Global Governance for Health: EQUINET experiences in Southern and Eastern Africa RANGARIRAI MACHEMEDZE EQUINET/ SEATINI Cape Town, South Africa 6-11 July 2012

EQUINET a network of professionals, civil society members, policy makers, state officials in east and southern Africa that aims to advance and support health equity and social justice through: sharing information and experience research building critical analysis and skills networking and building strategic alliances. Visit

Introduction  The nature of global health has changed dramatically in the past two decades, bringing in many actors to expand responses to global health needs: service delivery, prevention, and research and development  Besides governmental activities, the involvement in health of non governmental organizations, non- state providers of health, industry, faith-based organizations and civil society has increased.

Global Health Governance Architecture Source: Rekacewicz P Le Monde Diplomatique, September 2005

Limitations This increasingly complex architecture:  has led to concern about the lack of effective co- ordination across UN policies and  the inadequate machinery for monitoring implementation of the hundreds of multilateral treaties, which although sectoral in character, also impinge on global public health.

 The dominant economic paradigm that our countries have been forced to follow in the past two-three decades is neo-liberalism  Emphasises the free market ideology (washington consensus principles)  Trade liberalisation, financial deregulation, cuts in government spending, IP rules (US model), binding membership of WTO regulations, compliance with IMF and international financial institutions rules etc African experiences

Trade liberalisation - negative outcomes for Africa IMF/World Bank Structural Adjustment Programmes entry point to economic liberalisation Resulted in structural changes in virtually all sectors Social services sectors: health, education negatively affected Health sector effects included commercialisation (fee charges), public sector cuts, freeze or cuts health worker employment, fall in real wages for health workers African experiences

African experiences: the global context  US-Africa (AGOA)  US-NAFTA  US-FTAA  US-APEC IMF & World Bank WTO - PRSPs - Debt Relief & HIPC - Aid, Loans - Economic Reforms (SAPs) USEU  EU-SA FTA  Cotonou/EPAs  EU-MED FTA  EU-MERCOSUR - Binding Agreements - DSB Trans National Corporations African Governments Economic and Trade Reforms Lock in Washington Consensus Policies

World Trade Organisation Agreements and Health AoA  Liberalising agric  Removal of tariffs (revenue)  Food sovereignty/food security  nutrition TRIPs  Access to medicines  Farmer’s rights  GMOs GATS  Privatisation of health services  User fees AoA TBT GATsTRIPs SPS SPS/TBT-health issues, infectious disease control, food safety, environment, food security, biotechnology

EQUINET experiences and struggles for better governance in Health EQUINET is officially recognised by governments in ESA and by SADC and ECSA health community Works with governments over the years in SADC, ECSA to build regional solidarity, integrity and political coherence to:  Engage globally in these processes  Resist unfair and unjust policies

EQUINET experiences Participates in official processes and meetings  -doing advocacy on different issues e.g. reclaiming the economic resources for health from unfair global policies  -demanding equitable health systems Demanding national governments to implement laws at national levels to ◦ Fully use flexibilities in trade agreements particularly GATS and TRIPs ◦ Protect indigenous knowledge systems ◦ Resist WTO plus obligations in bilateral or regional agreements ◦ Regulate the movement of goods and services (domestic regulatory framework)

EQUINET Experiences Participating in Global Health Governance working on:  Supporting regional integration on health related issues especially demanding fairness in economic partnership agreements  Collaborating with other institutions and networks beyond the governments and intergovernmental bodies Publications on different areas  Newsletter  Policy briefs  Discussion papers  Reports Available on: