Globalization, Health Sector Reform, Gender and ... - Ford Foundation

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Policy-level initiatives (such as the Women’s Health Project, SouthAfrica) address the lack of transparency of sector programs—fewcommunity groups have access to information. Indeed, many primaryhealth workers themselves know little about health sectorreforms and new health sector strategies. The “people’s right toinformation” movement in India is an example of a direct approachto improving transparency of local government.Health Sector Reforms in the SWAPHealth sector reforms are normally a central part of a health sectorprogram. Their aim is to improve accountability, efficiencyand transparency in the sector. While there are differences amongdonors in the relative importance and precise specification of particularreforms, they are usually incorporated in some way intohealth sector programs. The components of health sector reformsare summarized below.Health Sector Reforms consist of:• Implementation of new public management systems;• Reorganization of the health ministry linked to overall reform of the public sector’s budgeting,accounting and planning systems;• Decentralization of sector activities, including local ownership and accountability for the planningand/or management of service delivery; decentralization of financial management;• Improving stakeholder participation and accountability to primary stakeholders;• Introducing alternative financing mechanisms, including contracting out of services to the privateor NGO sector, user fees, social and private insurance schemes, and privatization of drug marketing.Core Services in Health Sector Programs are:• Family planning and reproductive health (includes nutrition and prevention and treatment of sexuallytransmitted diseases);• Child health;• Communicable disease control; and• Some curative service provision.23
Reproductive Health and Family Planning Services normally include:• Family planning, with a central focus on supplying contraceptives to women;• Insufficient attention to men, issues of choice and dignity of women;• Limited prenatal care; and• Emergency and essential obstetric care.Compare this with the essential elements of reproductive healthagreed at the International Conference on Population and Development(Cairo,1994):Essential Elements of Reproductive Health as Defined by the ICPDProgramme of Action:State of complete physical, mental, social well-being consisting of:• Satisfying, safe sexual life;• Access to appropriate, safe, effective, affordable, acceptable methods of family planning based oninformed choice and dignity;• Services for safe pregnancy and childbirth;• Prevention, diagnosis and treatment of RTIs/STDs/HIV;• Elimination of harmful practices (FGM, domestic violence, sexual trafficking); and• Emphasis on: poverty alleviation, girls’ education, women’s empowerment and reproductive rightsas core, and the role of civil society and communities.Source: Adapted from Joan Kaufman, Overhead, Regional Ford Foundation Meeting on the Gender and ReproductiveHealth Impacts of Health Sector Reform, Yunnan Province, China, March 12-17, 2000.Sector-Specific Government MachineryDrives Sector-Wide ProgramsFrom the perspective of women’s reproductive health and rights,sector-wide programs are constrained by the way in which thesector is defined operationally. Because the Ministry of Healthdrives the process and financial flows and because reforms areministry-specific, the importance of water, sanitation, transport andeducation for women’s reproductive health and rights cannot easilybe institutionalized in a SWAP. However, there are some exceptions.The Pakistan Social Action Plan, a multi-donor social sectorprogram, is an example of a cross-sectoral program which incorporatesprimary health care, primary education and sanitation intoa sector program support initiative (Elson and Evers, 1998).24
Page 1 and 2: Globalization CommitteeReproductive
Page 3 and 4: Globalization CommitteeReproductive
Page 5 and 6: ContentForeword 5Understanding the
Page 7 and 8: ForewordMacro-economic and social r
Page 9 and 10: Experts’ Perspectives on Globaliz
Page 11 and 12: 1. The InternationalContext of Heal
Page 13: undermine the reforms themselves. C
Page 18 and 19: certain conditions: where economic
Page 20 and 21: “women’s ability to negotiate d
Page 22 and 23: Structural Adjustment Programs. Sec
Page 26 and 27: 2.c. The Private Sector in SWAPsTar
Page 28 and 29: 3. The Experienceof ReproductiveHea
Page 30 and 31: User feesThere is sketchy evidence
Page 32 and 33: Judging from policy guidelines and
Page 34 and 35: lobbied local government for a Wome
Page 36 and 37: ReferencesAfshar, H. and C. Dennis,
Page 38 and 39: Part IIThe Reproductive Health Agen
Page 40 and 41: comparing the different countries w
Page 42 and 43: 2. Can HSR ProvideAccessible,Equita
Page 44 and 45: Some of the greatest obstacles to s
Page 46 and 47: ole of the public sector in health
Page 48 and 49: Decentralization and financing syst
Page 50 and 51: Part IIIAction Points for the Ford
Page 52 and 53: Developing Alternative Approaches
Page 54 and 55: Globalization, Health Sector Reform
Page 56 and 57: Absence of Cross-Country Data,Compa
Page 58 and 59: Evers and Juárez do address this p
Page 60 and 61: 2000c) Although South Africa’s he
Page 62 and 63: Human Rights Relating to Women’s
Page 64 and 65: acceptable, states are in violation
Page 66: Human Rights Needs AssessmentsA nec
Page 69 and 70: References1. Barbara Evers and Merc
Page 71 and 72: In practice, however, the ICPD agen
Page 73 and 74: Incorporating Women’s Health Conc
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Interacting with women (users/poten
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Appendix 1Center for Health and Gen
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Appendix 6Latin American and Caribb
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Enemark, U. and F. Schleimann. 1999
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Nduati, R., and Kiai, W. 1996. Comm
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Dovlo, D. 1998. “Health Sector Re
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