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Fighting the privatization of health care in El Salvador     

By Gloria Pereira-Papenburg

If you need to see a doctor at the public hospital in the town of Jiquilisco , El Salvador , you’ll find that paying a “voluntary contribution” is part of the normal procedure. For example, four months ago 34-year-old Rosa Penado brought her daughter to the local hospital emergency room. The girl needed a hernia operation, and her mother was charged 500 Colons (about 100 Canadian dollars). She could only pay half the cost, and so has not returned to the hospital because she is afraid that she will be asked for the rest, which she does not have.

The case of Rosa Penado and her daughter is just one of hundreds documented by the Human Rights Ombudsman of El Salvador. After investigating the situation of the right to health care in rural communities of the north coast of El Salvador , the Ombudsman’s preliminary report concluded that the fear of not being able to pay for the necessary health care services prevents people from seeing a doctor.

In Uzulutan a simple visit to a doctor in a public hospital costs half-day’s worth of salary. Others who can get the money to pay for hospital services often can’t afford to pay for prescribed medications. Half the people of El Salvador live below the poverty level. The proportion of poor people is higher in the rural areas, such as Jiquilisco, and therefore user fees put health care services out of the reach of most.

More than one in ten people in El Salvador will not live beyond age forty. A quarter of the people do not have access to health services, and 34% do not have clean drinking water at home. (UN Human Development Report 2002) This is the context in which health care professionals, with the support of many Salvadorans, have been fighting for months against privatization of health services and for real access to these services. The doctors went on illegal strike as the only way to make the government to review its position. Hundreds of doctors faced losing their positions; several received death threats.

In the Journal of the Human Rights Commission of El Salvador, the Physicians Union described how the government of El Salvador reduced its financial support for public health care, and undertook a campaign of disinformation to convince the people that the workers are responsible for the health care crisis, that the system is beyond repair, and that the only solution is privatization.

The Inter-American Development Bank (IDB) and the World Bank claim to be supporting projects that improve health care systems in Latin America, but they seem to be particularly inefficient, since public services are declining and corruption is increasing. In the specific case of El Salvador, the IDB approved a loan in 1998 to support the modernization of the Ministry of Health and Social Assistance (a process begun five years earlier with a World Bank loan). The health care sector reform proposal that emerged would transfer direct service provisions to the private sector. The health care unions are concerned that the proposal gives priority to profit-seeking concerns and put health needs in a secondary position.

The unions believe that public health care in El Salvador could achieve its goal of universal high-quality coverage. There have been important improvements in health in the last decade, even with under-paid workers, understaffing and poor working conditions. The public system can take credit for the improvements since they have occurred without corresponding progress in other sectors, sanitation, housing and employment that are important factors in the health of the population.

The Salvadoran group “Journalists Against Corruption” denounced a bill that had been sent to the Salvadorian Congress, saying that it would restrict access to information on the proposed new health care system. They are concerned that this would mean the new health system would be managed without monitoring from media or from the public in general (Transparency International considers El Salvador to be a country with a high degree of corruption). The journalists point out that the Salvadorian Institute for Social Services is one of the institutions most affected by corruption, and that the government has never shown interest in bringing these practices to an end. Many people believe that a cleansing of the Institute’s management will allow better health care without need for private funding.

Disregarding opposition from all sectors, the President of El Salvador sent a proposal to the National Assembly to privatize health care services on October 16. The opposition parties rejected it in an unexpected move by a political party that usually votes with the government. The following day, the National Assembly approved a decree blocking the privatization of health care; they called it a “health guarantee”. The President stated that the legislative decree was unconstitutional and he had no other option but to veto it.

Thousands of Salvadorans took to the streets of San Salvador on October 23 in support of the strike by health care workers and to protest against privatization. It was a huge show of solidarity with the strikers, with up to 80 thousand people according to international journalists. The people said that they would not accept any changes to their “guarantee of health”. This was the second massive public demonstration against health care privatization within a month.

In view of this public outcry, the President softened his position; he would not veto the decree but he would make amendments. It was not clear how much these amendments would dilute the “health guarantee” so this was not acceptable to the doctors on strike.

At the end of the month, the mayor of San Salvador, a physician and a member of the leftist opposition party Farabundo Marti National Liberation Front, offered to serve as a mediator. He proposed that a commission be formed to formulate new proposals to reform the health care sector starting from scratch. The same evening (October 31) the President publicly announced that he accepted the mayor’s proposal and would not veto the “health guarantee”. This opens the door to negotiate a settlement with the health care workers but there is still the matter of the reinstatement of workers fired at the beginning of the strike, and other sanctions that had been imposed on the strikers.

The 350 doctors on illegal strike have been without salaries for three months, although they have provided emergency services. They say that they will not go back to their regular schedule until any economic, administrative or judicial sanctions are lifted. Despite the fact that the physicians have tremendous popular support, they find themselves now under a media campaign against them, to make an example for other workers who might dare to confront privatization in other areas.

It is possible that the government of El Salvador will try again to introduce private participation in health care but, for now it will have to wait. This may have an impact on other privatization projects in El Salvador, such as the electricity services, and also in other Latin American countries, in projects that are being strongly opposed by the people.

The strong opposition by the people might not be enough to stop these privatization projects. As we saw earlier, the governments are being pushed by the Inter-American Development Bank (IDB) and the World Bank (WB) in the gradual transfer of health care and other social services, previously covered by the government, to the private sector. Privatization is part of the conditions attached to loans by international financial institutions to third world countries.

These institutions have kept this position despite repeated expressions of concern from the UN Committee on Economic, Social and Cultural Rights, the monitoring body of the International Covenant on Economic, Social and Cultural Rights. This Committee has said, since 1990, that the international financial institutions should pay greater attention to the protection of human rights when implementing their policies.

Over the years, the Committee has produced several General Comments to different articles of the Covenant. Comment No. 14 on the right to the highest attainable standard of health (from 2000) says that “States parties have an obligation to ensure that their actions as members of international organizations take due account of the right to health. Accordingly, States parties which are members of international financial institutions, notably the International Monetary Fund, the World Bank, and regional development banks, should pay greater attention to the protection of the right to health in influencing the lending policies, credit agreements and international measures of these institutions.”

This means that we must keep vigilant about the defense of human rights in El Salvador and, here in Canada, make our government accountable for its participation in the financial institutions that have such a strong influence on the realization of these rights.

Privatizing peanuts -

 no debt relief without it

By Derek MacCuish

Peanut farming in Senegal is a tough business. The rain failed this season, and the peanuts didn't grow. There are a million peanut farmers in Senegal . Six million people depend on the crop for income and support. They are facing deep widespread hunger which may become starvation.

The season before last farmers took a loss despite a good crop. Economic restructuring and privatization meant the end of government collection of the harvest at a set price. The crop wasn't collected efficiently, and farmers anxious to sell were open to exploitation by middlemen.

The IMF has been leaning on the government to get out of the peanut business for a while. Last spring, the government stopped collecting the harvest, as part of the economic restructuring the IMF was requiring in exchange for economic assistance and debt relief. When the private sector didn't respond and there weren't enough trucks to pick up the crop, too many farmers couldn't get a fair price. If they could get buyers, farmers accepted payments at a fraction of the set rate, suspicious of the government credit system being used for the first time and taking the cash in hand.

Senegal is one of several heavily indebted poor countries facing years of delays in debt relief for failing to comply adequately with IMF structural adjustment programs. The privatization of groundnut (peanut and other crops) agriculture is part of the restructuring required by the IMF and World Bank, as is privatization and deregulation of electricity.

Other countries stalled in their debt relief programs because of structural adjustment conditions include Malawi , Guinea-Bissau , Guyana , SaoTomé & Principe , Honduras and Nicaragua . (see Upstream Journal Jan/Feb 2002)

Over the past year almost half of the twenty countries in the IMF/World Bank debt relief program, the Heavily Indebted Poor Country (HIPC) Initiative, have been stalled completely, unable to progress to the program's "Completion Point" and full debt relief. The Completion Point is when most relief arrives, including the cancellation of debts to wealthy countries, like Canada , that have attached their cancellation to the IMF/World Bank program.

The adjustment programs in these countries have similar features: privatization of state industries, including public utilities, cut backs in the civil service, and deregulation of investment and industry standards. These have been features of adjustment programs for years, but more recently the financial institutions have been using the promise of debt relief to push them more vigorously.

Six countries have completed their adjustment programs to the satisfaction of the IMF and World Bank only to find that the debt relief provided is not enough to give real breathing room. The level of relief provided is based on IMF predictions that earnings from exports would reverse their decline of several years, and provide stable income to bolster the cuts to debt payments. Instead, commodity prices have continued to decline in real terms, leaving these countries still heavily in debt, their income from exports lower than ever.

A large part of the problem is the refusal of the World Bank, the largest single creditor in these counties, to consider full cancellation. A third of debt payments goes to the World Bank, with a substantial portion being interest payments (see table). At this point, only the government of Ireland has indicated that full cancellation by the World Bank should be an option under consideration. The Canadian government refuses to take this stance.

Note: Derek MacCuish, the SJC’s coordinator of economic justice programs, will be in Washington in early December to meet World Bank, IMF and government officials to press for reduced conditions and deeper debt relief. He will represent the Halifax Initiative Coalition of Canadian human rights, development, church, labour and environmental organizations. See the next issue of the Upstream Journal for his report.

Guatemalan visitor describes his community’s efforts to become self sufficient and provide a decent standard of living

“Everybody talks about the weather, but nobody does anything about it...”

by Eric Lamoureux

The temperature was uncomfortably close to freezing as I walked to the metro with Julian Marcelo Subac. In my broken Spanish, I asked him how he was faring through the Canadian autumn. Later, hearing him speak of life as a coffee-grower in Guatemala , I felt a bit foolish for asking. Here was a man from (much) warmer Central America, but considering what he has lived through cold air was probably not such a hardship: the violence of civil war, a government run by murderers, the collapse of coffee prices, the increasing starvation, and now the threat of the Plan Puebla-Panama and the Free Trade Area of the Americas. And he hasn’t suffered his problems in silence; he is doing something about them.

A Cakchiquel Mayan and a member of an organic, fair-trading, coffee cooperative in San Lucas Toliman in the Guatemalan highlands, Marcelo gave a number of talks in and around Montreal at the end of October. He described the life of a farmer in a country where twenty percent of landowners own 80 percent of the land. People growing coffee for those landowners make the equivalent of about three to four dollars for a ten-hour workday. In good times, the basic diet is rarely more elaborate than tortillas and salt; in bad times, parents go without so that children can be fed. Life expectancy rarely exceeds sixty years. The chemicals involved in coffee production make matters worse.

Guatemala was supposed to be different after the 1996 Peace Accords. A Land Fund was set up, ostensibly to get more land into the hands of more people. Instead, due to the influence of large landowners and foreign interests, this fund has become nothing more than a typical bank, raising land prices as well as the indebtedness of the poor people. With notoriously brutal former dictator Efraim Rios Montt as President of Congress, the government has done nothing to help; many members of Rios Montt’s ruling party had appropriated the people’s land when they fled government-sponsored violence during the civil war. Today, land reform remains a dangerous proposal in Guatemala .

To make matters worse, global coffee prices have fallen dramatically as low cost Vietnamese robusta coffee beans flood the global market. In many parts of Central America , growers don’t bother to even harvest their beans; the expense is greater than the price they will receive at market. Landowners have taken advantage of this crisis to cheat workers of their wages, or sack them. In Guatemala , where forty percent of rural people are out of work, 600,000 people have been thrown off the land in the past months. This translates into more than just the loss of a job; it means loss of access to shelter and to land for growing food. The United Nations World Food Organization estimates that eight million people in Central America are at risk of starvation this year.

By contrast, Marcelo’s cooperative side-steps the global market and sells its organic crop directly to consumers. Set up with the help of a students’ group from the University of British Columbia , this fair trade arrangement helps provide a decent standard of living for growers and their families. It frees them from dependency on landowners and on international middlemen (whom they call “coyotes”). Being organic, fair trade coffee protects the health of the producer and the consumer, it respects the environment, and it leads to the promotion of biodiversity. A portion of the sales proceeds goes to improving the community, obtaining more land, protecting worker rights on plantations, and providing financial assistance to orphans of the civil war. Marcelo stressed that this is the only reasonable alternative for growers in Guatemala , and furthermore it offers a high quality product to consumers in Canada .

But there was another problem. Just as Marcelo’s community found a viable system for supporting itself, other threats arose. Recent talks on the Free Trade Area of the Americas and on the Plan Puebla Panama seek to create an Americas-wide trading area that is more likely to improve the bottom line of multinational corporations than the lives of average Central Americans. The poor risk losing their land through expropriation, dam-building, or the growing land hunger of multinationals. Landless, they may find the only work will be in the maquilas, or sweatshops. Marcelo’s people have organized demonstrations to protest these plans, but the government has ignored them.

Hearing of these new developments, it’s easy to throw up one’s hands in exasperation and say, “You can’t win!” Alone, they probably could not. That was why he was in Canada , in chilly October. If his people are to succeed, they need support from Canadians.

First, we need to support their attempts to gain a decent living through fair trade. These products – and they are not limited to coffee – may be a bit more difficult to find and cost more, but consumer demand is making them more readily available and cheaper. Fair trade can only change things if we support it, and buying fair trade products helps people.

Second, we need to better educate ourselves about the impact of the FTAA and the PPP and work to stop them. The Canadian government is an influential members of the development banks that are lending money for the PPP, and it is at the table at the FTAA talks. Development and trade deals which do not come from the people and do not put their interests first are criminal. We need to tell our government that we want no part in such deals, and that we want them stopped.

The main problem for Marcelo’s people is not the weather. Although unjust trade may seem as difficult to deal with as bad weather, it isn’t. People at this coffee cooperative are doing their share and more to make things better. The onus is now on us in the north. Supporting fair trade, and insisting that our government listen to us, are concrete actions we can take to help keep global trade from crushing people. These steps allow us to break down this monumental problem and tackle it. And doing that is more constructive than complaining about the weather.

The Acteal massacres after five years

Injustice and impunity continue despite latest court judgement

By Karen Rothschild

December 22nd 2002 marks the fifth anniversary of the massacre of forty-five indigenous women, children, and men, in the municipality of Chenalho, Chiapas . Members of the social organization Las Abejas, they had been displaced from their home communities by paramilitary violence and had taken refuge in the community of Acteal.

They were massacred in the Acteal church while taking part in a day of prayer for peace.

On November 12, prison sentences were confirmed for nineteen indigenous men now detained in the Cerro Hueco penitentiary in Chiapas . They were sentenced to thirty-six years and three months for their part in the Acteal massacre. Nearly eighty people have now been sentenced in connection with the massacre.

Another six people were cleared of legal responsibility in the massacre. In the opinion of the Fray Bartólome de Las Casas Human Rights Centre in San Cristóbal de Las Casas, this latter decision did not sufficiently take into account the existing evidence against these six men. In addition, the Centre has signalled the need to recognize the responsibility, in relation to the massacre, of members of the administration of former Chiapas state governor Cesar Julio Ruiz Ferro. The Centre has more than once pointed out that the Mexican army, despite being barracked in the area, made no move to prevent the Acteal tragedy. In their opinion, the army=s role should be investigated, as should allegations from witnesses regarding military participation in training the perpetrators of the massacre.

Statement issued by members of Las Abejas, 13November 2002:

AAs an organization and as victims of this massacre, we say that justice has only been partially rendered. Although some have had their sentences confirmed, other members of the group who perpetrated the massacre were released ... and they are the ones who were really responsible for organizing the massacre. In addition, there are twenty-seven persons who have not been brought before the law, despite the fact that warrants have been issued for their arrest. In the same way, no charges have been laid against public servants and the people who planned the massacre - such as former state governor Julio Cesar Ruiz Ferro and former president Ernesto Zedillo Ponce de León. There has been no punishment for the big shots.

In the same way the ( Chiapas state level) investigations for crime crimes have not prospered. Our demands for justice have simply been packaged and archived by the administrators of the state justice system. There is still not a rule of law for the benefit of all. There is only partial justice...

There are people who have been publicly accused. These are the people whose actions caused the displacement of the different communities of Chenalho. We are the witnesses that these six persons who have been released are those who are really responsible for the massacre. We have made a formal accusation, and we have given information as to how the attack was planned several days ahead of time and how it involved a large number of heavily-armed men from the communities of Los Chorrros , Puebla , La Esperanza, Canolal, Pachiquil, and Quextic. Many of these men are still free, still living in their home communities.

At this time, we are living in a climate of insecurity. The present municipal president and the municipal council do not have the will to further the cause of justice. We have tried in vain to insist that the situation be resolved. Today there is a death threat in the community of Pechiquil...

There is a long way to go before full justice is reached, and much is still to be done in the case of Acteal. But we do not see any political will, on the part of either the state government or the federal government, to respond to our legal demands for justice. We are still living in a situation of injustice and of impunity...@

Visitor to Montreal speaks about social repression in Guerrero, Mexico

By Karen Rothschild

On November 4th, 2002 the SJC hosted the visit of Mexican social activist, Eleuterio Mayo Vargas, a student and community organizer at the Ayotzinapa Rural Teacher Training College in the Mexican state of Guerrero. Sr. Mayo is the general secretary of the executive committee of the Socialist Federation of Students and Peasants. His talk focused on student resistance to the privatization of Mexico =s education system as well as on campesino resistance to the Plan Puebla Panama development programme.

The Rural Teacher Training Colleges

The Ayotzinapa Rural Teacher Training College is one of the thirty-six Anormal schools@ set up in 1935 by President Lázaro Cárdenas. The purpose of these schools was, and still is, to bring basic education to rural areas by providing teacher training to students from campesino and indigenous families with limited financial resources. Graduating students will go on to become teachers in remote and marginalized communities.

In the state of Guerrero, and in other regions of Mexico , rural teachers are all too frequently the targets of political repression. The rural teacher training colleges in particular have been viewed by the authorities as hotbeds of radical activism and, in the days of the Cold War, leftist subversion. The neoliberal policies of recent Mexican governments, with their emphasis on cutting social spending and increasing the role of the private sector in the provision of social programmes, represent a direct threat to the survival of the teacher training colleges.

The seventeen remaining (out of the original thirty-six) Anormal schools@ are struggling against government moves to limit their autonomy, reduce their budgets, and harass student leaders. Budget cuts have been aimed at reducing the student intake, eliminating free board and lodging for students from distant areas, and ending the financing of the farming activities that have been an essential means of support for these rural schools. In two of the schools, it is now forbidden to organize independent student councils or committees. All too often, government authorities have reacted with legal harassment, police violence, and even the use of the Mexican army in response to peaceful efforts on the part of students and their parents to defend the schools..

The Plan Puebla Panama in the State of Guerrero

Sr. Mayo briefly described three scheduled development projects that are part of the Plan Puebla Panama in Guerrero. There are plans to construct hydro-electric dams at La Parrota on the Papaguayo River in the municipality of Acapulco as well as in Quetzalapa in the municipality of Ometepe . Both of these dams will flood land on which crops are being grown to supply regional markets. The attitude of the government is that there is an imperative need to generate more electrical power and that food can be imported.

In La Parrota, where 1800 hectares will be flooded, campesinos are being offered compensation of 300 pesos per hectare. Most people have relatively small plots of land - usually less than ten hectares. The price of a new house or apartment in the area is approximately 120,000 pesos. Expropriation thus means the loss of land, home, and livelihood.

The third project is a Volkswagen car factory which, despite the fact that it will emit toxic wastes, is to be built near a residential area. During the construction phase, there will be jobs for local people on a six-month contract basis. However, local residents anticipate that, once the factory is in operation, there will be few jobs for them.

Sr. Mayo briefly described the history of social repression in the state of Guerrero, going back to the Adirty war@ against the guerrilla movements of the 1970s.. He emphasized the fact that leaders of social organizations have historically been the targets of such repression. (Mexican writer Carlos Montemayor has pointed out that social activists such as former school teacher Lucio Cabañas have taken up arms when the paths to peaceful social change were blocked by official violence.) He referred to the disappearance of teacher Gregorio Alvaro López and the violent death of an activist at his own college, the imprisonment of Benigno Gúzman of the Campesino Organization of the Sierra Sur, and the massacre of seventeen of that organization=s members at Aguas Blancas in 1995.

The traumas of war and political violence can never really be forgotten. This history of repression is always present in Sr. Mayo=s mind when he talks of current civic resistance in his home state of Guerrero to the projected local manifestations of the Plan Puebla Panama .