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Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems. Methods Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.

"Next Generation" Trade and Investment Agreements: Upcoming Challenges for Public Services

This is an excellent recent presentation by a EU public services group about the attacks on public services in the EU by the trade agreements of countries like the US ('next generation' trade deals refers to US style negative list agreements which are particularly aggressive in privatizing and capturing public services, permanently (example, the US capture of healthcare around the globe by transnational corporations) ending public ownership and voter control over irreplaceable services and resources.. It shows the strategies which this global scheme, uses. Very much worth reading.

Some analyses of domestic regulation disciplines – compilation for MC11 (2017)

This is a recent analysis of proposed (by a number of countries) Disciplines on Domestic Regulation from Sanya Reid Smith of TWN, an NGO that has been involved in WTO matters for a long time. It was made before the recent WTO Ministerial Conference in Buenos Aires. You can see that its the WTO which is disciplining the countries domestic regulations. ------------------------------------------ Introduction Domestic regulation disciplines on services are being negotiated in a number of trade agreements including at the World Trade Organization (WTO), in the Trade in Services Agreement (TISA) 1 and in other free trade agreements (FTAs) such as the Regional Comprehensive Economic Partnership (RCEP) 2 and those being negotiated by the European Union (EU) 3 . It seems that domestic regulation disciplines (DRD) will also be negotiated at the Eleventh WTO Ministerial Conference (MC11) from 10-13 December 2017 in Buenos Aires, Argentina. 4 The European Union, Australia, New Zealand, Switzerland etc (‘EU et al’) released their DRD proposed text on 1 December 2017. 5 "These proposed DRD would restrict laws and regulations re services licensing etc, even non-discriminatory laws which apply to domestic and foreign companies equally. Yet, as United Nations Conference on Trade And Development (UNCTAD) staff note, services regulation is important for a number of reasons including: protecting consumers, ensuring universal access to essential services cultural diversity, quality, safety, correcting market failures (eg: information asymmetry where the service provider has more information than the consumer, natural monopolies, negative externalities (eg environmental degradation from transport) where those not directly involved suffer costs). 6 After highlighting that many regulatory frameworks are still at an emerging stage in developing countries the UNCTAD staff conclude that ‘it is key for developing countries that international rules for services trade preserve the right to regulate (RtR) and grant the necessary policy space to experiment in the search for those policies that best suit individual countries’ specific, developmental needs.’ Given this, the UNCTAD staff note that ‘one would expect developing countries to take a cautious, rather than an offensive approach towards the development of these disciplines, with their main goal to preserve the RtR.’ 7 This compilation includes excerpts from existing analyses of the same DRD proposed in the WTO or in TISA." ----------------------------------- Compiled by Sanya Reid Smith, Third World Network

Trade Liberalization and Universal Access to Education Services

"The exclusion therefore does not appear to apply to education services in cases where such services are provided on a non-commercial basis but which are supplied in competition with another service provider. Similarly, the exclusion would not appear to apply to education services that are supplied on a commercial basis even where these services are supplied in the absence of competition with any other service supplier. The exclusion would seem to apply only in those cases where education services are provided by completely non-commercial, absolute monopolies. In most countries, however, education services are normally supplied through a mixture of public and private suppliers, or frequently include certain commercial aspects. A strict reading of Article 1:3 would indicate that such services fall outside the exclusion. In any case, wherever uncertainties about the scope of the exclusion arise, the language will almost certainly be interpreted narrowly. The WTO Council for Trade in Services, for instance, has supported the view that even in the context of sensitive public service sectors such as health and social services, the exclusion “needed to be interpreted narrowly”. "Despite the significance of GATS coverage for education services, there are indications that some member governments may not fully appreciate the limited scope of the “governmental authority” exclusion. Many governments may not recognize that certain aspects of education services and their regulation are likely already subject to those GATS obligations that apply horizontally, including most-favoured-nation treatment and transparency."