PHA-Exchange> From Savar to Cuenca: a chronicle (2)

[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 2:

 

a)    Global/Regional Secretariats and steering group

Guidelines relevant to a PHM global secretariat were evolved in November 2002 in Bangladesh before the shift of PHM secretariat to CHC in Bangalore. 

 

A few general points are included here. 

The concept of a global secretariat with a full time coordinator and a small team of communication officer, secretariat assistant etc., was a necessary aspect of the phase 2002-05 because the PHM was an evolving movement.  However, as the movement has grown both in visibility and in terms of demands on global secretariat teams this is not a viable proposition now.

a)    A large number of activities/responses/functions presently carried out by the global secretariat and coordinator can be better done perhaps more effectively by regional coordinators if they have the capacity and aptitude to be inclusive, representative and responsive.  Ravi Narayan was available full time on this global assignment.  Funding partners were supportive, as were PHM resource persons from the region.  This led to an unusual combination of supportive factors not easy to find in every hosting region willing to host the secretariat. 

b)    Enhancing regional coordination with supportive NGOs hosting regional secretariats and providing at least part time coordinator is needed. 

c)     I must be noted that global and regional coordinators are not expected to do both executive and convening roles, which can be conflicting. 

d)    As a general rule, steering groups should not consist of icons or very famous or well known resource persons. These should be on advisory groups.  Efforts should be made in a concerted way to identify and foster younger leadership in all regions. 

e)    All councils or steering group members should have limited periods on the group/council - never more than 2 years so that there can be rotation of responsibilities and 'new blood'. 

f)      Some watch on 'representativeness' and 'responsiveness' of council or steering group members must be maintained.

g)    While funds and other forms of resource support may be provided from the global budget of PHM, regionalisation should also focus on regional capacity building which should ultimately lead to regional capacity to plan, organize, raise own resources and evolve local governance and advisory structures without too much reliance or dependence on global efforts/coordination.  

 

5. ISSUE CIRCLES.

 

The experience of the secretariat in supporting/facilitating issue based circles and campaigns have been very diverse. 

i.        Only three circles the WHO-WHA Advocacy Circle; the Research Circle and the War and Disaster Circle have been consistently active helping greatly to enhance PHM visibility, relevance, contribution and to some extent impact. However, even these three circles, need to plan their communications on PHA-Exchange and the PHM website in a more coordinated way to interest new members in their activities. 

ii.       Efforts to facilitate a PHM - HIV/AIDS circle after the UNAIDS request for a dialogue in 2002 and the interest shown by WHO with its 3 x 5 initiative to dialogue with PHM around IHF/WSF Mumbai, January 2004 saw some activity leading to the development of the People's Charter for HIV / AIDS before the Bangkok World AIDS Conference.  However, this circle has been somewhat dormant since.  

iii.     A Macro-economics and Health Circle worked on a statement/PHM position on Jeffrey Sachs report.     

iv.    Politics of Health-IPHC had offered to host such a circle. 

v.     Disability and Economics Circle - a meeting was organized at one of the GFHR fora and there was some interest from many. 

vi.    PHA2 - international organizing committee (IOC): This was set up to help with PHA2 organisation and mobilization. 

vii.  More recently, a Global Health Watch, a Global Right to Health Campaign and a WHO-CSDH dialogue with PHM are three PHM-related activities which are evolving into relevant and perhaps effective circles of PHM members working together. 

viii. PHM Communication Circle: The idea of bringing together PHM resource persons and secretariat support group members who help with communication, Website, News Brief, PHA-Exchange, PHM Charters translation and media has failed consistently in spite of efforts in 2002. Recently, however, after PHA2, such a website linked communications circle has been established. 

ix.    IPHU at PHA2 resulted in three potential circles of IPHU student volunteers in the areas of Trade and Health; PHC experiences; and Social Determinants of Health. These are evolving slowly. 

 

6.    FUNDING AND FINANCIAL MANAGEMENT.

 

This was a major challenge and learning experience for us.  

 

i)       The PHA1 funding strategy had successfully managed to raise adequate resources from two types of funding partners during the pre PHA1 mobilization strategy. 

a)                      Government - social and health development funds - Dutch, UK (DFID), Finland (FINIDA), Belgium, and Sweden (SIDA). 

b)                      Funding agencies (NGOs) like DHF-Sweden, Oxfam Bangladesh, WSM Belgium, Int.  Solidarity Foundation, Finland, Plan International and the Rockefeller Foundation. 

c)                       The total amount mobilized was enough to fund PHA1. 

 

ii)      There was a balance left over which was used to support the early PHM evolving activities in 2001 and 2002 This support was for mostly planning meetings and steering group meetings and some support to a few PHM resource persons to attend regional and international conferences to present and promote the Charter and encourage PHM mobilization in the region.  Some of these balances were also used to support publications. 

iii)    From January 2003, a fund raising group was formalised. 

iv)   The group had two or three meetings over the years in London and Bangalore to review the funding situation and plan strategies for longer term sustainability. 

v)    Specific funding agencies were contacted and dialogues initiated with follow up action. 

vi)   It soon became obvious that the funding climate had changed since PHA1, and Government funding and grants from larger international agencies needed proposals in logical framework format that were also SMART (i.e., with goals/functions that were Specific, Measurable, Achievable, Reachable and Targeted).  Since the growth of PHM was not predictable in the same way as a more specific conference event or a immunization campaign or project, all efforts to try 'logical framework approaches' to 'project proposal' evolution failed (though we tried and submitted them to the Dutch government and DFID).  

vii) A new alternative strategy was started nicknamed the 'Friends and Neighbours Policy'.  It identifies smaller funding partners and grant giving agencies that would consider supporting specific events, publications, initiatives or needs of PHM in solidarity with PHM goals. Since the grants would be small --never more than 5-1000 Euros-- the consequent paperwork and justification of the request would also be minimized.  Sometimes these agencies were already supporting the PHM members NGOs and all they needed was information on a genuine need or a strategic opportunity. 

viii)                        At first, this seemed a risky approach needing a lot of time and effort and correspondence, but with the help of PHM members this approach was quite successful. From March 2002 till April 2005 we raised over 200,000 Euros by this approach.

ix)   Another approach linked to this Friends and Neighbours Policy was for the Secretariat coordinator to write letters to different regions and founding networks to raise some regional/own travel support or contribution for every PHM need, event or initiative.  This approach also got a good response and many regions like USA, Europe, Australia and even Asia and Middle East and many networks like IPHC, WGNRR and ACHAN always responded positively and so the PHM's financial burdens were shared. 

x)    This method became well established and the PHM external evaluation in June 2004 noted it as one of the strengths. 

xi)   The same policy was extended to the PHA2 funding and while over 30 groups supported PHA2, finally the most significant aspect of PHA2 funding was unlike that of PHA1, where most participants were supported by travel grants. For PHA2, less than a 100 participants were supported with travel grants raised by the Secretariat.  Over 1400 participants supported their own travel.  The PHA2 organisers also raised lots of local support and solidarity from the Cuenca University and local groups and this greatly reduced the costs.  PHA2 was as large an event as PHA1, but was made possible at a fraction of the cost exemplifying the growing strength/capacity of the movement and the capacity of the PHA2/IOC and the region.  For PHA2, we raised only a bit over 300,000 Euros directly, but nearly a million dollars totally if we include local/regional fund raising.

xii) The Friends and Neighbours Policy has shown that it is possible to raise funds without strings and without following donor-driven agendas.  But this is still risky and needs a lot of effort - often stressful and sometimes quite frustrating. 

 

7. SOME STRATEGIC THRUSTS. 

 

The Bangalore phase of the PHM evolution has seen five additional strategic thrusts that are seen as crucial to long-term sustainability. 

 

a)   Rebuilding Bridges.

Inevitably, the movement's organizing group and many of the supportive members, over the years experienced stresses and strains that sometimes lead to breakdown in some post PHA1 communications and reduction in enthusiasm levels. As we discovered these along the way, we took proactive steps to help heal these feelings by encouraging everybody to appreciate the larger inspiring reality of the evolving PHM.  One of the nice experiences of the secretariat team was to see nearly all such issues cleared and people getting back to work with PHM strongly in organising PHA2.  We believe that this was a crucial contribution and a lesson for the future. 

b)   Mobilizing newer and more youthful leadership.

Another effort on our part was to identify and support newer, younger leadership in PHM so that the movement was more sustainable and not over-dependent on the 'networkers' and 'activists' of the pre 2000 AD era.  Efforts were made to give newer resource persons (who were less well known globally/regionally, but showed great potential capacity and enthusiasm) a greater opportunity to get more involved with PHM initiatives and take more focused responsibility for management and action.  

We are very glad that a large number of younger leaders are visible in all aspects of PHM activities. They need to be supported and encouraged in the next phase as well.  

The presence of youth in all aspects of PHA2 organization and the effective IPHU experience bringing together over 50 mostly younger activists were also symbolic of this trend.  Efforts were also made to keep in touch with IFMSA, IPSA and other student groups focusing on younger potential leadership.  This whole process needs to be maintained. 

c)    Engagement with mainstream, not only confrontation. 

Another major thrust in the PHM Secretariat's efforts since 2003 was to shift the focus of PHM initiatives from only confronting the mainstream through protests, street actions and other modes of democratic dissenting - (which are very necessary because of the over dominance and spread of neoliberal economic and political determinism) to a more confident and more strategic process of engagement with the mainstream using strategic openings and opportunities so that we built 'space for alternative thinking' even within mainstream institutions and the public health system.  

Whether it was the advocacy with WHO, active involvement with WHA or the active participation in the GFHR for a, or whether it was the PHM country relays that included meetings in the universities and with policy makers in every country visited, we consciously promoted the presentation PHM concerns, perspectives and Charters in mainstream institution and to policymakers with the confidence that 'evidence' was on our side.  It worked to some extent at least, especially in events related to WHA, GFHR, GHW releases, WHO-Health Systems Task Force and WHO-CSDH where we saw and see some results and impact.

d)   Inspiring  and informing 'evidence gatherers'.

We have also attempted to take the PHM Charter to academic and research institutions so that mainstream institutions orient/inform their students about these perspectives and help to build up greater awareness among the future academics and researchers on the social determinants of health and the alternative socio-epidemiological analysis that is central to the People's Charter.  This effort has been more successful than earlier envisaged.  The Charter is now recommended to students at the London School of Hygiene and Tropical Medicine, some of the Scandinavian Schools and other institutions.  Mainstream journals have run articles by PHM resource persons.  There is increasing interest in academics and 'evidence gatherers' in PHM concerns and analysis.  The Global Health Watch report has been another such linking effort.  Over 125 contributors to GHW1 included only 25 with a direct PHM linkage and similarly the Latin American GHW brought together over 30 resource persons from the region in a collective evidence gathering exercise.  The IPHU and the WHO-CSDH knowledge hubs in which PHM is very involved are all additional opportunities.  

e)   PHM as a Generic, not a Brand.

PHM needs to be recognized by all partners and adherents as a generic process rather than as a brand of which one is a formal member. PHM recognizes network and campaign groups at local, national, regional and international level as natural partners and does not try to make them 'members'.  PHM has met and worked with many groups and formations without too much hassle, encouraging groups to recognize PHM as a partner.  This has also helped towards PHM's visibility and outreach.  The challenge for maintaining this clarity between recognizing a lower-case-phm as spontaneous movements at every level and a higher-case-PHM which encompasses initiatives/events, associations sponsored by the Global PHM will continue to be a healthy impetus for the growth and evolution of PHM. 

 

8. DISAPPOINTMENTS AND CONTINUING CHALLENGE.

 

There were some areas in which the Secretariat team remained disappointed, because not much headway could be made.  These will continue to remain as challenges to be addressed in the next phase. 

a)    The PHM website, communication and media efforts continue to be dominated by English and the English-speaking world continues to be more involved in PHM because of this dominance.  While a concerted effort was made to break this language divide by more Spanish-English efforts for PHA2, the language divide remains a big challenge.  It s not just a matter of a communication gap, but much more so the loss to PHM of a potentially rich cross cultural fertilization of ideas and creativity. 

b)    There are indeed people/community (grassroots) level PHM efforts taking place in many parts of the world.  However, the communication of these efforts are not reflected adequately in our website, publications and reports; they appear to be focused only on national events as if they have no global level relevance.  Much more efforts must be made to record/document/share these grassroots initiatives especially by harnessing younger volunteers to document them and perhaps more creative media efforts to focus on reporting them. 

c)     Enhancing responsiveness of the PHM participants in governance structures at all levels and enhancing representativeness of those participants will continue to be a great challenge. For PHM to be a more effective movement, this internal democracy has to be constantly strengthened at all levels. 

 

9. IN CONCLUSION 
 

The next phase of PHM evolution and development post-PHA2 will hopefully be a phase marked by greater representativeness and responsiveness of PHM structures, for governance, action and communication. It needs to be:

                                i.a phase of greater decentralization and regional- and country-level capacity building. 

                               ii.a phase of greater maturity and direction in our PHM initiatives focused on, as needed, engagement and/or confrontation with the mainstream policy and system building efforts. 

We must remember that PHM is fast becoming recognized as an Alternative to the Globalization of Health from above. 

 

The increasing recognition by the non-PHM world of the PHM world is a challenge, as well as a great responsibility for us.  Are we building the movement adequately to be responsive to such expectations?  That is the continuing challenge before us. 

end.
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