Matching Grant Challenge
BruceMatch
We’re slowly making headway in our annual fund drive, but not nearly fast enough to meet our make-or-break goal.  On the bright side, a generous CounterPuncher has stepped forward with a pledge to match every donation of $100 or more. Any of you out there thinking of donating $50 should know that if you donate a further $50, CounterPunch will receive an additional $100. And if you plan to send us $200 or $500 or more, he will give CounterPunch a matching $200 or $500 or more. Don’t miss the chance. Double your clout right now. Please donate.
 unnamed

Yes, these are dire political times. Many who optimistically hoped for real change have spent nearly five years under the cold downpour of political reality. Here at CounterPunch we’ve always aimed to tell it like it is, without illusions or despair. That’s why so many of you have found a refuge at CounterPunch and made us your homepage. You tell us that you love CounterPunch because the quality of the writing you find here in the original articles we offer every day and because we never flinch under fire. We appreciate the support and are prepared for the fierce battles to come.

Unlike other outfits, we don’t hit you up for money every month … or even every quarter. We ask only once a year. But when we ask, we mean it.

CounterPunch’s website is supported almost entirely by subscribers to the print edition of our magazine. We aren’t on the receiving end of six-figure grants from big foundations. George Soros doesn’t have us on retainer. We don’t sell tickets on cruise liners. We don’t clog our site with deceptive corporate ads.

The continued existence of CounterPunch depends solely on the support and dedication of our readers. We know there are a lot of you. We get thousands of emails from you every day. Our website receives millions of hits and nearly 100,000 readers each day. And we don’t charge you a dime.

Please, use our brand new secure shopping cart to make a tax-deductible donation to CounterPunch today or purchase a subscription our monthly magazine and a gift sub for someone or one of our explosive  books, including the ground-breaking Killing Trayvons. Show a little affection for subversion: consider an automated monthly donation. (We accept checks, credit cards, PayPal and cold-hard cash….)

pp1

or
cp-store

To contribute by phone you can call Becky or Deva toll free at: 1-800-840-3683

Thank you for your support,

Jeffrey, Joshua, Becky, Deva, and Nathaniel

CounterPunch
 PO Box 228, Petrolia, CA 95558

A Constitutional Aim

The Right to Health in Ecuador

by CARINA VANCE

fter two decades of social and political upheavals that nearly bankrupted the government on several occasions, Ecuador is now enjoying the most stable period in its history. This new calmer context has enabled the country to break with the priorities of previous governments. Rafael Correa’s government has rehabilitated public services, placing fundamental issues such as education and health, previously the preserve of the technocrats, back at the core of politics and citizenship.

Ecuador’s new constitution, approved by referendum in 2008, gives an important place to public health. It recognises the need for a far-reaching structural reform of the sector, not only the government’s management of it, but more broadly its many social, economic and cultural ramifications through a radical review of the country’s health policy based on a new social contract.

Article 32 of the new constitution states: “Health is a right guaranteed by the state and whose fulfilment is linked to the exercise of other rights, including the right to water, food, education, sport, work, social security, a healthy environment and everything that promotes well-being. The state shall guarantee this right by implementing economic social, cultural, educational and environmental policies. It shall guarantee permanent, timely and non-exclusive access to programmes, actions and services promoting and providing comprehensive healthcare and reproductive health. The provision of healthcare services shall be governed by the principles of equity, universality, solidarity, interculturalism, quality, efficiency, effectiveness, prevention, and bioethics with a fair gender and generational approach.”

Article 32 highlights the government’s multi-disciplinary approach. In addition to direct action, the goal is to combine healthcare policy with various related social issues — such as access to potable water — and lay down some fundamental principles to guide the state in the management of its services.

The true novelty of the constitution is the role allocated to well-being (sumak kawsay in Quechua), of which public health is one of the pillars. It is not just a development tool, a way of ensuring that the economy operates smoothly because a healthy workforce is able to produce more; it is also a prerequisite for the common good, since healthy citizens are better able to exercise their democratic rights.

The constitution also stipulates the requirements for the effective implementation of universal access to healthcare. Article 362 states: “Healthcare as a public service shall be provided through state, private, autonomous and community institutions, as well as those that practice alternative and complementary ancestral medicine. … Public state health services shall be universal and free of charge at all levels of care, and shall include necessary procedures of diagnosis, treatment, medicines and rehabilitation.”

By placing health back in the realm of public service, the constitution has freed it from the market forces that governed it over the past decades. The exercise of human rights is the departure point in this historic process. Now it is up to the state to ensure that universal access to healthcare becomes a reality by setting up an integrated public network of medical services and consolidating the national health system.

Such an ambitious objective clearly requires significant financing. Since Rafael Correa became president six years ago, public investment in healthcare has totalled more than $9bn (the four previous governments only spent a combined total of $2.6bn).

Health coverage has grown proportionately. In 2006, 16m medical treatments were provided. In 2012 the figure was more than 40m. The increase was due to the building of new infrastructure (14 hospitals and 956 health centres by 2017), greater flexibility of consulting hours, and a determination to improve coordination between the central health administration and the many services depending on it at grass roots level, as well as clear rules on complementarity with private health service providers.

Ecuadorians are benefitting from an unprecedented redistribution of wealth. This historic effort has allowed public health to become a key factor in social justice. The increase in the number of hospitals and healthcare centres throughout the country has given millions of patients access to services from which they had been excluded, because of distance, poverty, discrimination or lack of information. Even taking demographic growth and an increasing demand for checkups into account, the increase in consultations suggests that the new public health service has successfully passed its field trials. Public health policy has mobilised all the public sectors, as reflected in the objectives for the National Plan for Good Living for 2013-17.

The remaining questions are how health services and preventative actions will be taken on board by society, and how the people themselves, as the driving force of citizenship, will take charge of their own part in the process. The task now facing the government is to show that real democracy remains the most important social determinant. The right to health in Ecuador today may be perceived both as a victory and a challenge.

Carina Vance is Ecuador’s health minister.

Translated by Krystyna Horko.

This article appears in the excellent Le Monde Diplomatique, whose English language edition can be found at mondediplo.com. This full text appears by agreement with Le Monde Diplomatique. CounterPunch features two or three articles from LMD every month.