Adopted by the 50th World Medical Assembly Ottawa, Canada, October 1998

Preamble

1. Members of the World Medical Association are concerned about health care systems in all countries having adequate resources to meet the basic needs of their populations(1).
   
   
2. However, during the last decade there has been a trend of widening inequalities in health and deteriorating access to health care for the poorer strata of society, and women in particular, in many countries of the world, especially in the least developed nations.
   
   
3. The unfavourable economic situation and high debt burden of many least developed countries have led to Structural Adjustment Programmes (SAPs), advocated by international financial institutions and implemented by governments. Under SAPs, governments of the countries concerned have reduced spending for social services, including health care, without providing an adequate alternative financing system which would ensure access for the poorer strata of society.
   
   
4. These adverse developments have led international fora to develop initiatives to improve the situation. The 20/20 Initiative, adopted at the 1995 World Summit on Social Development in Copenhagen(2), asks for 20 percent of the spending of national governments and of international donors to be allocated to basic social programmes, including primary health care(3) . The Highly Indebted Poor Countries (HIPC) Initiative, agreed upon by the Boards of the International Monetary Fund and the World Bank in 1996, undertakes to provide comprehensive debt relief for some of the world's poorest nations, bringing their debt burdens down to sustainable levels(4), enabling increased spending in the social sector. Although some progress has been reported, broad support for them will reinforce these positive initiatives and thereby increase the possibility of achieving concrete solutions for the health needs of the world's poor.
   
   

Recommendations

The World Medical Association,

6. RECONFIRMING the guidelines on access to health care which were adopted in 1988 at he World Medical Assembly in Vienna, and which aim at equity in access irrespective of economic factors such as cost-financing and transportation,
   
   
7. RECONFIRMING its call in 1983 at the Assembly in Venice to take an active part in the development of plans concerning medical care in rural areas(5),
   
   
8. RECOGNISING that economic policies have an impact on health and health care,
   8. RECOGNISING that recent economic and health sector developments have widened inequalities in health and made a negative impact on equitable access to health care, especially in the least developed countries, and
   
   
9. RECOGNISING the potential of the 20/20 Initiative and the HIPC Initiative to provide means to improve health and access to health care for the poorer strata in the least developed countries,
   Recommends that National Medical Associations
   
   
10. CALL UPON their governments:
    
    
    1. to adhere to and foster international proposals regarding improved investment in the social sector;
    2. to adhere to and foster policy initiatives regarding debt relief of the world's poorest countries; and
    3. to provide expertise early in the decision-making process regarding SAPs, public expenditure cuts and health care sector reforms.
       
       
11. CALL UPON international financial institutions and other major donors:
    
    
    1. to change their policies along the same lines;
       
    2. to stop all interventions that lead to reduced access to and reduced provision of essential health care, both in terms of quality and quantity;
       
    3. to improve the poor's, and particularly women's, access to good quality health care; and
       
    4. to carry out health impact assessment studies before structural adjustment policy measures are implemented.
       
       
12. EXCHANGE information among themselves to coordinate efforts for policy change in these areas.

References:

1. World Medical Association Statement on Access to Health Care, adopted by the 40th World Medical Assembly, Vienna, September 1988 (10.70).
   
   
2. The Declaration and Programme of Action of the World Summit for Social Development, United Nations, 10 March 1996.
   
   
3. Anonymous. Report of the International Meeting on the 20/20 Initiative, Oslo, Norway, 23-25 April 1996.
   
   
4. IMF and World Bank. Multilateral debt of the Heavily Indebted Poor Countries. IMF and World Bank, Washington DC, 1995
   
   
5. World Medical Association Recommendations Concerning Medical Care in Rural Areas, adopted by the 18th World Medical Assembly, Helsinki, June 1964 and amended by the 35th World Medical Assembly, Venice, October 1983 (10.50).