PHA-Exchange> PHM and WHO under the new DG

[Aviva]

WHO AND ITS CIVIL SOCIETY INITIATIVE (CSI) IN THE NEW ADMINISTRATION: SOME
NOT SO NEW BUT TIMELY REFLECTIONS.

As many of you know, after the People's Health Assembly in December 2000 in
Bangladesh, the WHO Director General created the Civil Society Initiative
(CSI) at WHO headquarters.
Its role continues to be important and SHOULD BE enhanced under the upcoming
administration. From the People's Health Movement (PHM) perspective, some of
the important roles the CSI should play are worth repeating. They are here
presented in no special order of priority and not all are necessarily new
suggestions.

WHO, through the Initiative, should continue to work with NGOs to strongly
encourage them to hold governments accountable on their promises and
actions. A good way this can be done is by national NGO umbrella
organizations issuing annual reports on the performance of the respective
national health systems.  If needed, WHO should offer training to national
NGOs staff on how to do this. CSI may have to come up with some core funding
for this. [If WHO will continue to be serious about the Initiative, the new
DG better be prepared to fund the Unit adequately]. This training is a
particular priority, because civil society needs to monitor the impact of
the upcoming PRSPs. Otherwise, the World Bank will rely on government
reports that are going to paint a rosy picture of poverty reduction in order
not to lose funding. WHO has to become an ally in the independent monitoring
of the health impact of policies applied at national level.

In CSI's everyday dealing with civil society, it should address them as
"partners"; that has an important symbolic value which CSI should not
betray.

The staff of the Initiative has to actively reach out and go to national,
regional and related thematic NGO meetings so CSI can be seen and counted.
With this new responsibility, it would be a mistake to stay in Geneva all
the time. CSI's presence in PHM meetings has been highly appreciated.

WHO policy drafts and World Health Assembly resolutions that reach CSI staff
desks should be shared with key partners in the network that the Initiative
has slowly set up; this should be done around the same time that they are
sent out to ministers  --and not much later (or never), as has often been
the case. CSI can even give partners deadlines to react to these and  then
CSI should find the way to feed-in civil society's inputs/reactions into the
internal WHO decision-making process. This will enhance and protect the
sense of transparency and openness WHO wants to convey.

CSI should encourage partners to email the Initiative's staff when they have
concerns relating to their voices not being heard by WHO.  Organizing a
list-server is an option CSI may want to consider. A website would also
definitely be needed (and it should have a feedback/interactive mechanism).
[A website restricts participation more than a list-server since internet
access is difficult and expensive in places CSI definitively wants to
reach].

CSI is to issue, and widely distribute through the network, occasional
"Notes of Concern" on issues that they want a quick response on from civil
society representatives worldwide; this can strengthen WHO's position in its
dealings with individual governments, other UN or bilateral agencies (or
even internally, when issues that interest civil society are facing
opposition within WHO). PHM and other civil society groups can and will be
CSI's strategic allies when its staff needs their support on issues that
they also feel strongly about. CSI should use this people's power in the
most constructive sense of the word.

This will, of course, also mean that PHM and other civil society groups
should feel free to send CSI their "Notes of Concern" seeking CSI's support
when it agrees with the respective issue.  Some "Notes of  Concern" may even
be issued jointly by WHO and civil society representatives, especially when
it is a Note about the deterioration of the health situation in a given
country.
Such actions will cement the WHO/civil society relationships.

CSI should also consider issuing quarterly opinion pieces on points of view
shared between WHO and civil society (its partners) and points of view in
which they agree to disagree; the reasons for disagreeing would be presented
dispassionately. Again here, transparency is the essence.  This will
certainly enrich the discussion and bring new inputs to the ongoing
dialogue.

It is important that CSI reassures and lets the partners know, early on, how
the Initiative plans to interact with and influence other clusters within
WHO --how CSI plans to engage them in a dialogue to pass on the feelings,
suggestions and grievances of civil society representatives.  This is linked
to holding these clusters accountable of doing what they agreed to do when
CSI contacted them initially on a certain issue.
Further, in a few cases, this will mean bringing the partners' views to the
Director General and even WHO's Board.

The other side of the coin is that CSI will have to produce a yearly
document in which it tells partners what it expects from the Initiative and
what it expect from us, the partners. We will then react to these .

CSI should be prepared to offer (unsolicited) constructive criticism to
partner NGOs that have lost touch with the communities they are supposed to
serve and are more on the top-down side of things.

Working with the DG's Office, circulars have to be sent to the field
authorizing WRs (country representatives) to deal/interact with civil
society representatives in-country!! This is unpostponable. Even more, this
has to be proactive; WRs should invite/engage local civil society
representatives into an ongoing dialogue --not to overrule ministries, but
to listen to the "other side" in an official setting (and not behind closed
doors). WRs should be instructed that not only governments are their
counterparts. [It takes two to tango.].

CSI doing good things in Geneva only is totally insufficient. To consolidate
CSI's mandate, it has to fight for this local aspect of the Initiative in
this (or some equivalent) manner.

CSI should email WRs quarterly with an update of what is happening between
WHO and partners and reminding them to reach out to local partners.  A
yearly meeting could be called by WRs inviting all local partners working in
health. [It is likely that WRs would need some training or briefing to do
these new things with civil society. If so, CSI should propose the
mechanisms and the contents. and provide the seed money].

The new human rights paradigm in health and in WHO should become a center
piece in the contents of what the Initiative will be doing with partners. In
short, civil society would like WHO to move  into a position of leadership
in the human rights approach as much as UNICEF is doing now. The same is
true for leadership on the issue of health and poverty; the
Initiative --with partners' contributions-- could help tip the balance. A
"Note of Concern" on this would be fitting.

Every January, CSI should mail to partners the proposed agenda and official
documents for the upcoming WHA so that civil society can prepare position
papers on key issues (and even meet to agree on a common position; CSI could
be instrumental in calling for a consensus position of most partners). PHM
and network NGO members can also then organize to lobby their respective
governments to vote in a certain way during WHA.

CSI should convene and co-chair a full one day session with partners every
WHA! Ideally on day 2. The agenda can be set jointly, but should cover the
key agenda points the ministers will be discussing so some lobbying can be
done from day 3 on.  A press conference at the end of the day 2 session will
help; it is sure it will be well attended by the press.

CSI could further consider publishing an annual monograph equivalent to
UNICEF's  The Progress of Nations, but on health issues, especially ranking
countries as relates to issues of access, equity and health as a human
right. This would have the potential of getting a meaningful discussion on
key issues going every year.

CSI can expect partners to start approaching its staff on concerns related
to, among other:
? WHO/private industry links,
? a greater voice of/role for civil society in the policy decision-making
process of WHO,
? the Global Fund and its management,
? increasing (bolder) WHO leadership in the health sector overall and
particularly on issues dear to civil society members (as presented, for
example, in the People's Charter for Health),
? giving more guidance to countries to face clearly deteriorating health
situations (even if it means taking opposing stands with the WB),
? a greater focus on health concerns and civil society de-facto
participation in upcoming PRSPs,
? instructing the WRs to work with civil society local leaders,
? a re-pledging of WHO to PHC a la Alma Ata/Health for all NOW with greater
political clout,
? a much more forceful backing of non-regressive health care financing
strategies along the line of community based pre-payment schemes and openly
opposing fee for service as a regressive direct tax,
? going beyond mere warnings on the issue of the potential negative effects
of privatization.

We understand that many of the things here proposed require a very high
level of clearance at WHO that may be difficult to get. But we take it as a
process characterized by a series of small battles and small victories. The
idea is that, in the process, partners should become CSI's true allies, its
power base to pressure whoever on tough, hard-felt issues.  Partners can
carry out quick reality checks for CSI on proposed upcoming policy or other
issues; they can be CSI's sounding board and its strategic allies.

We invite readers to post comments and additional ideas on CSI's future role
here at pha-exchange at kabissa.org

Claudio Schuftan, Ho Chi Minh City
aviva at netnam.vn