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Healthcare Costs Push Almost 100 Million People Into Extreme Poverty Every Year

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By Max Lawson for Oxfam India

When I first arrived in Kenya, it was some time before I could get a car. Instead, I was moving around by taxi. I met my driver Micah on the first day, and he helped me hugely, taking my kids to school, and helping me navigate Nairobi, where Oxfam International recently shifted its base too. He has become a family friend now, and his kids, June and Phillip often come at my place to play with my boys.

As a taxi driver, Micah earns about $30 a day at most, so after working six days a week, the maximum amount he takes home is around $720 a month. This means he is far from the poorest of the poor. He lives with his family in a working-class area, but not in one of the slums in the city. He also owns some land outside Nairobi in the Rift valley, where he has some cattle and grows some crops to support his income.

Three weeks ago, his 104-year-old grandmother was attacked by thieves in her home in the far west of Kenya. She ended up in intensive care for three weeks. Sadly, she died. The family was then landed with a bill of 5.4 million Kenyan Shillings, or 54,000 dollars. This is the equivalent of six years of Micah’s earnings. The hospital refused to release the body until they were paid, while charging him for every day when the body was being held in the morgue.

To pay this bill he has leased his land to someone else for six years. He has also taken out a loan on his car, as well as borrowed money from family and friends to be able to release the body for burial. Sadly, these stories are all too familiar in Kenya and other developing countries. Often in our reports, I have quoted the figure that every year 100 million people are forced into extreme poverty by the catastrophic impact of health costs. There are 100 million stories like Micah’s every year.

This week I was in Indonesia for the World Bank and IMF meetings. On Wednesday night, I was chatting to a taxi driver there. His name was Eddie. He has two boys of similar age as Micah’s children, a wife and an elderly mother living at home. I asked him what he felt about President Joko Widodo, who is up for re-election next year. He said he thought Widodo was brilliant.

I asked why, and the first thing he said was that the President has introduced universal healthcare. He only has to pay a small amount each month to have his whole family covered. His wife recently had some problems with her back, which required surgery and an MRI, costing around 60 million rupees, or approximately $5,000, which she got from a public hospital. He did not have to pay a thing. He described how good it felt to no longer have to worry about the cost of getting sick.

The original architects of the welfare state in the UK and the United States spoke about ‘freedom from fear’. Universal health coverage is not just about the money saved by the poor; it is also about freedom from fear. Freedom from worrying about how you will afford to look after your children if they fall sick. Freedom from going bankrupt without any notice. Eddie is better off financially, and he and his wife no longer have to worry. His life is more secure now, and he is happier as a result.

Politicians in rich countries in the 20th century and politicians like President Joko Widodo understand that this is a profoundly progressive and popular thing to do for your people. The Indonesian health service still faces major challenges, but the commitment of the government to securing good health for everyone is clear. Steps like this mean a lot to ordinary people.

Oxfam’s Commitment to Reducing Inequality index (CRI) 2018 released this week. It got quite a bit of media coverage in different countries, and we ended up in quite a debate with the Government of Singapore in particular which was fun. They came in the bottom ten, partly because of their actions as the notorious tax haven, and partly because they are one of few countries without a comprehensive minimum wage. They were not happy.

It is possible for governments to do the right thing and provide health care for all their citizens. I hope the Government of Kenya realises this. Until then, fear of sickness will be the everyday experience of hundreds of thousands of Kenyan families.

 Mickey Mouse Tax Cuts

With the mid-terms approaching in the United States, the campaigning is hotting up. One group that I have been following for a while who I really think are brilliant are called the Patriotic Millionaires. They are a group of rich Americans who came together in 2010 to oppose tax cuts on the rich.

Proud “traitors to their class,” members of the Patriotic Millionaires are high-net-worth Americans, business leaders, and investors who are united in their concern about the destabilising concentration of wealth and power in America. The mission of the Patriotic Millionaires organisation is to build a more stable, prosperous, and inclusive nation by promoting public policies based on the ‘first principles’ of equal political representation, a guaranteed living wage for all working citizens, and a fair tax system:

  • All citizens should enjoy political power equal to that enjoyed by millionaires
  • All citizens who work full time should be able to afford their basic needs
  • Tax receipts from millionaires, billionaires and corporations should comprise a greater proportion of federal tax receipts.

They have filmed this short video of an heiress to the Disney fortune speaking about her opposition to tax cuts. It is brilliant. She also gives away some important Disney secrets too.

Max Lawson is the Head of Inequality Policy, Oxfam International and is based out of Nairobi, Kenya. He can be reached via Twitter @maxlawsontin 

This story was originally published by Oxfam India.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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