The Institute for Global Health and Development
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Item Colombia and Cuba, contrasting models in Latin America's health sector reform(Wiley, 2006-09-21) De Vos, Pol; De Ceukelaire, Wim; Van der Stuyft, PatrickLatin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far‐reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful – and radical – example of ‘market‐oriented’ health care reform, and Cuba, which followed a highly ‘conservative’ path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign – especially North American – corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.Item Cuba's international cooperation in health: An overview(Baywood Publishing, 2007-10-01) De Vos, Pol; De Ceukelaire, Wim; Bonet, Mariano; Van der Stuyft, PatrickIn the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the “Integrated Health Program” was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.Item Cuba's health system: Challenges ahead(Oxford University Press, 2008-05-02) De Vos, Pol; De Ceukelaire, Wim; Bonet, Mariano; Van der Stuyft, PatrickCuba's exclusively public health system has been quite unique in pairing limited resources with excellent results. It continued to perform well during the economic crisis of the 1990s, and now that the hardships are being overcome, new opportunities are developing—as well as threats: (1) economic recovery should permit reinforcing of the system's effectiveness; (2) Cuba's increasing international solidarity in health also poses it corresponding challenges at home; (3) the ageing of the population necessitates adjustments to the health care system. However, the original principles of the health care system are not under question. Cuba can be considered a unique laboratory, and deserves more attention from the international public health community.Item Social movements are key towards universal health coverage [Letter](Elsevier, 2009-12-03) De Ceukelaire, Wim; De Vos, PolItem Governments, civil society, and social determinants of health [Letter](Elsevier, 2009-01-24) De Ceukelaire, Wim; De Vos, PolItem Political will for better health, a bottom‐up process(Wiley, 2011-06-24) De Ceukelaire, Wim; De Vos, Pol; Criel, BartLately, different voices in the global public health community have drawn attention to the interaction between the State and civil society in the context of reducing health inequities. A rights‐based approach empowers people not only to claim their rights but also to demand accountability from the State. Lessons from history show that economic growth does not automatically have positive implications for population health. It may even be disruptive in the absence of strong stewardship and regulation by national and local public health authorities. The field research in which we have been involved over the past 20 years in the Philippines, Palestine, Cuba, and Europe confirms that organized communities and people’s organizations can effectively pressure the state into action towards realizing the right to health. Class analysis, influencing power relations, and giving the State a central role have been identified as three key strategies of relevant social movements and NGOs. More interaction between academia and civil society organizations could contribute to enhance and safeguard the societal relevance of public health researches. Our own experience made us discover that social movements and public health researchers have a lot to learn from one another.Item A human right to health approach for non-communicable diseases [Letter](Elsevier, 2013-02-15) De Vos, Pol; Stefanini, Angelo; De Ceukelaire, Wim; Schuftan, ClaudioItem Empowerment for the right to health: the use of the most significant change- methodology in monitoring(Harvard School of Public Health, 2015-12-10) Polet, Fanny; Malaise, Geraldine; Mahieu, Anuschka; Utrera, Eulalia; Montes, Jovita; Tablang, Rosalinda; Aytin, Andrew; Kambale, Erick; Luzala, Sylvie; Al-Ghoul, Daoud; Darkhawaja, Ranin Ahed; Rodriguez, Roxana Maria; Posada, Margarita; De Ceukelaire, Wim; De Vos, PolQuantitative evaluations might be insufficient for measuring the impact of interventions promoting the right to health, particularly in their ability to contribute to a greater understanding of processes at the individual, community, and larger population level through which certain results are obtained. This paper discusses the application of a qualitative approach, the most significant change- (MSC) methodology, in the Philippines, Palestine, the Democratic Republic of the Congo, and El Salvador between 2010 and 2013 by Third World Health Aid and its partner organizations. MSC is based on storytelling through which the central question-what changes occurred?-is developed in terms of, who did what, when, why, and why was it important?- The approach focuses on personal stories that reflect on experiences of change for individuals over time. MSC implementation over several years allowed the organizations to observe significant change, as well as evolving types of change. Participants shifted their stories from how the programs helped them- and what they could do to help others benefit from the programs- to what they could do to help their organizations.- The MSC technique is useful as a complement to quantitative methods, as it is a slow, participatory, and intensive endeavor that builds capacity while being applied. This makes MSC a useful monitoring tool for programs with participatory and empowering objectives.