Most health workers are women. Women, as service users, are directly affected by changes in health service delivery.
Photo © John Brown All Rights Reserved
You may remember awhile back I posted World Pulse Highlights Cambodia's Women Through Their Own Eyes. In the post I wrote, "I began to wonder how tough it is for the "Average Joe" and his wife to go through the birth process with access to adequate health facilities in such short supply. I then thought of a street dweller who lives on my street that is about to give birth any day. I asked a man familiar with her situation, "Where is she going to have her baby?" "Right there" he said, pointing to her plywood and plastic shack."
The good news is that the woman did indeed give birth to a beautiful little baby girl in her ramshackle living quarters with the assistance of a midwife who was paid 5000 riels (1 USD = 4100 riels May 2009) for her services.
I also learned that the midwife might have been trained by Doctors Without Borders (Medecins sans Frontières / MSF). Apparently, MSF delivered two of the infant's older siblings and has been transitioning women to take up some of the duties MSF previously performed through a training program. This seems as if it's a sustainable way to help reconstruct the healthcare system in Cambodia in the absence of any government-funded assistance.
Allow me to set the scene a little more clearly. The new mother's family shack is located roughly 200-300 meters from a strip of "karaoke bars". Every evening expensive new SUV's that sport red white and blue RCAF (Royal Cambodian Armed Forces) license plates cruise by the hovel enroute to the bars. Joining these nightly caravans are white pick-ups driven by Cambodian government ministry officials whose green and white tags are adorned with the word "State".
What began to perplex me is why so much money is being allocated to vehicle purchases by the government or the people who drive them and so little to healthcare? MSF was doing it's job needless to say, and the new mother forked over two days pay to the midwife to have her baby, but how many babies could be delivered in Cambodia for the price of a pick-up or SUV?
In a two-page position statement issued by Public Services International (PSI) entitled "Women's Health a Common Agenda", they assess the current state of health sector reform around the world. What's happening?
According to PSI, the continuing trends in the health sector include:
1. Reduced public funding
2. Increased privatization
3. Increased user-pays - often higher costs for those least able to pay
4. Reduced access to services
5. Reduced women's and child health support services
6. Migration of health professionals from high need to low need regions
7. Fewer jobs and career opportunities for women
8. A shift of responsibilities from the state to families and in particular women
9. A shift in health management from professional health workers, often
women, to commercial managers, usually men.
The assessment continues, "The problems are magnified in poor countries. Lack of clean water and sanitary facilities, poor basic health care and epidemics are widespread. Already minimal services have been further cut as a result of regional financial collapse and the inevitable interventions by international financial institutions such as the IMF and the World Bank."
Transnational Corporations (TNCs) also enter the picture and PSI states, "their motive is bottom-line profit." Unconcerned with women with "deep needs and shallow pockets" they are expanding under the "direct urging of international financial institutions."
I don’t know about you but earning a buck twenty-five for delivering a baby seems like a bargain to me, even if it is two days pay for 35% of Cambodia's populace. The midwife makes out comparatively well relative to those 5 million folks but a DOLLAR AND A QUARTER?
"Women's Health a Common Agenda" concludes, "We want to make sure that changes in the health sector are better suited to workers, the majority of whom are women." "Just as importantly we want to ensure that changes are suited to the women who use health services"
What they are saying here folks is they think delivering a baby for a woman who lives in a wooden hut is worth more than a buck and maybe we all should rethink the wisdom of people giving life in these hovels to begin with.
PSI says they need our help because they "need to know more about the problems and successes from the perspectives of NGOs in health."
That perspective is probably important in most places but in Cambodia, maybe just standing near a shack watching a nightly government motorcade could be of more value.
John Brown Photojournalist On LIGHTSTALKERS
My Mondo Library Photography
My Photoshelter Photography Archive Homepage
Photo © John Brown All Rights Reserved
You may remember awhile back I posted World Pulse Highlights Cambodia's Women Through Their Own Eyes. In the post I wrote, "I began to wonder how tough it is for the "Average Joe" and his wife to go through the birth process with access to adequate health facilities in such short supply. I then thought of a street dweller who lives on my street that is about to give birth any day. I asked a man familiar with her situation, "Where is she going to have her baby?" "Right there" he said, pointing to her plywood and plastic shack."
The good news is that the woman did indeed give birth to a beautiful little baby girl in her ramshackle living quarters with the assistance of a midwife who was paid 5000 riels (1 USD = 4100 riels May 2009) for her services.
I also learned that the midwife might have been trained by Doctors Without Borders (Medecins sans Frontières / MSF). Apparently, MSF delivered two of the infant's older siblings and has been transitioning women to take up some of the duties MSF previously performed through a training program. This seems as if it's a sustainable way to help reconstruct the healthcare system in Cambodia in the absence of any government-funded assistance.
Allow me to set the scene a little more clearly. The new mother's family shack is located roughly 200-300 meters from a strip of "karaoke bars". Every evening expensive new SUV's that sport red white and blue RCAF (Royal Cambodian Armed Forces) license plates cruise by the hovel enroute to the bars. Joining these nightly caravans are white pick-ups driven by Cambodian government ministry officials whose green and white tags are adorned with the word "State".
What began to perplex me is why so much money is being allocated to vehicle purchases by the government or the people who drive them and so little to healthcare? MSF was doing it's job needless to say, and the new mother forked over two days pay to the midwife to have her baby, but how many babies could be delivered in Cambodia for the price of a pick-up or SUV?
In a two-page position statement issued by Public Services International (PSI) entitled "Women's Health a Common Agenda", they assess the current state of health sector reform around the world. What's happening?
According to PSI, the continuing trends in the health sector include:
1. Reduced public funding
2. Increased privatization
3. Increased user-pays - often higher costs for those least able to pay
4. Reduced access to services
5. Reduced women's and child health support services
6. Migration of health professionals from high need to low need regions
7. Fewer jobs and career opportunities for women
8. A shift of responsibilities from the state to families and in particular women
9. A shift in health management from professional health workers, often
women, to commercial managers, usually men.
The assessment continues, "The problems are magnified in poor countries. Lack of clean water and sanitary facilities, poor basic health care and epidemics are widespread. Already minimal services have been further cut as a result of regional financial collapse and the inevitable interventions by international financial institutions such as the IMF and the World Bank."
Transnational Corporations (TNCs) also enter the picture and PSI states, "their motive is bottom-line profit." Unconcerned with women with "deep needs and shallow pockets" they are expanding under the "direct urging of international financial institutions."
I don’t know about you but earning a buck twenty-five for delivering a baby seems like a bargain to me, even if it is two days pay for 35% of Cambodia's populace. The midwife makes out comparatively well relative to those 5 million folks but a DOLLAR AND A QUARTER?
"Women's Health a Common Agenda" concludes, "We want to make sure that changes in the health sector are better suited to workers, the majority of whom are women." "Just as importantly we want to ensure that changes are suited to the women who use health services"
What they are saying here folks is they think delivering a baby for a woman who lives in a wooden hut is worth more than a buck and maybe we all should rethink the wisdom of people giving life in these hovels to begin with.
PSI says they need our help because they "need to know more about the problems and successes from the perspectives of NGOs in health."
That perspective is probably important in most places but in Cambodia, maybe just standing near a shack watching a nightly government motorcade could be of more value.
John Brown Photojournalist On LIGHTSTALKERS
My Mondo Library Photography
My Photoshelter Photography Archive Homepage
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