged their support for removing user fees and called on developing country governments to undertake this policy change. Gordon Brown also announced a $5.3bn package to help developing countries deliver on the pledges, of which the UK will provide at least £250million. The meeting also saw heads of State from Ghana, Malawi, Nepal, Tanzania, Ethiopia and Sierra Leone commit to extending free health care.

Robert Zoellick, the President of the World Bank, co-hosted the event, and although he stopped well short of announcing a new World Bank position opposing user fees (his speech has been described as ‘less than enthusiastic support’) it is clear that the pressure is on for the Bank to change its stance. This really is a historic opportunity for change, so our September action calling for the Bank to remove user fees for basic healthcare is extremely timely. The UK government must use the momentum of this historic moment to push the Bank to acknowledge the harm that has been caused by user fees and pledge to proactively work to remove them, following the example of so many nations and international institutions.

You can view all the speeches at the event on the UN website (scroll down to the 23rd September, the event title is: ‘Special Event: Innovative International Financing for Health event, hosted by the Prime Minister of the United Kingdom’), and a press release on the event on the website of the Taskforce on Innovative International Financing for Health Systems.

Aaron Oxley starts work as RESULTS Executive Director

This week we have been joined by our new Executive Director, Aaron Oxley. Many members of the RESULTS network already know Aaron due to his long history of involvement with RESULTS, first as a member of the London group and more recently as a Trustee. We are very excited to have Aaron on board, and are looking forward to big developments at RESULTS over the coming years.

Aaron told us: “It is my pleasure to have taken up the role of Executive Director this week. The new visibility this has given me to all the successes and hard work going on around the network is truly humbling, so I want to start out by saying a big thank you to all our activists. My own commitment is to come and meet with every group as soon as possible, so please get in touch if you’re having a special event (or want to run one!) where I could attend, meet everyone, and help out. I want to hear firsthand how we in the office can better support and encourage you in your activism, and to build a shared vision for RESULTS’ next steps. It is an exciting time, and I am looking forward to working alongside you to change the world.”

New RESULTS Group Launching in Edinburgh

Calling all poverty-fighters in Edinburgh!

RESULTS is hosting an introductory event on Thursday 1st October for all those interested in getting involved in a new RESULTS group in Edinburgh or who are simply curious to know more about who we are and what we do.

See the flyer below for more information and please help us get the word out to people in the Edinburgh area.

Birmingham MP Calls for Removal of User Fees

Following a meeting with a member of the Birmingham RESULTS group, Gisela Stuart, MP for Bartley Green, Edgbaston, Harborne and Quinton has written to Douglas Alexander urging him and the UK government to assisting countries to remove these fees for the poorest of patients.

In a recent post on her website, Gisela Stuart said “In many developing countries pregnant women and babies die needlessly because they can not afford what are called ‘user fees’ for getting the most basic health care. When the World Bank meets in October the UK should make it its core position to get the World Bank to stop insisting on user fees.”

She says “I have written to Douglas Alexander and reminded him of the good results achieved in countries like Ghana and Burundi where the removal of these fees has resulted in many lives being saved”.

“The most basic health care should not be denied to the poorest; we all have a responsibility to improve their lives.”

Congratulations to Gisela Stuart and the Birmingham RESULTS group for championing this issue at this crucial moment.

Your Money or Your Life: over 60 organisations call on world leaders to act at the UNGA and make health care free in poor countries

RESULTS UK joined over 60 organisations today in launching a report calling on world leaders to act ahead of the high level event on health on 23rd September at the UN General Assembly to make health care free and save lives.

User fees for health care are a life or death issue for millions of people in poor countries. Too poor to pay, women and children are paying with their lives. For those who do pay, over 100 million are pushed into poverty each year.

On 23rd September world leaders will meet at the United Nations General Assembly in New York for a high-level event on health. On the table is a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all.

The seven countries are Burundi, Ghana, Liberia, Malawi, Mozambique, Nepal and Sierra Leone. The need to make health care free and expand access in these and other countries is beyond question, but to do so successfully requires high-level political commitment and sustained additional financial and technical support.

RESULTS UK’s Deputy Director, Louise Holly, says “For more than two decades, RESULTS has been advocating for the donor community to do more to improve the health of the world’s poorest people. Poor health is both a cause and effect of poverty. Poor housing and sanitation, malnutrition and lack of access to medicine lead to poor health. Conversely, someone who is ill is unable to attend school, provide for their family and play an active role in their community.”

“User fees have prevented the poor – particularly women, girls and the disabled – from accessing crucial health services. Those who do pay medical expenses are often pushed further into a spiral of poverty and debt.”

“It is now widely accepted that removing user fees leads to better utilisation of health services by the poor. After decades of delay, the World Bank announced in 2004 that they now have ‘no blanket policy on user fees’ but are not providing sufficient support to countries who want to provide free healthcare.”

Sixty-two organisations are calling on leaders in the North and South to back this proposal on 23rd September and announce the additional and long-term support they will provide over the coming years to make it a success.

Earlier this month, RESULTS UK members got together to learn about the impact of user fees on the poor. They will be meeting their MPs and will be asking them to speak to the Secretary of State for International Development, Douglas Alexander, and request that he push the World Bank to adopt a clear policy against user fees during the Annual Meetings of the World Bank in October.

A copy of the report ‘Your Money or Your Life’ is available at:

www.oxfam.org.uk/resources/policy/health/your-money-or-your-life.html

‘Being Courageous’ Brings About Results

After a very brief breakfast with the British High Commissioner, we spent our first day in Delhi with an NGO called Saahasee (which means ‘being courageous’ in Hindi). Saahasee has been working for the past two decades to restore the dignity of the urban poor who live in slums of Delhi and other cities.

The programme that we visited was in an area on the outskirts of Delhi called Mangol Puri. Thousands of poor families were relocated here after being moved out of the city by the government. There are now approximately 250,000 people living in a very congested area 2km wide.

Urban slums are characterised by ill health, poor housing, a lack of basic services such as sanitation and low employment. Saahasee has developed a grassroots-led mechanism to address some of these challenges and is working with communities to help people, particularly women, become self-reliant and improve their living standards. They aim to bring poor families out of a cycle of poverty and dependence and into the realm of social and economic freedom.

Saahasee’s model is to develop and support women’s self-help groups. The women identify the challenges that they want to address and are given the training that they need to address them rather than bringing in external people.

Working together, the women have proved to be a formidable force, capable of bringing about significant changes. They have challenged local government officials to provide them with paved roads, electricity supplies and water and sewage connections. Although living standards in Mangol Puri are still relatively poor, we were told that they have dramatically improved and will continue to improve thanks to the tireless advocacy of the women.

Across Delhi, there are more than 25,000 active women participating in these self-help groups. Microfinance and TB control are just two of the many areas that the women are working on. Together, the groups have been able to pool millions of rupees in savings which are then loaned out to individual women. The most common reasons for taking loans are to repay more expensive loans, to fund marriages, to start up small enterprises and to manage their households.

TB is a major challenge for these communities so many women have been trained up to be DOTS providers. We had the privilege to meet some TB patients who shared their stories with us:

Rinky is a 13 year old girl who developed TB at the beginning of the year and started to take her treatment under DOTS supervision. When her grandmother died, the whole family had to return to the grandmother’s village and Rinky stopped taking her treatment for two months. When we met her she had just started taking her treatment again and was being advised that she must complete her course of treatment no matter what happens. She explained that the treatment made her feel sick and dizzy but she understood that she needed to take the full six-month course of drugs. Her sister had previously had TB so she knew she would get better if she followed her sister’s example.

‘Being courageous’ is a trait that all of the women and girls that we met shared. It is also a trait that RESULTS’ members share as speaking out for the rights of the poor can be challenging and intimidating, especially when it requires confronting powerful decision-makers. As these communities have shown, having the courage to stand up for what you believe in – especially when many people come together – can have a major, positive impact.

TB Timebomb

Our visit to Mumbai has focused on health challenges that face the densely-populated urban population. More than 18 million people dwell in the city and overcrowding is a major cause of transmission of airborne diseases such as TB.

To learn more about TB in India we visited the Hinduja Hospital, a private hospital that also provides free services to those who cannot afford to pay fees. Although TB treatment is provided free by the government, 70% of people prefer private healthcare even if they don’t earn enough to pay for it.

Dr Zarir F. Udwadia, an internationally renowed TB specialist, explained that TB is an epidemic of neglect and injustice. Although we have the tools to prevent and treat it, too many patients are receiving inadequate services. Poor practice is creating a dangerous pool of drug-resistant TB and resulting in many unecessary deaths. We heard the tragic story of a woman who had to undergo seven years of treatment and have one of her lungs removed before she was put on the correct treatment for her multi-drug resistant TB (MDR-TB)

At least 5% of TB cases in India are MDR-TB but Dr Udwadia believed that this was an underestimate. There is currently no data for the levels of extensively drug-resistant TB (XDR-TB) because there are insufficient diagnostic services. Patients who cannot afford private health care are denied access to expensive second-line drugs and left to their fate. A survey carried out by Dr Udwadia’s team found that only 3% of private physicians knew how to give the correct treatment for an MDR-TB patient.

With more than three-quarters of Indians infected with latent TB, India is clearly sitting on a TB timebomb. We heard that the government cannot afford to treat all of its cases of drug-resistant TB but it seems that they cannot afford not to act. Urgent efforts are needed to ensure that all patients with standard TB successfully complete their treatment which will reduce the number of new MDR cases. The government, possibly with the support of donors such as the UK, must also ensure that all patients with drug-resistant TB receive the necessary care and treatment that they need to both save their lives and reduce further transmission.

“We don’t need politicians, we’re the ones who do all of the work!”

For every 1,000 children born in India today, 90 will die before their fifth birthday as a result of preventable diseases like diarrhoea. Although there have been several national initiatives to increase sanitation coverage in India, more than 122 million households in the country are without toilets and over 170 million people in India don’t have access to safe water.

Today we saw first-hand how the UK Department for International Development is supporting civil society groups in India to increase access to sanitation services and also to empower poor communities. We visited the Dharavi slum (made famous by the film Slumdog Millionaire) and saw a DFID-supported programme run by the NGO SPARC which has built and maintains communal toilet facilities for the local population. Around 70% of people in the area make use of the facilities because they do not have their own toilets at home.

Users can either ‘pay as you go’ or families can buy a monthly pass for 20 Rupees (around 40 pence).  Signs like those above inform pass holders which facilities they can use. Although this solution is less ideal that every household having access to its own private facilities, this initiative has vastly improved health outcomes. Before the toilets were built, local people would goes days without going to the toilet because of the shame of having to do so in public. We were told that this caused serious illnesses which prevented people from going to school or work. The toilets have also helped families economically because they are spending less on doctors.

Later in the afternoon, we visited members of a ‘Slum-dwellers Association’ who are working together to improve living standards. A group of women have been employed to contruct and maintain communal latrines. With this income, the women told us they were able to maintain their households and send their children to school. Some of them also invested money in a microcredit scheme to provide greater security for the future.

When asked what they thought of politicians, one woman answered “We don’t need politicians, we’re the ones who do all of the work!”. Another agreed strongly with this view – she had lived for many years on the streets and when she went to local officials for help she was turned away because she had no rights. However, when it came to the elections, she said, the politicans were keen to ensure she used her right to vote!

Tragic TB Death of Slumdog Father Marks Beginning of RESULTS UK Delegation to India

By Louise Holly

Following an early start and a ten hour flight, our delegation has arrived in Mumbai for what we hope will be a good night’s sleep before we begin our programme of activities on Monday morning.

Soon after boarding the plane we were handed a health screening card to complete. The Indian Ministry of Health and Family Welfare require all visitors from countries that have reported cases of Swine Flu to declare any flu-like symptoms they have had in the last 10 days and contact passengers have had with other carriers of the virus.

India is home to more than 1.2 billion people, around 16% of the world’s population. Avoiding major outbreaks of a highly infectious disease like Swine Flu in such a densely populated country is rightly a high priority for the Indian Government.

Our fact-finding trip to India will focus on other health challenges, however. Whilst Swine Flu thankfully remains under control at present, other diseases are already taking a devastating toll, particularly on India’s poorest communities.

Tuberculosis (TB) kills more adults in India than any other infectious disease. Around 1,000 people die every day – almost one death every ninety seconds – making India the highest TB burden country in the world. TB remains a major barrier to social and economic development. An estimated 100 million workdays are lost due to illness and the country incurs a huge cost due to TB—nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs.

Yesterday, the media reported controversy surrounding the death of a Slumdog Millionaire actor’s father from TB. Azhar Ismail had allegedly been turned away from a Mumbai hospital because he posed a risk to other patients. If the father of one of the most high profile children in India can die from a preventable and treatable disease then what hope is there for the millions more infected with TB?

During our four-day visit to India, we will be learning about the progress that India has made in scaling up its National TB Programme and how it is dealing with the additional burden caused by TB-HIV co-infection and multi-drug resistant TB. We will also be looking at interrelated health challenges that affect the poor such as those caused by lack of access to adequate sanitation and clean water.

As we visit programmes and talk to people on the ground involved in the fight against diseases of poverty we’ll report back our findings and reflections. Although our trip has began with a tragic reminder of TB’s impact in India, we hope there will also be positive stories to share.