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Liberalization of Trade in Health Services

Balancing Mode 4 Interests with Obligations to Provide Universal Access

South Centre, January 2008

INTRODUCTION

Many countries of the world, developing ones included, have got very strong ambitions on the increase in market access and national treatment commitments for the presence of their natural persons supplying services. At the higher chain of services industries, large corporate companies need to move their workers, in good time, to various subsidiaries across the globe, so as to heighten efficiency, competitiveness and profit margins. At the lower end of the industry, developing countries want to send their skilled and semi-skilled services suppliers to work temporarily in developed countries, so as to capitalize on the tremendous strength and benefit in the flow of remittances.

The movement of natural persons to supply services is a very common phenomenon, particularly in the health sector. Doctors, nurses, and other health service suppliers are on the move in search for better opportunities than are available at home. In the WTO negotiations under the General Agreement on Trade in Services (GATS), developing countries are ambitiously pursuing enhanced market access and national treatment commitments from developed countries for provision of services through the presence of natural persons, including in the health sector. It is well known that the systems for providing health services in developing countries, particularly in sub-Saharan Africa (SSA) are stretched thin.

In a situation where the community of the world's Nations has obligations, imposed by law on governments, to provide their people with universal access to basic health services, legitimate questions of concern arise, regarding what this ambition means for implementing these obligations. Is there a clash of interest and obligation? Are the two issues diametrically opposed? Such that attaining both is impossible? Can these countries deliver on the right to health enshrined in many of their national Constitutions, as well as in international legal instruments to which they are signatory, and in many cases have ratified, yet at the same time aggressively export health service suppliers to other countries?

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