Regional Seminar on
GATS and Public Health
27th – 29th August 2007
Cinnamon Grand, Colombo, Sri Lanka
Organized by Health Action International Asia-Pacific (HAIAP) in collaboration with
Ministry of Health, Sri Lanka
Ministry of Healthcare
385, Ven. Baddegama
Wimalawansa Himi Mawatha,
Health Action International Asia-Pacific Colombo 10
(HAIAP) Sri Lanka
No. 05, Level 02, Frankfurt Place Website: www.health.gov.lk
Tel: + 94 112 554353
Fax: + 94 112 554570
The Regional seminar on GATS and public health organized by Health Action International in collaboration
with the Ministry of Health Sri Lanka was held from the 27th to the 29th August,2007 at the Cinnamon Grand
Dr. Athula Kahandaliyange, the Secretary to the Minister of Health, delivering the welcome address, stated
that Sri Lanka provides free public health care services at the point of delivery to all individuals who require
it, as free health care is considered an investment rather than a profit making industry. The government
spends over 62 billion rupees a year on health care and health related services, which is the third highest
expenditure next to defense and education. As a result SriLanka has attained commendable standards in
the health care sector compared to other developing countries; but the rising health budget has made it
difficult to maintain these standards. International agreements such as TRIPS and GATS have a negative
influence on public health. Policy makers and negotiators are not aware of the implications of such
agreements until they come into practice. Therefore it is imperative that we create a critical mass of
activists knowledgeable on GATS and Public Health who will be able to initiate public debates. An informed
and educated public will then bring pressure on trade negotiations to focus on the national health policy
goal- Health is a fundamental human right- and resist the WB, IMF and WTO agenda to make health a
OBJECTIVES OF THE SEMINAR
Dr K Balasubramaniam
Advisor & Co-ordinator,
Why this Consultation?
Next to food, health and health care are the major concerns of the people. Regular access to basic health
care and essential drugs should always be available. Therefore it is universally accepted that a
fundamental function of governments is to ensure and protect peoples‟ access to essential services such
How is this ensured?
Traditionally this meant that health services were considered a public good. Governments owned and
provided health services in all developed and developing countries except the US. Health services were
never thought of as profit making concerns in these countries. Health services were never affected by
This scenario changed when the General Agreement on Trade in Services – GATS - was agreed upon by
Trade Ministers (and not health Ministers) in the World Trade Organization. Health has now become a
One of the objectives of the consultation is to offer a forum for participants to understand the GATS
process, consequences of liberalizing the health sector and to share experiences of selected countries that
have given specific commitment under GATS. In order to achieve this objective the following questions will
be posed, examined and critically analyzed.
1. Why and how did the GATS get on to the negotiating table?
2. How are healthcare services supplied under the GATS process?
3. What are the consequences of liberalizing the health sector and opening it to foreigners under the
General assumption is that globalization and increased market activity is socially beneficial. More market
activity is even more advantageous as a part of the grand plan of globalization. When this grand
globalization plan is unable to meet vital human needs such as health, it is simply attributed on market
What is market failure?
Market failure is not at all like an engine spluttering and coming to a stand still. It is like an express train
that whizzes through the railway station leaving all the waiting passengers. This is what has happened
Globalization has increased poverty in the developing countries. Data from Human Development Reports
published by-UNDP support this statement. The richest 5 percent of the world‟s people receive 114 times
the income of the poorest 5 percent. The richest 1 percent of the world‟s population receives an income as
much as 3.42 billion people or 57 percent of the world‟s population.
The 25 million richest Americans have an income as much as almost 2 billion of the world‟s poorest people.
In 54 countries there was a negative growth in the per capita GDP income during 1990-2001. Of the 67
countries with data for poverty rates available, 37 countries saw poverty rates in the 1990s increased. In
South Asia, home to almost 500 million poor people, the number has hardly changed during this period.
The ratio of the incomes of the rich and poor countries between 1820 and 1992 is given below.
Year Ratio of income of the Rich and the Poor
1820 3 1
1913 11 1
1950 35 1
1973 44 1
1992 72 1
The UN has classified the poorest and structurally weakest countries as Least Developed Countries LDCs.
In 1971 there were 21LDCs; in 2000 there were 49. In a period of 29 years 28 countries have fallen down
into the category of LDCs.
The ultimate goal of healthcare services is Good Health for All. This is a non-market outcome. Therefore
markets will necessarily fail in the health sector. Can we correct this market failure under the existing
international trade rules of the World Trade Organization? According to Ralph Nadar, “Big Business and its
lawyer – lobbyists wrote the rules of the WTO”. Do we have substantial evidence to support that WTO will
ensure “Good health for all”.
How should developing countries respond to GATS?
This is the major objective of the consultation. There has been very little or no public debates or
discussions about the way in which privatization of public services such as health care at the national level
is linked to the global trade expansion policies of the WB, IMF and WTO – the three intergovernmental
agencies overseeing the grand globalization plan although it has been shown that opening up healthcare
services poses a serious threat to public services.
Why has there been no public debate on GATS in countries of the region?
The answer has been given by a social scientist “An ignorant and misinformed public can hardly participate
in a public debate”. This consultation will, hopefully, create a critical mass of health activists knowledgeable
on the GATS who will be able to initiate/catalyze public debates on GATS and public health in countries of
Why public debates?
Liberalization and opening of healthcare markets depend on an agreement by negotiators of one
government to another to open up. This is where public debates become crucial. An informed and educated
public will be able to influence a country‟s response by bringing pressure on negotiators. By lobbying and
campaigning, public pressure can get the negotiators to keep in focus the national policy goal – “Health is a
Fundamental Human Right” and resist the WB, IMF & WTO agenda to make Health a marketable
OVERVIEW OF GLOBALIZATION, TRADE AND HEALTH
UNDP RCC Colombo
Globalization is an umbrella understood as a process of increasing integration of nations across economic,
social, technological, cultural, political and ecological spheres (Wikipedia). It is characterized by a quest for
a global market for goods and services through greater trade (WTO, FTAs) and investment flows (FDI),
movement of people (Immigration) and diffusion of knowledge across national borders aided by rapid
The key drivers of globalization can be categorized as follows:
• Lowering of national barriers through a process of liberalization and privatization for movements of
goods, services and factors related especially capital flows
• Rapid technological advances leading to dramatically lower costs of communication and
• Dramatic decline in transaction costs of both time and money due to the IT revolution (relatively
costless in many cases)
• Interrelated advances in organization of factors of production and distribution (deverticalisation of
firms) as exemplified by global supply chains spanning across the world
Growth in World Merchandise Exports, Trade/Output Ratios (1948- 98)
1948 1950 1973 1990 1998
Billions Current $ 58 61 579 3438 5235
Exports per capita 123 149 466 651 951
Trade/Output Ratio, - 8 14.9 19.7 26.4
Constant 1987 Prices
The table above illustrates the rapid growth of World‟s merchandise export over a period of 50 years. It
shows that, from 1973 to 1990 the exports have multiplied by six times, which is relatively high compared to
the previous years.
Total net Resource Flows to Developing Countries by type of flows, 1990-2005 (Billion of Dollars)
Source: World Investment Report, UNCTAD, 2006
The graph above shows a decline of total net resources from 1996 to 2001 and an even steeper increase in
flows from 2001 to 2005.
Trade and Health
Agreements, their key provisions and potential impact on health are categorized below:
Agreements Key Provisions Key Potential Impacts on Health
Trade Relates Aspects Sets the floor for protection Increase in price of patented drugs;
of Intellectual Property of IPRs (e.g. Patents, reduce affordable access to
Rights (TRIPS) Copyrights) essential medicines for poor,
Patentability of traditional
knowledge leading to biopiracy.
Sanitary and Affects national policies for It may be difficult to ban products
Phytosanitary Measures food safety, animal and such as GMOs; increased costs of
(SPS) plant health risk assessment (Interim report of
WTO Panel on US-EC case on Ban
of GMO, 2006)
Technical Barriers to Affects regulations, It may be difficult to regulate
Trade (TBT) standards, testing and imports on health and safety
certification procedures so grounds if measures are perceived
that they are not trade as restricting trade
General Agreement on Seeks to liberalise trade in Undermine governments’ ability to
Trade in Services services covering 160 deliver and regulate health services
(GATS) sectors including health in an affordable and equitable
Source: WHO 2004
Source: Rupa Chanda, 2005
Source: Rupa Chanda, 2005
The two scatter graphs compare the distribution of total health expenditure and total private sector health
expenditure in developed and developing countries. According to this graph most developed countries have
high health expenditure per capita compared to the developing countries including China and India. Most
developing countries show higher percentage of private sector spending compared to most developed
Trade in Health Services
Trade in Health Services is currently low but is expected to grow. The low level of growth in Health services
is due to inhibitions in the sector such as:
• Regulatory restrictions preventing movement of professionals and patients
• Institutional constraints (monopoly and exclusivity restrictions) prohibiting foreign
• Technology related barriers
• Political sensitivity of liberalizing the health sector
These inhibitions will be reduced through the following trends and potential:
– Increasing trends of privatisation in health sector and gradual withdrawal of the State in
public health provisioning
– The growing trends in worldwide health care expenditures which were estimated at $3.3
trillion in 2001 and were expected to grow to $4.4 trillion per year by 2005 [Rupa Chanda,
– The potential for trade in health services has expanded rapidly over recent decades. The
technological and economic forces working towards global market integration are unlikely
to leave the health sector unaffected.” [Rudolph Adlung and Antonia Carzaniga, WHO,
GATS is set to be the chief vehicle for trade in health services in the future.
GATS attempts to create a structure and discipline on services trade on a multilateral basis and
request/offers are made taking a “bottoms up” approach. While these maybe considered favorable aspects,
the unfavorable aspect is the Ratchet effect. It is a lock in where countries effectively can liberalise more
not less. Irreversibility is practically not possible. Modification of schedule of commitments are possible only
possible after 3 years and only after due compensation undefined at the moment. (Art. 21)
GATS and Health Services: Key Issues
• Scope and Coverage:
GATS has a comprehensive coverage of 160 services sectors. Basically “anything which you cannot drop
on your foot is within GATS”. GATS applies to all measures affecting trade in services (Art1.1).
Institutionally includes services offered by central, regional and local governmental authorities and NGOs
with delegated regulatory powers (Art. 1.3a). The Preamble to the GATS Agreement notes the need for
early achievement of „progressively higher levels of liberalisation in trade in services‟ through successive
rounds of negotiation‟
On a general level, GATS does not apply to measures affecting trade in services supplied in the exercise of
governmental authority [Emphasis added. Art.1.3.(b)(c)].Qualification means any service which is supplied
neither on a commercial basis nor in competition with one or more service suppliers. Fair amount of
ambiguity surrounding the interpretation of these provisions: no coherent use of the term even within the
WTO. Negotiating guidelines of GATS state that no sector shall be excluded a priori from the scope of
negotiations [WTO, 2001]. Some legal interpretations based on case law relating to law of treaties and
similar provisions in EC law suggest that exclusion would depend not on the nature of this service as a
government function but on the fact that it is neither supplied on a commercial basis nor in competition with
other service suppliers [Markus Krajewski, 2003]
It appears that Article 1.3 of GATS is likely to be interpreted narrowly and that most public services are
likely to fall within the sectoral scope of GATS
The list of health related services illustrated in:
– Division 93 of the United Nations Central Product Classification (CPC based on the nature
of the service delivered)
– Services Sectoral Classification List of WTO
– Many health relates services do not fall within health services
• e.g. medical education services classified as education services and medical
transcription services as data processing services
• Medical and dental services, veterinary services and the services provided by
nurses, midwives etc which have been grouped separately under Professional
Listed below are the total members of GATS Commitments on Health Services and the number of
commitments by developing countries.
Service Category Total # of Commitments No. of Developing
Medical and Dental Services 64 36
Hospital Services 44 29
Nursing, Midwifery Services 29 12
Other health Services 17 15
Source: Gopakumar, Syam, 2006
Modes of Service Supply under GATS and Health Opportunities and Risks
Below is a look at the opportunities and risks according to the modes under GATS.
Supply Modes Opportunity Risk
Mode 1 Cross Border Supply of Service Increased care to remote Diversion of
(telemedicine, ehealth) and underserved areas resources from
Key driver: Advances in Information other health
Mode 2: Consumption of services abroad Generates foreign Crowding out of
(patients travelling abroad for hospital exchange earnings for local population
treatment) health services of and diversion of
Key Driver: Costs, quality and availability importing countries resources to
of treatment, natural endowments service foreign
Mode 3: Commercial presence Creates opportunities for Development of
(establishment of health facilities in other new employment and two-tiered health
countries) access to new system with an
Key Driver: Lower barriers to entry technologies internal brain
drain of medical
Mode 4: Presence of natural persons Economic gains from Permanent
(doctors or nuses practicing in other remittances of health care outflow of health
countries) personnel working personnel, with
Key Driver: Lower barriers to entry overseas loss of
Source: Based on WHO, 2004
Points for Discussion
• Social good of public health versus economic good of health services trade
• Potential Disconnect between GATS and objective of Health for All
• Danger of widening inequities in health services access
• Regulatory constraints for improving health access, no room for hindsight correction
• Autonomous Liberalisation reversible route versus legally binding nature of obligations in GATS
• Health as a human right should inform and guide the proposals to liberalise health in services
• Countries need to institutionalize the process of evaluation of both requests and offers in health
related services before making legally binding market access and national treatment commitments
• A key question to ask in this regard relates to the inter agency coordination in trade policy making
and participation of health ministries and civil society in the process
• Need for a multi-stakeholder dialogue by generating and sharing evidences at several levels to
examine closely the interplay between international trade and health policy at all levels
• International trade-health policy coherence at national and international levels (Resolution at the
59th World Health Assembly, 2006)
THE GENERAL AGREEMENT ON TRADE IN SERVIVES AND PUBLIC HEALTH
Dr K Balasubramaniam
Advisor and Co-ordinator
Health Action International Asia – Pacific
Health is a Fundamental Human Right. Primary function of governments is to ensure this fundamental right
by protecting peoples‟ access to healthcare service. Traditionally Healthcare services were considered a
public good; a public good is owned and provided by governments. It is never considered a profit making
concern and is never affected by trade. Yet this is not enshrined in the constitution of most countries.
Therefore civil society has argued that since all countries in the Asia- Pacific region have signed or ratified
International Human Rights Conventions and Treaties which health as a human right, the governments are
obliged to promote and protect the Right to Health.
During the immediate Second World War period GATT was signed to revive the economy of the devastated
nations. GATT – General Agreement of Tariffs and Trade, 1944 was an International Agreement that
focused only on movement of goods across borders. But in 1986, the developed countries led by the US
and supported by the Transnational Corporations (TNCs) introduced Intellectual Property Rights,
Investment and Services into international Trade. The whole scenario changed with the beginning of the
Uruguay Round of negotiations in 1986.
The following agreements were signed,
Intellectual Property- Trade Related Intellectual Property Rights (TRIPS)
Investment-Trade Related Investment Measures (TRIMS)
Services- General Agreement on Trade in Services (GATS)
The GATS is a legally enforceable multinational set of rules to cover a wide array of services that were
traditionally owned and provided by the state. The range of services covered by the GATS is very extensive
and is organized under 12 sections.
Business Communication Distribution
Education Construction & Sports
Health & Environment Culture and
Financial Tourism Transport and
Services Other Services
In short almost all aspects of our daily life are covered by the GATS.
Essential services are basic necessities and should never be left to the market to be sold and bought at
prices decided by market forces where profit maximization is the guiding principle.
In developing countries, provision of these essential services is of critical importance to poverty reduction
and economic, social and human development.
Sovereign nations have a moral mandate to ensure that these essential services are publicly owned,
controlled and provided so that even the poorest of the poor have regular access to the basic necessities
whether or not they can afford to pay.
GATS is not limited only to cross – border trade in services. GATS prevents government regulation of
foreign investment. GATS enables TNCs penetrate developing country markets and set up business in the
host countries according to their own rules.
There are five important rules of GATS.
Most favoured Nation (MFN): This requires a WTO member state to treat all other WTO member
For example WTO member states should treat the United States and small least developed
countries such as Nepal, Maldives equally. Is this a level playing field?
National treatment: This means that foreign TNCs must be given the same treatment as a national
For example TNCs which had contributed nothing to a host country‟s development would be
eligible for government loans on the same terms as domestic service providers in their countries
who have contributed to a country‟s revenue by direct income tax payments. And if TNCs enter a
developing country under the Board of Investment, special regulations provide exemption from
income tax for about five years.
Market access: This obliges a host country not to impose new quantitative or structural restrictions
on foreign service providers.
Domestic regulation: This requires that national and local regulations not be “more burdensome
than necessary” to the provision of services.
Compensation: This means that compensation should be given to the foreign investors if the host
country has revoked a specific commitment in a particular sector.
These five GATS rules have been designed to allow TNCs enter developing countries operate freely and
extract maximum profits catering to the high income earners by tying up the hands of the governments. Big
business and its lawyer-lobbyists wrote the rules of the GATS and these were thrust upon developing
countries, this shows yet another face of neo-colonialism.
GATS is a one sided investment tool that will give unhampered access to markets and human services and
grant them as much, if not greater rights than citizens to exploit much access.
Commitments made by governments are effectively irreversible. Privatization and de-regulation of services
are highly controversial, yet governments are not only signing away their own rights to regulate but the
rights of future generations to implement different policies. Before entering into negotiations to open the
market our negotiators should have full knowledge of the consequences and implications of opening health
– related services to Foreign Service providers.
Do these negotiators know the consequences of opening health related services to foreign service
The simple answer is NO.
This has been reiterated at the highest global political level. A Resolution adopted by ECOSOC – The
United Nations Economic and Social Council, 15th August 2001 (E/CN.4/SUB.2/RES/2001/4)is very
relevant to this consultation.
The Sub-Commission on the Promotion and Protection of Human Rights,
Affirming the fundamental importance of the delivery of basic services, particularly in the areas of health
and education, as a means of promoting the realization of human rights,
Emphasizing the responsibility of Governments to ensure the realization of all human rights, including
those to which the provision of such basic services is relevant,
Recognizing the potential human rights implications of liberalization of trade in services, including under
the framework of the General Agreement on Trade in Services (GATS),
Acknowledging and emphasizing the entitlement of Governments to regulate to achieve legitimate policy
objectives such as to ensure the availability, accessibility, acceptability and quality of basic services such
as medical services, education services and other necessary social services,
Noting that in its General Comment 14, the Committee on Economic, Social and Cultural Rights defined
the accessibility of a service as having four dimensions: non-discrimination, physical accessibility,
economic accessibility and information accessibility,
1. Calls upon Governments and international economic policy forums actively to ensure that, in the
formulation, interpretation and implementation of policies in relation to the liberalization of trade in
services, the liberalization of trade in services does not negatively impact on the enjoyment of human
rights by all persons without discrimination;
2. Requests the United Nations High Commissioner for Human Rights to submit a report on the human
rights implications of liberalization of trade in services, particularly in the framework of the General
Agreement on Trade in Services (GATS), to the Sub Commission at its fifty-fourth session;
3. Encourages other relevant United Nations agencies, in particular the World Health Organization and
the United Nations Educational, Scientific and Cultural Organization, to undertake analyses, within their
respective competencies, of the implementation of GATS on the provision of basic services such as
health and education services;
4. Recommends, through the High Commissioner for Human Rights, that the World Trade Organization
and its Council for Trade in Services, in conducting its assessments of the impact of GATS in its
current and future forms, include consideration of the human rights implications of the international
trade in basic services (such as, inter alia, the provision of affordable and accessible health and
education services) and the further liberalization thereof;
5. Also recommends, through the High Commissioner for Human Rights, that the World Trade
Organization take into account in assessments of the implementation of GATS the report to be
prepared by the United Nations High Commissioner for Human Rights and any analyses prepared by
other United Nations agencies;
6. Encourages the United Nations High Commissioner for Human Rights and other relevant United
Nations agencies that have not already done so to request observer status with the Council for Trade in
Services of the World Trade Organization;
7. Decides to continue its consideration of this matter under the same agenda item at its fifty-fourth
This ECOSOC resolution mandates the WHO, and the WTO to carry out studies on the consequences of
opening health related services to foreign investors. The WTO has also underscored the importance of
carrying out such studies; GATS Article XIX.3 requires WTO Council for Trade in Services to carry out an
assessment of trade in services both in overall terms and on a sectoral basis, prior to establishing
guidelines for each new round of GATS negotiation. Regrettably neither the WTO Council nor the WHO has
carried out studies on the impact of liberalization of trade in services on health and human development.
The ECOSOC Resolution and the GATS Article XIX.3 clearly underscore the critical importance for
developing countries to have a clear understanding of the full impact of liberalization on health and human
development before opening essential services, such as health, to foreign investors.
WHO, and WTO have been mandated to prepare analytical studies on the consequences of liberalization of
health services to guide negotiators from developing countries to enter into negotiations. No such studies
have been made up to date. Developing countries cannot, therefore, make any specific commitments till
guidance is made available.
To understand the potential implications of opening health care services, we should understand how
healthcare services are supplied under the GATS process.
There are four different ways in which services are supplied between countries. In GATS parlance they are
called four modes of supply.
Cross border supply
Foreign Commercial presence
Temporary movement of national persons
These are of critical importance since Governments of developing countries are pressurized by the
developed countries to enter into specific commitments on each of these four modes.
Mode 1-Cross border supply
Cross border supply refers to the flow of healthcare services from one WTO member country to another
WTO member in a way that does not require the physical movement of the supplier or the consumer.
There are non commercial tele-links such as Tele-links within countries to connect remote inaccessible
areas to the metropolis eg. Malaysia and Thailand. Tele-links between University hospitals in Japan and
healthcare sites in Cambodia, Fiji, Papua New Guinea and Thailand are also non commercial.
But commercial cross-border trade poses serious concerns. Telemedicine, high technology and capital
intensive infrastructure diverts limited budgetary resources from primary healthcare to the masses toward
specialized urban cities to cater for the affluent minority. WHO – 50th WHA Resolution on uncontrolled sale
of prescription drugs on the internet expressed serious concern over the uncontrolled sale of prescription
drugs which is another example of the dangers of cross-border supply.
Mode 2 – Consumption Abroad.
Eg. Health Tourism
WTO states that only a small number of economically advanced developing countries, preferably located in
the vicinity of major export markets may be able to benefit from health tourism or mode 2. This is an
important observation of WTO, for developing countries to take serious notice. For the majority of
developing countries with limited resources, the economic benefits of health tourism will be outweighed by
the social costs when the limited resources are drawn away from national health priorities to health tourism.
A recent publication of the World Bank posed the following question: What can be done to limit the
possible risks of trade? This question clearly underscores civil society‟s key concern that liberalizing trade
in health services will have a negative impact on equity of access and quality of healthcare.
What follows by way of suggesting remedial measures is disappointing. The authors continue as follows:
1. “GATS does not impose any constraints on the terms and conditions under which a potential host
country treats foreign patients, so, for example, foreigners may be charged extra for treatment and
these proceeds used to enhance the quantity and quality of basic domestic supplies”;
2. “There are no legal impediments in GATS that would affect the ability of governments to discourage
qualified staff from seeking employment in the private sector, whether at home or abroad, such as
through deposit requirement of guarantees that would make it financially unattractive for young
professionals to capitalize immediately on taxpayers investment in their education by seeking higher
3. “It is difficult to see any crowding-out effects, to the disadvantage of resident patients that could not be
addressed through adequate regulation that would not normally fall foul of GATS provisions. For
example, a country might require all private hospitals to reserve a minimum percentage of beds for free
treatment for the needy, to offer some basic medical services in remote rural areas, or to train beyond
the number required for the purposes of these institutions”.
Taking into consideration the ground realities in most developing countries, a critical examination and
analysis of the remedial measures suggested would seem to be unrealistic.
Mode 3 – Foreign commercial presence.
Health related service providers locate their business and operations in a country not their own.
Establishing a presence includes ownership or lease of premises .It is essentially an issue of Foreign Direct
Investment. There are two operative words in this mode that need closer examination.
Let us examine the word “Commercial”. This word implies that health will be a commodity to be sold and
bought in the market. WHO has clearly stated its views on putting health into the market. WHO states that
“By recognizing the right to health as a fundamental human right, international human rights law removes
health from the status of a marketable commodity”. The World Health Organization is the UN lead agency
in health. All countries in the world are members of WHO. The Ministers of Health of each member state
constitute the General Assembly which meets once a year every May in Geneva, where the World Health
Assembly is held. The assembly adopts resolutions, gives mandates for WHO and accepts WHO
documents. All these are binding on the Member States. If health is ever to become a fundamental human
right, it should cease to be a commercial product bought and sold in the market. But mode three commits to
the market place. Therefore we cannot accept mode3.
Let us examine “foreign presence”. Foreign presence includes ownership or lease of premises and is an
essential issue of FDI. Foreign presence is accompanied by foreign direct investment. A major goal of all
developing countries is to attract foreign direct investment.
What is the impact of FDI on Health?
Single objective of FDI is to get the maximum profit for the investors. Therefore it concentrates on high
technology curative services, ignoring the broader social needs of the population. It will lead to “Cream
Skimming”. The best example is private health insurance. Private health insurance covers young, healthy
rich persons and excludes the old, unhealthy and the poor. This is referred to as “Cream skimming” where
the insurance takes off the “Cream” of the Nation who will need minimal health care and excludes those
who need healthcare. WHO has advised developing countries that private health insurance, is a very
regressive way to finance health services and should be avoided.
The authors of the World Bank document, International Trade in Health Services: Current Issues and
Debates – World Bank 2006, states under the section on Mode 3 – Foreign Commercial Presence, that
there are considerable gaps in the knowledge base concerning FDI and trade in health services.
Unfortunately very little has been done to study the impact of FDI on Health.
Therefore it is currently impossible to fully assess the potential impact of FDI on health because of the
1. Uncertainty – There is no definitive interpretation of what existing agreements mean, together with
2. Lack in experience of cross-border trade in health services;
3. Lack of data; and
4. Lack of analysis of impact (partly a consequence of the above).
Where do we stand?
1. Uncertainty. We are not aware of the potential impact of FDI on health.
2. No analytical studies have been made by WTO, WHO on the impact of opening up health services
to the private sector
3. Therefore no informed decision can be made.
In spite of this warning by the World Bank developing countries are inviting foreign health service providers
through institutions like the Board of Investment (BOI) with open arms giving them tax holidays and prime
land at ridiculously low prices. Civil society should campaign against BOI inviting foreign health service
providers and more importantly increase public awareness of the warning by the World Bank.
Countries can do nothing if the uninformed decisions taken to invite foreign health service providers are
shown to have a negative impact or Health. The commitments once made on the basis of inadequate
information or otherwise are irreversible. This will constrain policies indefinitely whereas circumstances may
change profoundly over time and policies have to be changed. Like external debt, future generations are
bound by commitments made now on the basis of inadequate information.
In conclusion we have adequate evidence that developing countries, at this stage, should not commit to
Mode 3 of the GATS process.
Mode 4 – Temporary Movement of Natural Persons
This includes movement of natural persons as people seeking “non-permanent” entry or “Temporary Stay”
for supply of services. Permanent Migration is explicitly excluded.
Implication of migration of doctors
This will inevitably lead to shortages of doctors in the exporting country. We must consider that
considerable resources go into doctors‟ training from taxpayers‟ money. Tax payers do not get anything in
return due to migration of doctors. Migrating doctors do not send back remittances to the home country
unlike maids who go to Middle East.
Developing countries need informed negotiators. At present these negotiators have no guidance.
WTO & WHO have ignored the mandate given by UN ECOSOC by not carrying out analytical studies on
the Health Impact of opening up health services to foreign private sector.
No public debate on how GATS is linked to global trade expansion policies of WB, IMF& WTO and the
Why no public debates?
A social scientist in Sri Lanka has given the reason why there are no public debates on vital issues.
“A misinformed and ignorant public can hardly participate in a critical public debate”. An informed and
educated public is, therefore, a prerequisite for a meaningful public debate. An informed and educated
public can influence a country‟s response to GATS by bringing pressure on negotiators to keep the national
policy goal that “Right to Health is a Fundamental Human Right” in focus during the negotiations and resist
WB, IMF and WTO agenda to make health a marketable commodity. The objective of this consultation is to
create a critical mass of health activists and socially conscious individuals, knowledgeable on the GATS
process, who will be able to initiate/catalyze public debates on GATS in the countries of the region.
GATS – LOOKING AT IT FROM HEALTH
Dr K Weerasuriya
Would Trade Organization, TRIPS, GATS as a part of globalization
Globalization is a process from which we cannot retreat. In order to take advantage of this situation the
stake holders must focus on managing the process in such a way that it will serve as a tool to enhance the
quality of public health care.
It is a fundamental truth that the market is not a mechanism for achieving equity in health or cost effective
use of resources. Therefore we should look at how we can adopt “Trade in Services” to serve objectives
other than trade. But there are other sectors where “Trade in Services” have proven to be advantageous in
developing countries. These being: - Personal software services, H1B visas and outsourcing, Personal
Tuition for schoolchildren, Call centres, Medical Transcription services, X-ray and reporting services.
While serving the need of developed world, the developing world improved financial services, education –
mainly tertiary, telecommunications, specialized High-level technical services and Health & Life Insurance.
Why is there a focus on Services?
Source: GATS AND HEALTH RELATED SERVICES
MANAGING LIBERALIZATION OF TRADE IN SERVICES FROM A HEALTH POLICY PERSPECTIVE (Nick Drager and David P. Fidler)
The focus on services in International Trade is due to the increased growth rate in the export of services, as
the graph above illustrates.
Health related Services
When one analyzes export of services in health and education, in both developed and developing countries
are at the tail and of other sectors‟, as illustrated in the following.
Source: GATS AND HEALTH RELATED SERVICES
MANAGING LIBERALIZATION OF TRADE IN SERVICES FROM A HEALTH POLICY PERSPECTIVE (Nick Drager and David P. Fidler)
GATS aim through “Trade in Services”
GATS attempts to formalize the system of “Trade in services” with rules and regulations assuming that it
will provide level playing ground which will lead to more trade and prosperity. Services in Health can be a
part of GATS. But it is doubtful if trade in services in health will lead to improved health for the majority as
liberalization of trade can lead to “cream skimming” and impoverishment of basic services.
Aims in liberalization of health under “Trade in Services”
Liberalization of health services under GATS should aim to produce better quality, affordable, and effective
health-related services, leading to greater equity in health outcomes. Liberalization should also ensure the
necessary policy and regulatory space governments require to promote and protect the health of their
populations, particularly those in greatest need.
Framework, opportunities and threats in GATS
There are opportunities as well as risks in the liberalization of health under the GAST framework as
Source: WHO 2004
How should developing countries respond to GATS
Developing countries should consider what can be done about health in GATS. Can developing countries
step-back from health aspects of GATS and observe only? Can developing countries dip their toes in the
waters of “Trade in Services” without getting caught in the swirling currents? Can developing countries
swim in the waters of “Trade in Services in Health” without being permanently affected? GATS is much
more flexible than the “All or None” approach of TRIPS. May be developing countries should take
advantage of that flexibility or they may wish to experiment through autonomous liberalization of certain
health related services, and only make commitments under GATS after a careful assessment of its effects.
However there is danger of “local” stakeholder interest pressurizing to continue the liberalization. Therefore
liberalization should be done with a clear policy statement and subject to clear measurable objectives being
Developing countries should prepare for negotiations in GATS and Health by identifying a focal point for
trade in health-related services within the Ministry of Health. It is also important to establish contacts and
systematic interactions (e.g., a GATS working group) with trade and other key ministries and with
representatives from private industry and civil society in developing countries. Countries should focus on
collecting and evaluating relevant information on the effect of existing trade in health-related services within
the country and obtain reliable legal advice not only on GATS but also on other international trade and
investment agreements (e.g., bilateral investment agreements) that may affect trade in health-related
services. Information and technical assistance will be provided by WHO on matters concerning trade in
health-related services which can be utilized by countries. LDCs‟ should develop a sustainable mechanism
for monitoring the impact of trade in health-related services generally and the GATS 2000 process
specifically. It is important that all requests for, and offers of, liberalization of trade in health-related services
are subjected to a thorough assessment of their health policy implications.
There will be advantages for health in GATS-these should be sought out carefully evaluated and made use
of. Unlike the TRIPS agreement, there is more flexibility in GATS that allows a country to choose their own
terms for liberalization before any commitments are made. So unless the clear benefits are evaluated in
terms of costs and advantages, we need not be in a hurry to embark on the journey.
• Get Your House in Order: National stewardship of the health system in the context of GATS
requires a sophisticated understanding of how trade in health-related services already affects and
may affect a country's health systems and policy.
• Know the Whole House, Not Just Select Rooms: The GATS process can affect many sectors
related to health, and this fact places a premium on health ministries‟ understanding the
importance of a comprehensive outlook on trade in health-related services.
• Remember Who Owns the House: GATS provides countries with choices and does not force them
to make liberalization commitments that are not in their best interests. If a country is unsure about
the effects of making specific commitments, it is fully within its rights to decline to make legally
binding commitments to liberalize.
• Home Improvement Means Health Improvement: Health principles and criteria, should drive policy
decisions on trade in health-related services in the GATS negotiations
PHM’s GLOBAL RIGHT TO HEALTH CAMPAIGN: A POTENTIAL REMEDIAL ACTION TO CORRECT
AND PREVENT THE NEGATIVE CONSEQUENCES OF GATS IN ASIA. (…YOU SEE/FIND WHAT YOU
Since the context of Globalization is a bit different in every country, GATS has both general and unique
connotations in each. The mantra we keep hearing is: Those who can pay should pay; cross-subsidization
The privatization of services is about curative care, not about preventive and promotive care; the latter two -
-and the curative care of the poor-- are graciously left to the public sector. But, because of its well-known
consequences on poor people, the commoditization of health is simply unacceptable. What this means is
that the Right to Health Care (RTHC) is non-negotiable. Health is not a marketable commodity if it is to be a
right. Public debates to make this clear to everybody are crucial; an informed and educated public and
authorities are needed to bring pressure on duty-bearers (trade negotiators included) to make them not
only understand, but also staunchly and resolutely defend the principle that the RTHC is a non-negotiable,
fundamental Human Right. PHM‟s Global RTHC Campaign is a vehicle precisely for this.
Brief summary of PHM’s Global RTHC Campaign
In a way, the campaign is a mini-study on the impact of the liberalization of trade in services on health and
Human Rights. It zeroes-in on issues that are now devoid of data where decisions are currently taken
based on assumptions or outright ignorance. The campaign starts with a diagnosis of equity in health, of
access to quality of care, and of affordability of health services –as much as it denounces these as HR
violations for which signatory countries have obligations under international law. It is based on the principle
that we are not begging, we are demanding. The campaign does look at the HR implications of
liberalization of trade so that the latter does not negatively impact HR. It departs from the principle that
more informed decisions can be made when people are properly informed.
Through the exploitation of the data generated by its assessment tool, the campaign aims at giving key
information to decision-makers and negotiators engaging them in public debates about the consequences
of privatization and other GATS provisions. Its focus is more on bilateral negotiations (which are the ones in
which poor countries are most vulnerable). The campaign thus helps bureaucrats, negotiators and the
general public understand the full impact of the liberalization of trade on health and on HR. Working with
groups of claim-holders organized in civil society, the campaign --which is participatory from the outset--
identifies and lobbies decision-makers and negotiators so as to establish dialectical claim-holders – duty-
bearers working links at different levels. The campaign also engages the press, labor unions, indigenous
NGOs, members of parliament, and political parties; it nurtures an ongoing relationship with them. It
exposes the flaws of the five main rules of GATS (Most Favored Nation, equal treatment of foreign
companies, no market access restrictions to foreign providers, equal national regulations for foreign
providers, and compensation to rich countries). In phases II and III, the campaign will involve/push WHO to
act more forcefully on the RTHC, as well as to get more actively involved in WTO (its council for trade
services included). As regards the four modes of GATS (cross-border, consumption abroad, foreign
commercial presence, temporary movement of persons), some of this was overlooked by us originally and
we will incorporate missing parts explicitly in our assessment tool.
In summary, the campaign thus is one of the critical analytical tools we ask you to consider for taking
If the immediate key question is: How should poor countries in Asia respond to GATS? A first definitely
worthy step is to join the RTH campaign! Because, if it is all about creating a critical mass of people and
cadres knowledgeable on GATS (as well as on other social determinants of health and on assorted causes
of violations of the RTHC), the campaign does exactly that. The prospects are good; the problems are
many, but well known; the opportunities are open and promising; as always, PHM welcomes the challenge
and welcomes all of you. Incidentally PHM has a brand new grant to implement the campaign in seven
countries in Asia.
*Get more information on the campaign at www.phmovement.org and follow the links to the RTH
WORKING GROUP DISCUSSIONS AND COUNTRY/ORGANISATION COMMITMENTS
It is a fundamental principle that Health should not be a marketable commodity, but a Human Right. All
governments in the region have committed to provide Health care to all those who require it by signing and
ratifying four major International Human Rights Treaties and Declarations collectively known as the
International Bills of Human Rights. Therefore health should not be subjected to GATS negotiations or any
other bilateral or regional trade agreement negotiation as it will create a fundamental contradiction between
primary health care approach and trade in health services, which requires privatization of health services
and health becomes a marketable commodity.
However most Governments find it difficult to maintain the commitments they have made to endorse health
as a human right due to mismanagement, corruption, unstable economic conditions and lack of a
comprehensive national health policy strategy to achieve these commitments. As a consequence trade in
health services is viewed as a means of generating resources to support increasing costs of providing
public health care and we see in many countries of the region the four modes of supply already allowed in
the health care system but not under the GATS provisions. Therefore keeping in mind the pragmatic
considerations, we must look at how health care can be improved in the developing countries of the region
within the existing system and national policies. The on going trade in services under the existing national
policies and legislation gives a good opportunity to study the impact of trade in service on health. This
information will provide guidance to key negotiators to make appropriate decisions in giving specific
commitments under the GATS process keeping in mind the government‟s goal is that health is a
fundamental human right and not a marketable commodity.
Mode 2: Medical Tourism
Medical tourism is profit driven and designed to benefit a few rich and privileged, it does not address the
provisions of public health needs. Added to this it will encourage the drainage of resources in terms of
personnel and facilities from public to private sectors depriving the majority of low income earners ability to
access adequate health care.
At present nothing prevents countries from allowing medical tourism in their countries. But giving specific
commitments under the GATS prohibits regulation of it and bring unanticipated problems such as sex
tourism and organ trade which are already emerging issues in certain countries.
Governments cannot prevent cross border travel for health care on a personal basis but should not agree
to give specific commitments under mode 2. The existing system which allows foreigners traveling to a
country for medical care should continue with provisions for:
i. a certain percentage of the income earned the transferred to the national health budget to
strengthen the national health service.
ii. Setting aside a limited number of heads in the hospital for foreign patients
iii. Carrying out social and medical audits on hospitals treating foreign patients.
Mode 3: Foreign Commercial Presence
The existing national policies allow Foreign Direct Investments (FDI) therefore it is not necessary to enter
GATS to allow FDI‟s. FDI‟s that have proven to be useful in terms of introducing new technology and
training local staff are given special privileges such as tax breaks as investment incentives.
The salary structure of the private sector has proven to be attractive for many health care professionals and
it has lead to an internal brain drain of professionals from public to private sectors. This has a negative
impact on transfer of knowledge and training younger generations.
Another issue that must be taken in to consideration is the exclusion of the Department of Health in
decisions pertaining to FDIs‟ related to health. In most countries FDIs‟ have been completely taken over by
the Departments of Trade and Industry.
According to WHO , Government expenditure on health should be at least 5% of a country‟s GDP; and this
should be exclude a foreign commercial contribution.
Mode 1 and 4: Telemedicine and Temporary Movement of Natural Persons
Telemedicine has its benefits within a country; it prevents travel costs for patients and is also beneficial if
the rural areas can get an exchange of information and diagnosis from the urban specialists. How ever
cross- border telemedicine will cater to a small affluent minority and divert the limited health resources from
the population who need them are unable to pay.
In most countries migration of Health Care Personnel is associated with frustration in the public health
system, lack of facilities, lack of medicines to patients and poor financial incentives. We believe that we can
stem the exodus by other means, including proper orientation, value formation, development of the health
system and not by just preventing migration and having compulsory service.
Globalization should be approached from the perspective of liberalizing the movement of knowledge and
persons, rather than the movement of corporations. In this context health should not be treated as a
marketable commodity. Countries that have not entered into liberalization policies should maintain their
status. Countries that already have entered into privatization that make health a commodity should put into
place strategies to counter the risks of privatization. WTO should not be the final decision-maker on health
and the WHO as should assert its role in health. There should be a special focus on the primary health
care provision model supported by WHO and health right activists. It must be also emphasized that the goal
of this consultation is not only coming up with recommendations but also making initiatives to operationalise
them in each of our countries.
HAIAP to print a handbook for activists on how to carry out campaigns opposing GATS in health.
(Inputs from TWN, Health Alliance for Democracy (HEAD) and Amit).
Launching national campaigns of public education that emphasize the strategic issue of principle
Contacting legislators, the media, unions, professional associations, parties and students to
provide factual information on the consequences of GATS in health.
Call national meetings along the lines of this 3-day regional consultation in the next 100 days in
each country here present where this is feasible.
Consider the joining and launching of PHM‟s Global RTH Campaign.
Being critical about upcoming studies on the outcomes of privatization, especially if they are
biased. (Note that economic analyses that do not consider equity in health issues are spurious).
• HAI will very soon be an NGO accredited with WHO, when HAI is accredited HAIAP should send
a letter to the Regional Directors in SEARO Delhi and WPRO Manila asking them to remind
member states to implement resolution WHA 59.26 of 27 May 2006 and encourage Ministers of
Health to take an active role in negotiations of GATS joining hands with Ministries of Trade and
Foreign affairs (as has been done for TRIPS); request the Directors to specifically emphasis that
when there is a conflict between health and trade, health considerations are to prevail (this is
already explicit in the DOHA Declaration).
• HAIAP and HAI Global to advocate for a follow up WHA resolution coming up in 2008 that spells
out that health considerations have to overrule trade considerations.
• HAIAP to encourage national partner NGOs to push for the creation of advisory committees to the
MOH to advice the government on GATS and health.
• Public sector health facilities to be banned from engaging in medical tourism; government
subsidies of any form for medical tourism to be condemned. Civil society organizations in each
country to carry out feasibility studies on taxing medical tourism and to advocate for the setting up
of oversight bodies on how the revenues from such a direct tax are spent on health care for the
• We cannot forget the need to work on country-specific coping mechanisms for the poor in relation
to access to medicines and to health care when already faced with the consequences of
Initial responsibilities of HAI AP Secretariat
Secretariat will circulate all presentations, recommendations in CDs, solicit comments and finalize the
report. Projects and activities will be discussed at the HAIAP Review and Planning meeting.
This material will be disseminated among “sister” organizations.
The possibility of publishing a booklet/primer on GATS will be explored within two months. Sanya
(TWN) in collaboration with Amit will work on this.
The progress in trade and health will be monitored.
Identify the locus in Govt. involved in GATS negotiations
Utilize organizational newsletters to disseminate information.
Post in edrug list
Link with Global Right to Health Campaign
Members share with others their plans and activities
Country/ organization level commitments
Peoples Health movement will serve as the vehicle to involve Public Health Associations in issues relating
to GATS. There will be special follow up on the Pacific islands. Dr. Ken Harvey stated he will explore the
possibility of taking up this issue at the Public Health Association meeting end of September.
Malaysia has committed to base discussions around National Drug Policy with national organizations such
as CAP. TWN‟s expertise will also be utilized. Prof. Izham stated that they will attempt to engage with
professional Associations through the existing network that has been active in opposing privatization. They
will also look in to the issue of lack of transparency when formulating Government policy.
Link with groups working on various areas related to GATS (for example groups working on issues related
to privatization of water). Possible partners/resources will be WTO Cell in MOHFW and IIM.PHM India will
discuss the possibility of making this a campaign issue in October at the general assembly.
Iran (not a WTO member)
Dr. Ali Bazegar has commited to discuss with PHM Iran to take forward issues pertaining GATS. The
issues on GATS and Public health will be taken up at the International Conference on Complementary
Medicine in Iran in May 2008.
The issues raised at the consultation will be placed at the annual general meeting of the Nepal
Pharmaceutical Association. They will use the drug information bulletin to disseminate the
recommendations of this meeting. Mr.Subish will also attempt to get PHM Nepal involved in his work.
Ms Hang stated that the recommendations developed at the meeting will be shared with the relevant
parties in Vietnam, such as the MOH, WHO and PHM Vietnam. The Public Health Associations will also be
drawn in to the process.
Representatives from Bangladesh stated that they will commit to organize a national workshop on
GATS(initiated by GK) – involving PHM, other networks, academia, universities, Doctors groups, individual
academics in social sciences, Government officials and political activists. They will also think of conducting
regional conferences (before national) based in Medical colleges in Chittagong and Rajshahi. The
pharmacological society and other associations will be involved in organizing the workshop and regional
conference within 3-4 months.
Copies of the publication on GATS by “The Network” will be printed and distribute among relevant parties.
Recommendations developed at the meeting will also be disseminated. Possibility of organizing a national
dialogue will also be explored.
YLKI will initiate a process to ensure a WTO cell in the MOHFW. They will collaborate with Institute of
Global Justice and explore possibility of organizing a national dialogue.PHM Indonesia based in Perdhaki
will also be drawn in to the process.
PHM”s (Kilos Bayan Para Sa Kalusugan) recent meeting was centered around globalization, they will
continue a follow up of the PHM meeting including GATS. A position paper, a meeting and a public
demonstration is being organised at present for the 13th of September on Access to Medicines; issues
pertaining to TRIPS and GATS will also be taken up at this event. Health Alliance for Democracy (HEAD) –
will share their campaign material available on GATS/TRIPS .
EPN (Ecumenical Pharmaceutical Network)
The issues discussed at the consultation will be taken up at the board meeting in October. Network
Newsletter will be utilized to disseminate information. They will also consider GATS as theme of next
meeting in May 2008.
Explore the possibility of incorporating GATS in the agenda of the Annual General meeting in November.
In general it is recommended that governments should not agree to specific commitments under the GATS
process but study the impact of on going trade in services under the four modes. Since most of the
governments in the region want to embark in GATS negotiations, our recommendations --and even those of
WHO--may not be heeded. It is thus better for us to set up the more achievable objective of building up a
constituency from the bottom up, i.e., raising consciousness as a key contribution to deal with the
consequences of GATS in health. In this context it must be reiterated that the objective of this consultation
was to create a mass of health activists knowledgeable on GATS issues as it is absolutely essential to
catalyze public debates on GATS. We need to raise public awareness in order to resist the WB, WTO and
IMF agenda to make Health a marketable commodity. Therefore by organizing this consultation, HAIAP has
definitely provided a worthy step forward to prepare developing countries in Asia to respond to GATS.
1. Dr. Kumaraiah Balasubramaniam was born in Sri Lanka and is currently the Advisor and coordinator of
Health Action International Asia - Pacific since 2002. He received his MBBS from the University of Ceylon,
now known as the University of Colombo. He also has a doctorate from the University of Manchester, UK.
Appointments held by Dr. Balasubramniam are,
1. Associate Professor of Pharmacology, University of Peradeniya, Sri Lanka 1975-1978
2. Senior Pharmaceutical Advisor, United Nations Conference on Trade and Development
(UNCTAD), Geneva, 1978 - 1983
3. Senior Pharmaceutical Advisor, Caribbean Community Secretariat, Georgetown, Guyana 1983 -
4. Pharmaceutical Advisor Consumers International Regional Office for Asia and Pacific, Penang,
Malaysia 1987 - 2001
i. Member of the WHO/HAI Drug Pricing Project
ii. Member of the Millennium Development Goals
iii. Member of the Editorial Board of PLoS Medicines
2. Claudio Schuftan, M.D. (pediatrics and international health) was born in Chile and is currently based in
Ho Chi Minh City, Vietnam where he works as a freelance consultant in public health and nutrition. He is an
Adjunct Associate Professor in the Department of International Health, Tulane School of Public Health,
New Orleans, LA. He received his medical degree from the Universidad de Chile, Santiago, in 1970 and
completed his residency in Pediatrics and Nutrition in the Faculty of Medicine at the same university in
1973. He also studied nutrition and nutrition planning at the Massachusetts Institute of Technology (MIT) in
Cambridge, MA in 1975. Dr. Schuftan is the author of 2 books, several book chapters and over fifty
scholarly papers published in refereed journals plus over two hundred other assorted publications such as
numerous training materials and manuals developed for PHC, food/nutrition activities in different countries
and human rights. Since 1976, Dr. Schuftan has carried out over one hundred consulting assignments 45
countries in Africa, Asia, Latin America and the Caribbean. He has worked for USAID, UNICEF, WFP, the
EU, the WB, the ADB, the UNU, DHHS (USA), WHO, IFAD, Sida, FINNIDA, the Peace Corps, FAO, CIDA,
the WCC (Geneva) and several international NGOs. His positions have included serving as Long Term
Adviser to the PHC Unit of the Ministry of Health (MOH) in Hanoi, Vietnam under a Sida Project (1995-7);
Senior Adviser to the Dept. of Planning, MOH, Nairobi, under a USAID funded project from 1988-93; and
Resident Consultant in Food and Nutrition to the Ministry of Economic Affairs and Planning, Yaounde,
Cameroon (1981). He is fluent in five major languages. He is currently an active member of the Steering
Group of the People‟s Health Movement.
3. Biplove Choudhary is a development economist, working as Programme Specialist, with the Asia
Pacific Trade and Investment Initiative (APTII), UNDP Regional Centre at Colombo. He has a doctorate on
foreign trade policy from the Jawaharlal Nehru University, New Delhi, India, and has studied the theory and
practice of international negotiations at the M. Phil level, also from the same university. He has 10 years of
experience in the field of globalization, trade and development. At the UNDP, he coordinates a diversified
portfolio dealing with issues such as bilateral investment treaties, services, regional and multilateral trade
processes with special reference to the Asia Pacific region. Additionally, in the past, he has consulted with
organizations working on national health policies with special reference to urban health issues in India.
4. Prof Krisantha Weerasuriya graduated with MBBS honors in Sri Lanka. Proceeded to UK where he
obtained PhD in Pharmacology and MRCP. Returned to Sri Lanka and joined the Department of
Pharmacology where he became the Prof and Head. He was the secretary, Drug Evaluation, Sub-
committee for several years. He is now in the Essential Drugs and Other Medicines (EDM), WHO South-
East Asia Regional Office (SEARO).
He facilitated two workshops organized by the Ministry of Health in 2005 to develop the Sri Lankan,
National Medicinal Drug Policy. This is in the process of implementation by the Ministry of Health.