Education: an Essential Component in Guaranteeing the Right to Health?

Cristina Sirur.

Volunteer journalist for Doctors of the World Spain.

e-mail: cristinasirur@gmail.com

Mariana Ruiz de Lobera.

Management of Knowledge and Learning Officer. Doctors of the World Spain.

e-mail: mariana.ruizdelobera@medicosdelmundo.org

A reflection from Doctors of the World Spain

Abstract: The following article is a reflection on how is the health situation in the world, in terms of political attitude and development aid, and reference to the Millennium Development Goals. Finally, we will see how education influences the development to ensure the human right to health, and how Doctors of the World works in this way, carrying out different international cooperation projects.

Keywords: Health, education, development, cooperation, OAD, ODM, primary care, human rights, doctors of the world

What is the current world health situation?

The joint efforts between international organizations, donor countries, receptor countries, and other organizations working in the health sector have achieved, in the last few years, improvements never before seen in certain global health indicators. Nevertheless, the gap between the poorest and the richest does not show signs of closing, and the international commitments are not being met to the extent that they should be. This situation has been made worse in recent years by a global crisis, a crisis that is not only economic. This is evident in the fact that certain values which should be universal are being questioned, for example, solidarity and the global right to health, the responsibility of every man and woman in the face of global poverty, and even their own state of well-being.

This situation can be illustrated if we analyze the evolution of the Official Development Assistance (ODA). Six of the member countries of the DAC (Development Assistance Committee of the OECD) reduced their ODA between 2010 and 2011, and of them all, the drop in Spanish aid, for the second consecutive year, has once again been highlighted. It is once again the largest reduction in absolute terms, with a reduction of 1,685 million dollars; that is, more than 28% with respect to 2010. The accumulative reduction of Spanish cooperation in the last three years is 36%. So, in 2011, Spanish aid occupied 11th place of the DAC for the total amount of ODA given, and 15th place with regards to effort.

There has been a serious setback in terms of following the path towards a commitment of 0.7% of Gross National Income for ODA, that the government had promised for 2012 (and that the other political parties with parliamentary representation had supported, through the Spanish National Pact Against Poverty), The ODA estimates established in the plan for 2013 indicate that this year, we will fall to 0.20%, a percentage which takes us back to 1990 and which is a great distance away from the agreed 0.7%.

Image 3.1 Development of planned and disbursed ODA 2002-2011 Source: Own development since the PACI (Annual International Cooperation Plan) and PACI follow-up reports.

The state of Spanish co-operation in health is in a critical state, with its relative weight the lowest it has been in the last 10 years. While budget cuts for spending in all departments between 2009 and 2012 have been on average, 30%, the Government Administration’s budget cuts for cooperation have been 50%. But in addition to this, within the cooperation cuts, the heath sector has suffered disproportionate cutbacks: while between 2009 – 2011 the total of ODA was reduced by 35%, health aid has reduced by 62%.

These figures show the loss of interest in the health sector of Spanish cooperation, a worrying fact considering that this is a sector whose cuts have consequences in the loss of human lives and in increased suffering.

This information gives us an idea of the setbacks in terms of political intentions, and as a reflection of this, the decline in the resources allocated.

In order to evaluate the world health situation, we can measure them by the Millennium Development Goals (established in the year 2000, to be achieved by 2015). Three of these goals (4, 5 and 6) are directly linked to health:

Goal 4: Reduce under-five mortality rates. This has been reduced all over the world. Even Sub-Saharan Africa, the region with the highest infant mortality rates, shows improvements in some of its indicators. In the period 2000-2010, its reduction rate was 2.4%; double that of the previous decade. However, there is still a long way to go. Every day, 19,000 boys and girls continue to die from avoidable causes.

Goal 5: Reduce maternal mortality. This will possibly be the most difficult goal to reach its target by 2015. 56% of deaths (almost 161,000) occur in Sub-Saharan Africa, where one woman every 200 births dies in this region. The second region is still Southern Asia, with 29% of total maternal deaths. The majority of these deaths are completely avoidable. If the women had access to adequate healthcare with qualified staff and cultural experience, this mortality rate would fall drastically. However, the lack of access is not only due to the lack of technical or human resources. In women’s health, a determining factor is gender equality, which affects even whether the woman can receive treatment or not, or her ability to decide whether or not she wants more children. Therefore, to tackle maternal mortality, we cannot simply consider the question as merely a healthcare issue – we need to combine this with analysis and researching solutions to achieve gender equality.

Goal 6: Combat HIV/AIDS, malaria and other diseases. Regarding HIV/AIDS, although we cannot say that we have the disease under control, we can ensure that the international effort is bearing fruit, and the number of infections is falling all over the world. Mortality as a result of this illness was 1.8 million in 2010, compared with 2.2 million in 2005, which shows a steep and constant decline. Nevertheless, the number of people who live with the HIV virus has grown 17% since 2001, and in 2010, the figure reached 34 million people. This is due to the increase in treatment. The problem is that it is a chronic disease, which means that these people need access to treatment throughout their whole lives. Therefore, precise strategies for fighting the disease cannot be established, but they must be integrated within the health systems, multi-sectoral, free from stigma and discrimination, and with a long-term vision.

Malaria continues to be, of the three biggest infectious diseases (AIDS, tuberculosis and malaria), where the focus of the MDGs lies. Of the three, this disease has the most sufferers, especially in children. There are 216 million cases of malaria each year, causing 655,000¹ deaths. 91% of deaths occur in Africa, and 85% of those killed are under 5 years old. As with HIV/AIDS, incidences of this disease has fallen 17% since the year 2000, and, most importantly, its mortality rates have dropped by 25%, thanks to the contribution of international cooperation. However, the commitment to reduce the mortality rates by 50% by 2010 has not been achieved.

With regards to tuberculosis, despite the fact that in 2010, more than one million people (of whom 350,000 were HIV positive) died from the disease, the mortality rate forecasts for this disease indicate that in 2005, it will be half than in 1990.

There is not long to go until 2015, a date which the international community set as a target for achieving the results forecasted in the Millennium Development Goals. Since the United Nations is already beginning to work on the scene post 2015, they have collated some of the important lessons learned. There are those which highlight the need for participation and ownership on the part of southern countries, and the design of the goals and indicators in an independent manner, ignoring the links between different MDGs.

What can we do from the perspective of EDUCATION to improve HEALTH throughout the world?

The link between health and education is clear, and this is illustrated in various declarations and international treaties, some of which we will discuss below.

The United Nations Committee on Economic, Social and Cultural Rights, in the year 2000, issued its General Comment no. 14, relating to the Right to the Highest Attainable Standard of Health, which is explained in article 12 of the 1966 International Covenant on Economic, Social and Cultural Rights. It indicates that the right to health is “An inclusive right…extending…also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. A further important aspect is the participation of the population in all health-related decision-making at the community, national and international levels.”

Human rights are indivisible, interdependent, complementary and equal, that is, they are inseparably inter-related. There are no rights that come above others, and they are complementary. The right to health cannot be achieved without decent housing, without access to education, etc.

Foto 1: 2011 Taller en Salud Sexual y Reproductiva.
Ciudad de Guatemala

The Alma-Ata Declaration (1978), in search of a solution to guarantee health for all, developed the Primary Health Care strategy. The minimum elements a Primary Health Care programme should contain, according to Alma Ata, are: “Education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs”.

How can we include, in our own actions, education to promote the right to health?

Doctors of the World work to defend the global right to health. In our projects, we incorporate the analysis of economic, social and cultural determinants and gender analysis. We identify strengths and weaknesses of the different entitlements (rights, responsibilities and obligations) in order to develop an action strategy which will help bring about a change in the standard of living of the most vulnerable populations. We avoid, in this way, assistance-based cooperation. We do not wish to offer a service which creates dependency and does not develop ability. In this commitment, educational work is fundamental, and assists development in a number of ways.

Establishing alliances with the Ministry of Education in order to incorporate, through the curriculum and/or training teaching staff in sexual and reproductive rights; furthermore, incorporating the Information, Education and Communication component into projects. Communication, for health, is “the social, educational and political process which increases and promotes public awareness of health, promotes healthy lifestyles and community action supporting health, providing opportunities and allowing people to be able to exercise their rights and responsibilities to develop environments, systems and policies beneficial to health and well-being.” Aside from the premise of educating, informing, persuading and explaining, as well as listening, communication in health provides individuals and communities with the advantages and resources necessary to prevent diseases and improve their quality of life.

Below, and to illustrate how, in practice, Doctors of the World connects Health and Education, we will explain in detail some of the projects which are being carried out in the field of International Cooperation, where the ‘Education’ component is a high priority.

In the region of Kilimanjaro, Tanzania, Doctors of the World have launched activities on “Sexual and Reproductive Health, STI/HIV, Gender-based violence“. Within their lines of work, “training of trainers from the Ministry of Education on a regional level, on sexuality, health and sexual and reproductive rights; for the teaching staff and primary managerial staff, health advisors and peer education in primary schools.

Since 2010, Doctors of the World has developed, in the Sahrawi Refugee Camps, an Agreement to reduce maternal and child morbidity and mortality rates, as well as the risks and the burden of disease in women of a reproductive age through the re-enforcement of public capacities and community participation. The intervention is completed with the creation of a Coordination Round Table. Within its strand of work, the creation of an Information, Education and Communication in SSR should be noted.

2. Foto 2: 2013 Formación Parteras entre Médicos del Mundo y Concert Action. Guatemala.

Finally, one of the most representative projects is that which is being developed in Guatemala City, aiming to strengthen the Health and Education Policies for adolescents and young people in Preventative Programme related aspects through education in two educational centres in zones 1 and 7 of Guatemala City. In this project, the Education factor is present in the majority of the strands of work: approach of incorporating comprehensive sex education in the formal education system and in youth organizations; implementation of the Comprehensive Strategy of Sex Education of the Department of Education in the classrooms at the two education centres; strengthening of the institutional capacity of the health and education sectors, through the provision of health personnel, methodological tools and focusing on gender, human rights and multiculturalism; cross-sector coordination (Health-Education Departments), and with civil society to develop alliances which promote the exercising of the Sexual and Reproductive rights of the adolescents and young people of zones 3 and 7 of Guatemala City.

Through the course of these 23 years of experience, we have learned a lot, always searching for the route which will allow us to guarantee the right to health of the most vulnerable populations, in a sustainable and respectful way. Participation and education for emancipation and empowerment of the holders of these entitlements, is the indispensable foundation which can support any act of cooperation for development. An organization which is not assistance-based, but aims to strengthen the capacities of the different agents so that they can lead their own development, naturally incorporates the educational component into its actions.

Notes

1. http://www.rbm.who.int/keyfacts.html

Reference bibliography

Prosalus, Medicos Mundi, Medicos del Mundo. La salud en la cooperación al desarrollo y la acción humanitarias. 2012 Report.

Website of the Commission on Social Determinants of Health from the World Health Organization: http://www.who.int/social_determinants/en

MDG, official website

DEL VALLE ROJAS, Carlos, (2003): “Comunicar la Salud”. Temuco Chile, Ediciones Universidad de la Frontera