PHA-Exchange> Asian Civil Society Conference on Macroeconomics and Health

[claudio at hcmc.netnam.vn]

from bala <bala at haiap.org> -----
      To: ferazzis at who.int

Dear Ms Silvia Ferazzi,

Thanks for your mail of 6th May and the consensus document.  I thank the 
organizers for inviting me to participate in this conference.

The agenda was very well structured to obtain the collective wisdom of 44 
representatives from the civil society and 15 Ministry of Health Officials from 
12 countries in the region and eight representatives from international civil 
society.  A total of seven and a half hours were allocated for small working 
group discussions and recommendations by 71 participants whereas as five and a 
half hours were allocated for the introduction and four presentations by 
resource persons.  I had, therefore, assumed that the objective of the 
Conference was to get the conclusions and recommendations of the participants 
based on the presentations by the resource persons & on their deliberations in 
the small working groups and that the WHO would use these conclusions and 
recommendations to promote  them in the WHO regions with regular participation 
of the civil society in macro - economic and health activities.

However I was disappointed that the final consensus document prepared by the 
drafting committee including the amendments agreed upon by the attendees will 
be the one promoted in the WHO regions.

Let me explain the reasons for my disappointment.  These are my personal views 
as a participant.

1.    I was a member of the WG discussing Theme 1 - "How can CSOs contribute to 
the policy debate and decision making?"  Dr Rita Thapar, Nepal, was the 
facilitator and Ms Fatema Yousouf, Bangladesh, the rapporteur.  Dr Thapa was 
able to get views and comments from every member of the group.  I expressed to 
the group civil society's concern that before civil society can contribute to 
policy debate, there should be a functioning national health policy in a 
country and this policy, as WHO has repeatedly re-iterated, should be based on 
a comprehensive primary health care and the fist priority should be to 
strengthen the health systems in developing countries.  The World Health 
Report, 1996, stated that in many countries health systems which should offer 
protection against disease have, in extreme cases, either collapsed or not even 
been built.  The situation has not changed.  This is reiterated in the 
consensus statement, Theme ii, "Besides in reomote back ward areas, where 
public health infrastructure is virtually non functioning...".  Therefore there 
is an urgent need to provide resources to countries to build effective health 
systems before they can successfully implement any health interventions.  This 
needs to be undersocred in any consensus statement.  Calling on the CSOs to 
setup into remote areas where there is no functioning health system, in my 
opinion, is not at all a viable option.

Another civil society recommendation is that the WHO should see health as an 
end in itself and not as a means to the end of economic growth as argued in the 
Report of CMH.

While the working group was in session, at about 11:00 am day 2, the 
facilitator was given a consensus statement prepared by the drafting group.  
She was requested to get comments on the consensus statement from the members 
of the group.  With just one copy of the document with the facilitator at the 
end of one and a half days of listening and talking, it was not realistic to 
expect about 18 members in the group to give meaningful comments within an 
hour.  These were again discussed during the last agenda item, "Plenary 
discussion and consensus on recommendations 15:30 - 17:00 hours.  It was then 
finalized by the drafting group.

The final document, in my opinion conveys the consensus of those who drafted.  
Let me take just one example.  

Item 1 of Theme ii, "How can CSOs contribute to increasing access to essential 
health services for the rural and urban poor?  states as follows.

1. "We recognize the knowledge that CSOs have of the deficiencies in the 
delivery of health delivery systems.  We also recognize the demonstrated 
capacity of several of them in providing basic health services in remote areas. 
(emphasis mine).

I cannot understand how this conference can agree on this consensus.  Let me 
explain.  One of the background documents circulated was"Health Activities by 
Participant Civil Society Organizations".  Detailed profiles of 41CSOs were 
given.  One of the questions posed was:

"Does your organization provide health services?  Specially to the poor", Forty 
CSOs answered this question.  One CSO, Vietnam Women's Union had not answered.  
Of the 40 CSOs which participated in the conference 21 or 53 percent did not 
provide any health services.  Thirteen or 33 percent provided primary health 
care services.  Two provided TB treatment, three family planning services and 
one surgical treatment for cataract to low income groups.  With over 50 percent 
of the CSOs at the conference not providing any basic health services, it is 
difficult to understand how this could be a consensus statement by the 
participants.

The second item in Theme II, states.  "CSOs, with financial support from public 
funds, should enter in active partnership with governments to undertake greater 
responsibilities in collaborating them in providing health care and health 
services at the primary and secondary level, (emphasis mine) both in rural and 
urban areas, more efficiently and cost effectively.  Besides, in remote and 
backward areas, where public health infrastructure is virtually non 
functioning, governments should provide a liberal package of incentives to 
motivate and strengthen the capacity of CSOs to fill the gaps.

Here again CSOs are asked to take responsibility for tasks that the majority of 
the participating organizations are not capable of under taking.

These consensus statements are similar to those in of the presentation by Mr 
Rajiv Misra.  I quote.

Delivering Health Services:

"Numerous examples of NGOs providing healthcare to the poor in the remotest 
regions.  These examples could be multiplied indefinitely by developing public 
private partnerships.

The poor would always be better served through NGOs than through government run 
services.  The bureaucracy can rarely acquire the understanding, empathy and 
the confidence of the beneficiaries that NGOs working closely with them 
invariably do.  Also they could often deliver services at lower cost without 
compromising quality".

In my opinion the consensus document reflects more the views of the resource 
persons and the drafting committee than the participants.  I shall very much 
wish to know the views of other participants.

We look forward to getting copies of the comprehensive report from the meeting 
which will include the conclusions and recommendations on the four themes 
prepared by the four working groups.

Best regards,

Dr Bala
___________________________________
Dr K Balasubramaniam
Advisor and Co-ordinator
Health Action International Asia - Pacific
Colombo, Sri Lanka
 
We are
> working to set up a dedicated conference webpage on the WHO macroeconomics
> and health website (you can find an initial version on:
> http://webitpreview.who.int/entity/macrohealth/events/civil_society_asia/en/
 
> Silvia Ferazzi
> Partnerships, Coordination of Macroeconomics and Health Support Unit
> World Health Organization
> email: ferazzis at who.int
>



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