blog Remco van der Veen

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Health for all, but not for me

We never met, yet we fight for the same cause. We shake hands in this blog post and speak with one voice. Against global inequality, exemplified by the gap between both of us, and in favor of universal health coverage.

One of us, Remco, is a 46-year-old father, lives in the Netherlands and has a steady income. That’s me. I know my child, wife or myself will be in hospital within 30 minutes and get the best medical care I can imagine if — god forbid — one of us should need emergency care. Chances are high that life will go on the way it did, with deeper feelings of gratitude. Medical insurance will cover most of the costs. And no one will go bankrupt.

And one of us, Chanceline, is a 27-year-old mother of three, living in a village in Eastern DR Congo. That’s me. A couple of years ago I left the city of Bukavu, with my husband. Living costs were too high. In the village we built our own house, grow our own vegetables, drink rain water. We cope. Until one of us gets ill. The nearest basic health center is 27 km away. We can’t pay transportation by motorbike. So we walk. And we pray that the center will be open, medicines will be available and no referral to the city hospital is needed.

Health for all in conflict-affected places demands decades of loyalty and dedication.

The city or the village? Hunger or illness? It’s not even a real choice. Poverty makes them go hand in hand.

Watch The Walk: a real-time video of Chanceline’s long walk to the nearest clinic.

This year my third child was born, a baby girl. Just like during my previous pregnancies, I walked back and forth five times to the health center for antenatal check-ups. I covered 270 km. Rain, mud, scorching sun and military check points couldn’t stop me. My husband was worried something might happen. He couldn’t accompany me, as he needed to stay home and take care of our older kids. The fifth walk is the most difficult. You have to plan it at the right time: be there in time to deliver and not too much in advance. Otherwise I need to find lodgings and stuff to eat and we don’t have money for that. But it went well. I walked back with my baby. Two days later we made the walk again, to vaccinate my newborn.

For me this is normal. But it shouldn’t be.

Unequal access to even the most basic health services is an indicator of worldwide injustice and moral illness. 400 million people have no access to life-saving health care. They risk their lives and their incomes for the simplest of medical services.

But an affordable dream is still a dream. I, Chanceline, know that all too well.

On paper the world stands united. The United Nations’ bold development agenda wants every person in the world, by 2030, to have access to essential health services without suffering financial hardship. ‘Essential’ includes — at least — modern family planning services, antenatal care, skilled birth attendance, DTP vaccinations and antiretroviral therapy.

Last year Amartya Sen called universal healthcare ‘an affordable dream’. Affordable it is. Over 300 brilliant economists declared that economic benefits of investments in health improvement are estimated to be more than 10 times greater than costs. They calculated that health improvements in the past decade constituted 24% of income growth in low- and middle-income countries. They reminded us that eradicating poverty starts with health and that good health systems mitigate the impact of disasters and shocks, foster education, cohesive societies and productive economies.

But an affordable dream is still a dream. I, Chanceline, know that all too well. Nothing has changed for me. The hills, the sun, the mud and the checkpoints are still there. I still walk a full day with my newborn for a 10-minute check-up. Affordable healthcare without financial hardship is supposed to be a human right. Where is my right?

Affordable healthcare without financial hardship is supposed to be a human right. Where is my right?

‘Act with ambition’ is this year’s Universal Health Coverage Day slogan. My ambition, as a young mother in Eastern Congo is to cope with reality.

And my ambition, as program Director of Cordaid, is to convince policy makers and donors that health for all in conflict-affected places like South Sudan, the Central African Republic and Eastern DR Congo demands decades of loyalty and dedication as well as long-term and flexible development aid. This goes against a lot of the current donor policies, obsessed as they are by short term investments, quick results and fancy public-private partnerships. But it’s the only way to make sure Chanceline’s kids do not run the risks their mother ran by giving birth to them.

Meanwhile Cordaid will continue relentlessly to strengthen hundreds of health centers and clinics in fragile areas around the globe. Including the one 27 km away from Chanceline’s place. With common effort and commitment, there could be a new one nearer to her house.

This blog was first published on medium.com, 07-12-2016.

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