Artigos sobre Privatização dos Serviços de Saúde Sexual e Reprodutivo
A Reproductive Health Matters (RHM), instituição beneficente sediada em Londres voltada para publicações e discussões sobre saúde e direitos sexuais e reprodutivos, está recebendo artigos sobre o tema “Privatização e comercialização dos serviços de saúde sexual e reprodutivo”. O prazo é o dia 1º de março.
Os artigos deverão focar, dentre outros tópicos, questões relativas ao panorama atual dos serviços de saúde nesta área, o funcionamento do setor público, os recursos investidos, o alcance do serviço privado e qual o perfil dos usuários.
Mais informações no site da RHM.
The past two decades have seen important growth in private health care all over the globe. Whereas private health care used to be available only to the rich and those living in cities in almost every country, private services of many different kinds are reaching out to more and more patients, including in the poorest countries and among the poor in more affluent societies, some funded through development aid. This is happening across sexual and reproductive health care, from private assisted conception clinics (including in countries with high rates of secondary infertility due to unsafe abortion and unskilled delivery care), to small private hospitals and NGO clinics offering antenatal and delivery care, safe abortion and many other reproductive and sexual health services in the absence of or alongside public services.
The growth of private health care has been supported ideologically by the so-called Washington consensus from the 1980s onwards, that free market capitalism is the only economic model to follow and should be applied not only in finance, business and trade, but also to social welfare services and agencies, including health care. This ideology has dominated the development aid policies of the World Bank, other international agencies and most if not all donor governments. Most aggressive have been commercial health corporations (mainly originating in the US) who are tendering for contracts from a growing number of governments to replace or supplement public health services.
The growth of private health care has been boosted by the failure of public health systems in many countries to ensure universal access to health services with a decent quality of care. There has also been a rapid growth in international NGOs (often with donor funding) which provide a range of reproductive and sexual health services in fee-charging clinics, mainly to high- and middle-income patients. While these may be charities or non-profit-making, they often function like profit-making, corporate entities in order to compete for patients and finance their own expansion. There are also a growing number of religious-run hospitals and clinics, many of whom have anti-choice policies under which they refuse to offer sexual and reproductive health (SRH) services, apart perhaps from maternity care, yet they may be the only health service provider in their area.
There has also been the phenomenon of the migration of providers and patients into the private health sector, whether on a full-time or part-time basis. Disillusioned, under-paid and unemployed public health care workers are setting up on their own or in small hospitals and clinics, whether on a non-profit or profit-making basis, in order to increase their income and improve and control their working conditions. Policies in the public sector supporting formal and informal fees, payments demanded under the table and other out-of-pocket costs, and non-governmental health insurance schemes have all encouraged people, even those with little money to spare, to try the private sector, since they are forced to pay anyway. For the most part, although some SRH health indicators have been improving in middle-income countries due to economic development and a growing middle class, the poor everywhere, especially those living in rural areas, are missing out. The lack of equity in access to health and health care has remained and may even be getting worse following the economic downturn.
These trends have consistently been opposed by those who support universal public health services funded from the public purse, e.g. by a tax-based national insurance system, a return to a primary health care approach, public health systems strengthening, increased education and training to expand the skilled health care workforce, and good salaries and working conditions for health professionals, mid-level health care providers and other staff.
On the other hand, many will point to a tremendous amount of innovation in public-private partnerships in SRH care, as well as tried and true programmes such as contraceptive and condom social marketing that are responsible for providing services for the poor, adolescents and single people, and marginalised groups such as sex workers and men who have sex with men in all parts of the world, making a positive impact on population health. Moreover, when countries refuse to support their own public health system adequately, or are afraid and unwilling to ensure that contested services such as contraception, safe abortion and assisted conception are available in the public sector, especially where fundamentalist opposition to these services is strong, if the private sector steps in to offer them, they should be supported and encouraged. On the other hand, there are many unethical practices such as offering monthly antenatal ultrasound scans or ultrasound for sex determination, or promoting cosmetic genital surgery, as a way of making money for no health benefit. Moreover, private services that have a “monopoly” position can use it to charge high fees or reduce quality of care to keep costs down. And many private services are unregulated, even in the most developed countries.
We are seeking papers for this journal issue about what is happening in countries as regards these complex issues, in the context of wider trends.
What is the current picture in countries for one or more specific SRH services and what does the future hold? Is the public sector being restricted, starved of resources, or falling apart, giving the private sector more space to move into? Are there public sector initiatives to stop or reverse such a decline and are these efforts working?
Do people cross back and forth between public and private SRH services – what are their pathways? With what outcomes? Who is using private/commercial SRH services and do these people end up in the public sector if there are complications or problems? What are the cost issues for patients?
Are private services actually doing a better job than the public health sector in any areas of SRH care, that is, are they achieving better outcomes, providing more and better services with a higher quality of care, or is this a false assumption/perception? Is there any evidence one way or the other?
Are there innovative public-private projects worth supporting in SRH care (or are there good reasons not to support them even if they are bringing improvements)?
Are there examples of well-regulated, ethical, inexpensive private SRH services that are improving women’s lives and supporting the delivery of SRH care that the public sector cannot or will not provide? Can these be accommodated alongside and reconciled with the public sector?
What motivates patients to opt for private SRH services when public sector services are available? How do patients evaluate privacy, quality, cost, provider competence etc in deciding whether to opt for private or public sector SRH services?
Are private services more attractive where SRH issues are shrouded in secrecy, stigma and legal ambiguity?
What realistic models for 21st century public (and private?) sector SRH services are worth promoting in the context of today’s policies and realities?
Publicada em: 03/02/2010