HEALTH

Every year since 2001 the European Union Budget has specified that 20% of all EU aid, including aid to ACP countries, should be allocated to basic health and education and that 35% should be allocated to social sectors. The Development Cooperation Instrument (DCI) includes a declaration that the European Commission has agreed to implement these targets by 2009. While the country programmes to Asia and Latin America reflect an attempt to comply with these targets, this is not the case for the ACP countries. A study noted that out of 61 ACP countries only 2 have included health as a priority.4 While in Asia and Latin America the EC often supports social sector programmes, this is not the case in ACP countries, despite international studies showing that Africa is furthest away from achieving the MDGs. Many ACP countries are trying to cope with serious problems in their health and education sectors, not least persistent financing gaps.

The European Parliament has asked for increases to social sector support in resolutions 2005/2141 on aid effectiveness and corruption in developing countries and 2006/2079 on budget aid for developing countries. Several recent studies conclude that the EU will only be allocating around 4% of the development assistance destined for the ACP to support health and education. This compares with 10% over the previous period. For tariffs to be removed on EU imports, for instance ESA countries ( face a potential overall loss of government revenue, estimated at US $473 million. This revenue finances public services. The reduction in public revenue comes at a time when most ESA governments are not yet meeting the Abuja commitment of 15% government spending on health, and when most countries are not able to meet the minimum costs of financing health systems of $60 per capita set by the World Health Organisation (WHO), or the costs of meeting the Millennium Development Goals. Losing public sector revenue puts pressure on households to fund health or leads to cuts in service provision. The United Nations states that trade law or liberalisation measures that reduce the quality and quantity of services the poor and vulnerable groups are ‘de facto discrimination’.

Under the conditions of unequal access and differentials in coverage, health care cannot be left to the market and Acp countries need to use government authorities to regulate providers, compel cross subsidies, increase risk pools, manage health worker migration and other measures needed to ensure universal health care coverage. Acp countries have thus been advised not to commit their health services in blind liberalization as this will irreversibly narrow these authorities. Hence while the EPA may expect countries to respect existing commitments, there is no basis for it to add further pressure for countries to liberalise or commercialise health services beyond their existing commitments.