Kā izskaust nabadzību?

Posted on January 11, 2011

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1.Universāla medicīniska aprūpe

Pasaules veselības organizācija savā jaunākajā ziņojumā šeit ir aprēķinājusi ka pasaules visnabadzīgākajām valstīm lai līdz 2015.gadam ieviestu universālu medicīnisko aprūpi gadā būtu jātēre 60$ uz katru iedzīvotāju.Latvijas gadījumā tie būtu aptuveni 60 miljoni latu.

The international health community had been long-awaiting last week’s launch in Berlin of the 2010 World Health Report. Its theme was how to finance health care to achieve universal coverage. Oxfam and others began with a stunt in front of the Brandenburg Gate, highlighting the devastating impact of user fees in denying health care to millions of patients; WHO Director-General Dr Margaret Chan spoke to this same issue just an hour later.

A number of health ministers gave inspiring presentations but it was disappointing not to hear from Sierra Leone. Its government stopped user fees for mothers and children in April and theresults have been instant and dramatic. The WHO says that malaria treatment for children there has shot up 372% and the number of women giving birth in hospital doubled in the first month – and is still rising.

Three big problems stop countries from moving closer to universal coverage: (1) they lack resources; (2) they over-rely on direct payments, that is, patients paying out-of-pocket and (3) what resources they do have are not always used efficiently or equitably enough.

To achieve health care for all by 2015, low-income countries (LICs) will need to be spending around $60 for each man, woman and child each year by 2015. But only eight of them have any chance of generating this from domestic resources alone. Aid and new financing tools (including financial transaction taxes) must plug the hole. In fact, if rich countries fulfilled their aid pledges now, the WHO says that the financing gap to achieve the Millennium Development Goals would be eliminated overnight.

Countries waste between 20 and 40% of their health spending due to inefficiencies, according to some estimates. A big slice of this is because of unnecessarily high prices for medicines, as well as their irrational use. Inefficiencies are also caused by not spending enough on things like health worker salaries, which leave staff little choice but to spend time raising income elsewhere.

User fees are the most regressive way of paying for health care. A country can never achieve universal health coverage if it over-relies on direct payments. Solidarity is key here – countries must redistribute resources from rich to poor and from healthy to sick by pooling and reallocating them according to need. The WHO has introduced an important target for all countries to reduce direct payments to only 15-20% of total health expenditure.This is the point at which financial catastrophe and impoverishment as a result of ill health falls to a negligible level.

The WHO cautions against fragmented and voluntary health insurance schemes, which work against efficiency and equity – but it should have gone further. Even social health insurance does not have a good track record in poor countries because so many people are employed informally. Oxfam’s paper on health insurance has covered these topics. Most importantly the WHO is clear that in every country there will be a proportion of people (sometimes very large) who cannot afford to pay anything toward their health care. Countries that have made the most progress towards universal care pay for these people’s health care with taxes.

The report is optimistic that, no matter how poor, countries can make immediate and significant steps to remove direct payments and move towards health care for all. In that sense it takes us back to the core of the 1978 Alma Ata ‘Health Care for All’ Declaration. The report puts the WHO back where it belongs – at the centre stage of setting the international health agenda. We wait now for other donors lagging behind on the topic of health financing, including the World Bank, to put their full weight behind the WHO.

Anna Marriott

2.Bolsa Familia jeb pasaulē lielākā un atzītākā tiešo naudas pārvedumu programma nabadzīgajām ģimenēm.

Bolsa Familia is not just another cash transfer programme. With over 11 million families as beneficiaries, it is the largest in the world and has been emulated across Latin America and even in the US.

Launched in 2003, it provides an invaluable safety net for a quarter of Brazil’s population, providing basic social protection income support at a cost equivalent to 0.4 percent of the country’s GDP.

The Brazilian government –like other Latin American countries suffering from the global economic slowdown – has now decided to include an additional 1.3 million families in the programme.

“One very positive aspect of Bolsa Familia – and other cash transfer programmes as well – is that while rescuing millions of people from extreme poverty it also turns them into consumers and helps stimulate local and regional economies”, said the Brazilian Minister of Social Development and Fight Against Hunger, Patrus Ananias, during his presentation of the programme at the ILO.

The idea is simple but makes good economic sense. Since low income families have high propensity to consume, the programme boosts demand for food and basic consumer goods that are mostly produced at the local and regional levels.

Bolsa Familia is perhaps the most visible of Brazil’s cash transfer programmes, but it is not the only or first one. During the 1990’s, the Brazilian reform strategies centred on strengthening the public pay-as-you-go system and extending social security coverage.

This has led to a reduction of 0.7 points per year from 2001 to 2007 in Brazil’s Gini Coefficient, which measures inequality of income distribution. In countries like Sweden, the Netherlands, Canada and France, sustained decreases over large periods of time in the Gini Coefficient have been associated with the development of strong welfare states.

“The Bolsa Familia programme covers an ethical and moral demand to protect human rights. The construction of a fairer society should certainly incorporate programmes such as this one as part of the development strategy”, said Mr Arnaldo de Souza Benedetti, representative of the Worker’s group in the Governing Body session and a member of the General Workers’ Union of Brazil (UGT).

“Practically all countries that have succeeded in eradicating extreme poverty have applied some sort of cash transfer policy. Even in high-income countries, there are parts of the population that cannot guarantee their own subsistence through work. Addressing this reality through cash-transfer programmes is taking a decisive step towards the construction of fairer societies”, said the Employer’s representative, Mr. Dagoberto Lima Godoy, Senior Adviser of CNI (the National Confederation of Industry of Brazil). He also pointed out some aspects in which Bolsa Familiashould be improved.

Unlike social programmes which provide universal assistance to the poor, Bolsa Familia has some conditionalities. It provides income support to families subject to their fulfilling of certain human development requirements, for example school attendance, vaccinations, nutritional monitoring and prenatal and post natal tests.

The rationale for designing the programme in this way is that poor families can become trapped into poverty over several generations if they are not able to access resources such as education, health, financial capital and networks.

“Poor children are likely to become poor adults unless steps are taken to improve their skills, avoid child labour and enable them to overcome the social and economic barriers faced by their parents. The Brazilian experience is an encouragement for all of us who work for the extension of social security to all. It is a good example of how to implement a massive and rapid social inclusion process at a relatively low cost. This evidence is consistent with several studies conducted by the ILO which show that developing countries can afford to build a comprehensive, even if basic, social protection package”, said Assane Diop, Executive Director for Social Protection at the ILO.

“Given its employment and social protection approach, the Brazilian experience in cash transfer programmes can be seen as a strong reflection of a national Decent Work Agenda”, he added.

Programa Bolsa Familia (PBF) is the consolidation of several previous government of Brazil cash transfer programmes (Bolsa Escola, Bolsa Alimentação, Cartão Alimentação and Auxílio Gas).

The objectives of Bolsa Família in Brazil are threefold:

• Immediate relief from poverty, by means of direct income transfer to families;

• Contributes to break the intergenerational poverty cycle, by means of conditionalities;

• Coordination of complementary programmes with the aim of helping with the development of the benefited families. Some of these programmes are: income generation activities, adult literacy courses, issuance of birth certificate and other documents etc.

The main characteristics of PBF are: targeting, conditionalities and transfers paid directly to the beneficiaries through magnetic cards, which reduces the transaction costs and avoids further corruption and manipulation. It takes the household as the basic unit. The family has the autonomy to use the cash without the government’s intervention, and the cash is transferred to the mothers. The conditionalities of PBF are basically related to education and health, consisting of:

• Education: school enrolment and minimum attendance of 85 per cent for children and adolescents aged 6-15 years old and 75 per cent for adolescents aged 16 and 17 years old.

• Health: fulfilment of the vaccination calendar and the growth and development for children under 7 years old; prenatal care for pregnant women and monitoring of lactating women.

There are three possible benefits paid by Bolsa Família:

• Basic income benefit (US$34): paid to the families considered in extreme poverty (with monthly per capita income up to US$35). The benefit is paid regardless of the presence of children or teenagers in the family;

• Variable Benefit (US$11): paid to families considered poor with income per capita up to US$70 who have children and teenagers up to 15 years old. Each family can receive up to three variable benefits or US$33.

• Variable benefit to the Teenager (US$16.50): paid to all families who have teenagers between 16 and 17 years old attending school. Each family can receive up to two variable benefits of this kind (up to US$33).

The beneficiaries of PBF are selected from the “single registry” database system (Cadastro Unico/CadUnico) which contains the socioeconomic profile of the population whose per capita income income is up to 50 per cent of the established minimum wage or whose total income is three times the minimum wage. The data collection for the single registry is conducted by local governments (Municipality) and is sent to the Ministry of Social Development for verification. It is important to note that the government does not exercise a punitive action over the non-compliance of the conditionalities. The non-complicance of conditionalities are viewed as a means to find out the reasons why there is such non-compliance and a means of further assessing the level of vulnerability and behavioural responses of the poor to their own situation. The monitoring of conditionalities is done by the designated teachers in schools and health attendants in each locality. The information of the monitoring activities are sent directly to each correspondent line Ministry (Education or Health) and then forwarded to Ministry of Social Development and Fight Against Hunger (MDS). Each family is issued a Social Identification Number (NIS) which is also reported to the bank and other relevant institutions for cross-checks and monitoring.



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