PHM-Exch> Counter Austerity! Vote for Bottom-Up Democracy in Health

[Claudio Schuftan]

From: <access at imaxi.org>


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Counter Austerity! Vote for Bottom-Up Democracy in Health

The time has come to invite the millions of people living with
life-threatening diseases to join the movement for the Right to Health. Yet,
surprisingly, there is some opposition to this invitation.

Within many Global Health 'silos' - the individual disease programs such as
TB, HIV, and Malaria, a handful of civil society organizations have
succeeded in gaining a place at the board table of the policy makers. In
other 'silos', including those of the non-communicable diseases, the handful
is actually just a finger-full, and participation is far too limited to the
mega multi-national NGOs. They all speak of 'community' and of the 'voices
of those in need', and often bring selected photogenic patients to meetings
to make their demands for still more resources 'look good', but this is not
meaningful involvement.

In some of the global health institutions (WHO, UNAIDS, UNITAID, Stop TB
Partnership, etc) 'delegations' have been established and run by big NGOs,
with 'representatives' selected by the inner-circle. Little if any effort
has been made to open the system of representation up to wider
participation, and many have resisted attempts to do so. Gatekeepers assure
that mostly the same usual suspects can attend high level meetings, and they
often 'represent' people living with the diseases in several institutions -
but without any real mandate. This also assures that the genuine and
unfiltered voices of people with 'serious' diseases are not heard, and that
they can't participate in the decisions that may be of life or death
importance to them. Although there are some very good and sincere people
involved, the systems of representation are exclusive, and institutionalize
elitism and nepotism. Conflicts of interest are hidden from view, and the
lack of civil society accountability is a green light to governments to
allow corruption to go unchecked on the ground. With no watch-dogs on the
streets, those above can 'alley-cat' without fear.

The coming years of hard times for health financing will impact hardest on
those at the bottom - poor sick people in hundreds of thousands of districts
around the world. Too many suffer and die needlessly already due to lack of
access to basic essential medicines and care, and the projections for the
future are deathly dreadful. Clearly, urgent action is needed to mobilize a
greater participation in health issues from more of the population, and to
harness these human resources to bring pressure on governments and global
institutions to keep promises, deliver better services and to increase their
support for the Right to Health for all, the underlying obligation of all
governments that are members of the United Nations, and all organizations
working in health. The present system of unaccountable representation must
be reformed.

Recent advances in mobile technology and social media now allow for greater
participation via SMS (FrontlineSMS for example) and simple messaging across
social networks in any language. Twitter, for example, can be used on any
non-smart phone in many low income countries, enabling almost anyone to
learn more and to 'have a say'. A growing number of innovative
'mobile-activists' around the globe have been developing systems for SMS
based information exchanges and even voting in referendums on local issues.
m4HealthDev projects and products, by and for the community, are gaining
ground each day, and now need to be scaled-up and replicated.

Today, some sixty million very poor people are sick and suffering, and must
be allowed to participate in decisions that are about them. Democracy is a
great tool for accountability and transparency, and is now the key tool for
mobilizing widely so that 'austerity' isn't fatal to many millions already
at risk. The time is now to begin the process of developing mPowered
patients, who can build their own systems of democratic representation, from
the bottom-up. Now, we must demand that those in power act to reform bad
practices, and support the march for the Right to Health by the voiceless.
>From the bottom to the top - the short message is "Democracy Now!"
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http://www.imaxi.org/content/counter-austerity-vote-bottom-democracy-health

Celina & Case, Coordinators
IMAXI Cooperative Trust (Kerala, IN)
http://www.imaxi.org
tweet: @IMAXIcoop

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