Moving from charity to rights

Global evidence on inequities in rural health protection 31

4.2.2. Moving from charity to rights

The evidence on ruralurban inequities indicates that in most countries a higher percentage of the urban population enjoy rights to health protection coverage than the rural population. As we have seen, the global figures show that while 22 per cent of the population in urban areas lack legal health coverage, 56 per cent of the rural population are not affiliated to any health scheme or system. The existing gaps reflect an absence of legislation or fragmented legislation that concerns more than half the global rural population. While some people without legal rights to health care may have access if they purchase care on a private basis, the majority are unable to do so and thus have no entitlement to health services when in need. Where legislation is fragmented, it may for instance exclusively cover registered formal workers while excluding seasonal and migrant workers, family members or those working in the informal economy. In addition to these gaps, and contrary to the principles of equity and universality, people living in rural areas often do not enjoy the same rights and entitlements as those living in cities. The reasons for low levels of legal coverage relate to the absence or insufficiency of inclusive legislation. In these cases, charities are often present whose purpose is to serve the rural population, the poor, the vulnerable or the otherwise excluded. Such charities are well- meaning and much appreciated, but they cannot serve as an excuse for government to ignore its responsibility to the population as a whole, providing legal coverage and equitable access to health care for all. As a prerequisite for equity and equality, a rights-based approach is the most appropriate framework for countries to use when considering ways to narrow and eliminate the urbanrural gap. This is not only in line with the human right to social security and health, but is also highlighted in various ILO Conventions and Recommendations, most recently in Recommendation No. 202 which insists on rights-based approaches to social security and health including the provision of basic guarantees for all irrespective of where they live. Thus, Recommendation No. 202 requires that inequities be addressed both across and within countries. Addressing gaps in rights requires a focus on at least basic guarantees to health services provided under the roof of universal health protection. Legislation should clearly specify the range, qualifying conditions and levels of benefits. Further, entitlements should be regularly and transparently reviewed, so that those making the decisions can be held accountable. Finally, the legislation needs to be implemented with a view to achieving equitable access to health care for all. Poor implementation of legislation is a key concern for rural populations: The absence of infrastructure, the lack of health workers or high co-payments are among the main reasons for poor access. Further issues relate to setting up approaches that match the specificities of rural populations, including personal and work status, or illiteracy with its related lack of awareness of rights.

4.2.3. Developing fiscal space and allocating resources to rural health protection