PHA-Exchange> From Savar to Cuenca: a chronicle

[Claudio]

A bit of history:



FROM SAVAR TO CUENCA VIA BANGALORE - EXPERIENCE OF THE PHM SECRETARIAT TEAM: Reflections on PHM Realities and Future Challenges.

 

[This is a ten pages excerpt of a 25 pages document of the same name posted in the PHM website. The full document is available for downloading in pdf format in the "papers" section of the site: http://www.phmovement.org/en/resources/papers . The direct link for downloading it is: http://www.phmovement.org/files/From_Savar_to_Cuenca_via_Bangalore_summary.pdf ] 

 

PART 1:

 

This background note is based on the experience of the PHM Secretariat team in Bangalore. The Secretariat team facilitated processes using governance and decision making structures that included the global steering group, geographical and issue based circles, PHM news briefs, the pha-exchange, the PHM website and the PHM funding group. This note tries to identify and highlight some of the challenges and options and was a background contribution to the PHM transition process and strategy meeting held in Frankfurt hosted by Medico International from 6-9th of February 2006. 

Recognising the importance of documenting this experience of the early organizational history of this global movement, we have evolved this short paper as a constructive contribution to the further development of PHM. 

 

1. PHM AS A MOVEMENT.

 

A movement is not an international NGO.  What is it then?

>From the beginning the PHM movement was a growing and diverse collective process of evolving circles at community, country, regional and international levels; it encompassed individuals, groups, organizations, networks and campaigns, linked by a commitment to the Health for All strategy, and to addressing the deeper determinants of health with communities and marginalized peoples through health action. 

 

PHM works in circles, not pyramids of decision making that are inclusive and not exclusive or ideologically straitjacketed; we build on trust, mutual respect, with an ethos of debate and dialogue; we accept diversity and plurality. From this perspective, PHM evolved charters and declarations focused on the urgent needs of impoverished people and communities. 

 

PHM's country circles are also inclusive, work with trust, mutual respect and responsibility, appreciate cross cultural diversity, are non-hierarchical and participatory in decision making and focus their concerns and activities on people and communities.

They concentrate on capacity building for the above. Being inclusive, without being ideologically vague, is one of the biggest challenges for the PHM. 

 

PHM was a new experience with no direct parallel for comparison and hence is a very exciting development. 

 

2. PHM VISION AND STRATEGY - WHAT AND HOW?

 

The People's Charter for Health (PCH 2000, available in over 40 languages), and its two updates the Mumbai Declaration of January 2004 and the Cuenca Declaration of July 2005 articulate PHM's vision.  The People's Charter for HIV/AIDS was released in Bangkok in July 2004; statements on Macro-Economics and Health, Public Private Partnerships, Trade and Health, Primary Health Care, Health Systems Research, Disasters (Tsunami) and the Politics and Power of Aid, the Researchers for Health Statement (PHA 2),; and a series of press statements by the PHM media group articulate evolving perspectives, responding to new international developments and challenges in health. 

 

Strategic Options - what does the Charter offer? 

The real challenge to PHM is not vision but strategy and action.  The challenge is to convert vision into meaningful strategic options at different levels. 

An overview of the Charter highlights PHM's key strategic directions. To us, Health for All, among other, means: 

 

Challenging the powerful interests of globalisation; encouraging people to develop their own solutions; holding authorities at all levels accountable; demanding that governments and international organizations reformulate, implement and enforce policies and practices which respect the right to health; building broad-based popular movements to pressure governments; demanding needed transformation of the World Trade Organisation and the global trading system including the intellectual property regimes; pressuring governments to introduce and enforce legislation to protect the health and rights of marginalized groups; demanding that education and health are placed at the top of the political agenda; holding corporations, public institutions and the military accountable for their activities; and developing people-centred, community-based indicators of environmental and social progress. 

 

It also means supporting actions and campaigns for the prevention of natural disasters and the reduction of subsequent human suffering; opposing privatization of health care; demanding that governments finance and provide comprehensive Primary Health Care and ensure free and universal access to health; demanding a radical transformation of the World Health Organization (WHO) so that it responds to the needs of the poor, avoids vertical approaches, involves people's organizations in the World Health Assembly and ensures independence from corporate interests; supporting and engaging in actions that encourage people's power and control in decision-making in health; demanding that research in health is carried out in a participatory, needs-based manner; building and strengthening people's organizations to create a basis for analysis and action; engaging in actions that encourage people's involvement in decision-making in public services at all levels; demanding that people's organizations be represented in all fora relevant to health; and supporting local initiatives towards participatory democracy.

 

This list is a selection from a much larger one in the Charters and represents those on which PHM has taken action or needs to do something urgently. 

 

PHM Current Strategies (2003-2006)

1.                Building country circles around community and national needs, challenges and opportunities.

·         These are ongoing in Bangladesh, India, Nepal, Pakistan, Italy, Sri Lanka, Philippines, South Africa, Egypt, Palestine, Lebanon, Iran, Australia, USA, Ecuador, Guatemala, Argentina and a number of others. 

·         PHM India, PHM Bangladesh have very strong, ongoing movement building experiences. 

2.    Building Regional Circles around regional needs, challenges and opportunities. 

  a.. Efforts have been made in East Africa; Latin America, the Middle East, and Asia. 
  b.. These efforts are an important adjunct to the process of increasing PHM participation in World Social Forum and Regional Social Forum processes. 
3.    Facilitating PHM representation, participation in local, national, regional and international fora and meetings.

There is regular PHM input/involvement in the World Social Forum, Regional Social Fora, the World Health Assembly, the Global Forum for Health Research, Health Promotion conferences; the Canadian Society of International Health meetings, meetings of National Public Health Associations, HIV and AIDS conferences and meetings.    In many of these conferences, PHM resource persons have been on specific panels raising PHM concerns and perspectives. PHM also organises special seminars for those interested in PHM so that they get an opportunity to meet the PHM participants, learn about the movement and join the movement if they are interested.  Report on these activities are posted in pha-exchange and in the PHM website. 

4. Evolving an advocacy strategy to bring WHO back to a Health for All perspective and to focus action on social health determinants. 

The WHO-WHA advocacy circle has very effectively advocated with WHO at different levels. This has included: advocacy in the annual World Health Assembly, participation in the Annual Research Forum of Global Forum for Health Research, involvement with WHO Commission on Social Determinants on Health, submission of position papers on areas of WHO concern and PHM interest, participation in WHO meetings, participation by WHO team members at HQ and regional levels in PHM meetings including the Second People's Health Assembly, dialogue by PHM at regional levels with PAHO, EMRO, AFRO, WPRO and SEARO.  

5. Building Global Solidarity through regular participation in the World Social Forum and Regional Social For.

This active participation has been a unique opportunity for PHM to dialogue with larger global social movements --this strengthening the health related agenda in their movements.  

6. Global Right to Health Campaign (since 2004)

This has evolved through consultation at various levels, an extensive campaign with People's Tribunals organized by PHM India, and meetings at WHA and other fora with the UN Special Rapporteur on Human Rights.  At PHA-2, after extensive discussion the global campaign was launched.  Efforts are on now to get around 40 country PHM circles involved, making local diagnoses of the right to health care and adapting the campaign to local opportunities. 

7.  Disaster and Humanitarian Responses 

·         This PHM Circle has been promoting collective initiatives during the build up to the Iraq war, and during the tsunami (South Asia), the Bam earthquake (Iran) and some Latin America disasters. 

·         The Tsunami statement on the politics and power of aid (April 2005), several press releases, the Tsunami Watch project are examples of practical initiatives that have greatly helped to enhance the visibility of PHM. 

8.  Active participation in the Annual Research Forum organized by Global Forum for Health Research (GFHR).

The WHO-WHA Advocacy Circle and the PHM Research Circle have been very effective in raising the profile of PHM on issues of relevant research important for People's Health. 

9.  The International People's Health University (since 2005).

·         This is PHM's response to the regional capacity building and training of younger generations of PHM activists. 

·         The IPHU functions linked to international and regional events associated with PHM. 

·         At PHA-2, the IPHC facilitated the first IPHU session from 10-16th July 2005, with 55 participants from around the world (2/3rd from Latin America). Two upcoming IPHU sessions are in planning stages. 

·         IPHU involves all potential academic, research and training centres within the global and regional PHM circles in this international training initiative. 

10.  Communications and Campaigns.

PHM has evolved a communication strategy to keep all its members informed about all that is happening. This includes:  the PHM website; the PHA-Exchange list server, regular news-briefs every 6 months, a set of ad-hoc PHM publications, a set of audio visual materials. 

PHM has also organized campaigns such as The Million Signature Campaign for the 25th anniverrsary of the Alma Ata Declaration, the No War, No WTO, Health for All Campaign, the Save UNICEF Campaign, the Women's Access to Health Campaign, etc. 

 

4.    GLOBAL GOVERNANCE AND DECISION MAKING IN PHM.

 

a.     The Global governance and decision making process in PHM included two components: 

I.       A global steering group which consisted of a group of founding networks and organizations and a group of regional focal points.

II.     A Global Secretariat with a coordinator and a secretariat support group.

 

i.        Apart from the eight member, representatives of the founding organizations, the global steering group also consisted of 9-13 additional members who were representing the thirteen regions into which all the original 75 countries (represented at PHA1) were divided.  

ii.       Efforts were made to specify the countries in each region to help regional networking. This was achieved for East and Central Africa, Southern Africa, Europe, India, Australia-New Zealand and the Pacific, also for Central America and the Caribbean.  It was less successful in South Asia, South East Asia, South America and, in the absence of focal points, not possible in China and West Africa.  The efforts in the Middle East region were probably the most effective. 

iii.     Apart from representativeness, the real problem experienced was responsiveness.  In spite of setting up a steering group list server, for governance and decision making, many SG members neither acknowledged the communications nor provided responses to decision making options or queries on matters of PHM planning and policy.  On the whole, volunteer activists of PHM were more responsive than most of the steering group and this was very supportive of the secretariat team's morale.  

iv.    Most regional focal points with some exceptions did not evolve any mechanism to communicate with country contact points in their region so this responsibility became an additional burden on the secretariat. Hence, potential strengthening of regional level communication strategies did not take place as widely as we had hoped.

v.     Enhancing regional coordination is an important organizational imperative not only to reduce the overall burden on the inevitably small global secretariat team but also to enhance responsiveness, regional decision making, regional capacitation and regional communication.  With the exception of Middle East and Central America which were good even before PHA2 and probably North America and Australia and Pacific after PHA2 this capacity will take some time to build in the different regions. The presence of unequal regional capacity at present will require some proactive global coordination for some time to come. 

vi.    The number of regions (original 13 of November 2001 proposal) has been found to very unrealistic and unwieldy in terms of organizational efficiency and support to decision making processes. 

vii.  Eight or Nine would probably be more feasible and practical especially if we are also going to consider finding more full time regional coordinators who have an NGO in the region backing them up with supportive services as hosts of regional secretariats.  

viii.  Some regional processes that have been strengthened particularly in the mobilization phase towards PHA2 should be recognized and strengthened further.  Key among these ongoing are: 

a)    Africa region: The regional meeting of Civil Society in Health organized in Lusaka, Zambia in February 2005. 

b)    Middle East in Region - the region has been mobilizing as a regional group for many years, but their efforts got a boost with preparations for PHA2 and the WHO-CSDH process thereafter the proposal for hosting the global secretariat. The Iranian PHM was included. There is a lot of country level potential particularly simultaneously is Egypt and Lebanon that can be tapped. 

c)     North America - PHA2 mobilization and the actual event has led to great strengthening of PHM mobilization in USA and Canada.  There is great scope for the North American region of PHM becoming a strong resource group for International Health Advocacy as also a funding support partner for PHM. 

d)    Europe Region -PHM Europe hosts PHM's funding operations, the Charter translations are tracked there; the Global Health Watch 1 secretariat was based there; the annual Women and Access to Health Care campaigns are facilitated/coordinated from there.  But country circles focused on local Health for All challenges were not yet established.  More recently, the evolving network regarding the movement against privatization of health care is gearing effort to local country level health actions.  The North and South of Europe and perhaps East and West have their own challenges and PHM Europe region has to tackle the challenge of bringing together nearly 46 countries with all their diversity. 

e)    Australia, New Zealand and Pacific - the Australian PHM has been steadily evolving for the last few years. The mobilization for PHA2 further strengthened the links with indigenous people and some extension of linkages with New Zealand also took place.  Other island country contacts need to be identified and the regional activity further strengthened.  

f)      Asia - originally divided into four regions (South Asia, India, South East Asia and China) Asia has had a mixed regional development.  The presence of HAI-AP, ACHAN, CIROAP and TWN and the strong PHM movements in Bangladesh and India have meant that Asian PHM circles have been meeting quite often at various network meetings.  Country circles have developed to varying extents in Nepal, Pakistan, Sri Lanka, Philippines and are evolving in Malaysia, Indonesia, Cambodia and Thailand.  Progress in Vietnam, Myanmar, China and Japan is, so far, poor.  UNESCAP involved PHM in orienting its new health unit team and also in evolving its health policy for Asia.

ACHAN which has been dormant for a while, but now recently, more involved with Tsunami Watch and also PHA2, should be revived to play a much more significant role with probably younger leadership.  

        g)  Latin America - these includes the PHM regions of Central and South America and the Caribbean.  The regional mobilization has been historical and strong even before PHA1 and now recently for PHA2.  The region is one of the most inspiring of the PHM regions for the wealth of movement experience including the growing indigenous people's empowerment, and the phenomenally creative culture of protest and celebration, as was evident at PHA2. The recent political changes with a growing axis of good - Cuba, Venezuela, Bolivia, Chile, Uruguay, Argentina (Peru?) offers a larger regional context of change that makes PHM more meaningful and viable in the region. 

 

In conclusion of Part 1, there is great potential and possibilities in enhancing regional coordinating both as a concept and thrust of PHM in the next two years building on the ongoing processes discussed above.  This should be done however with a specific focus of regional capacity building by a catalyst team which can do it in a participatory, facilitatory way enhancing local effort and local creativity.  It will not happen spontaneously so some global planning even to facilitate a group of people who will do this activity in a focused committed way must be operationalised fairly soon. 

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[This report is based on the reflections of the PHM Global Secretariat team in Bangalore which is preparing to hand over to the new secretariat team in Cairo in a few weeks. The report was a background document for a PHM transition and organizational development meeting in Frankfurt in Februrary 2006. Any comments or dialogue on the report may be sent directly to Dr. Ravi Narayan  (ravi at phmovement.org) with a copy marked to secretariat at phmovement.org. The comments and reflections are of the Secretariat team and not necessarily those of the PHM Global Steering Group as a whole].



to be continued
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