PHM-Exch> PHM EVALUATION REPORT 2011

[Claudio Schuftan]

THE PEOPLE´S HEALTH MOVEMENT



The evaluation was conducted from January to June 2011, by a team
consisting of six members residing in India, Mexico, South Africa,
Switzerland, Sweden, and Thailand. The evaluation was conducted through
document review (global docs, evaluations, report, publications, etc),
interviews and electronic survey questionnaires with the Steering Council,
country focal points, IPHU alumni and faculty
Evaluation findings



*1. Do the current strategic objectives respond to the movement’s mission
articulated by the People´s Charter for Health and other strategic
documents? ***

PHM has over the years increased its reach and visibility and become a
unifying movement around the ‘Right to Health’ and contributed to the
renewal of thinking around ‘Health for All’ including social determinants
to health. The People’s Charter for Health sets out an alternative set of
values to the neo-liberal view of the world and calls on action on many
fronts – it carries a strong symbolic value. Some would like to see PHM
taking on more / different issues and some PHM activists don’t feel their
voice is sufficiently heard at the global level, Not everyone puts effort
into the global level advocacy. Local and global PHM advocacy initiatives
could have more interconnectedness.



*2. To which extent have the current PHM global programs, thematic circles,
and other activities achieved the strategic objectives and responded to the
PHM mission? *

The movement has a number of global campaigns and programmes, the Right to
Health Campaign (RTHC), the International People´s Health University
(IPHU), the Global Health Watch (GHW), and WHO Watch. These have raised the
profile and visibility of PHM. The RTHC and IPHU have reached out to new
people and groups and been strong vehicles for dissemination of knowledge
and building capacity of young and new activists. There is however a need
for long-term planning and follow-up for those interested in PHM. The GHW
receives strong appreciation from international activists, academics and
government officials.

Thematic circles have functioned less well although some have gone through
adjustments and are now considered global programmes, like the WHO Watch.
PHM also partners with the World Social Forum in the vision that ‘another
world is possible’. Communication tools like PHM-Exchange and the websites
play an important role in sharing information and supporting networking.
Most global programmes incorporate some gender analysis, but many would
like to see this come out stronger.





*3. To which extent has the current governance structure (including
management system and financial controls) enabled the movement to achieve
reasonable levels of inclusiveness and transparency? *

A small group of committed individuals, most of them volunteers, has put in
enormous efforts over the years to support the movement. These individuals,
from diverse backgrounds and regions, are united by the core values of the
PHM. There is overall agreement within the Steering Council that it is not
functioning optimally in terms of accountability and that the SC needs a
term limit for members. Limited communication within the SC and between the
SC and the Coordinating Committee (CoCo), as well as with the rest of the
PHM (including Country Focal Persons) has led to misunderstandings,
under-appreciation and a perception of lack of transparency.

There is recognition of a generation gap and a need to include more women
and marginalized groups in leadership. It is thus crucial that the action
plan for a new governance structure is implemented as planned leading up to
the People’s Health Assembly (PHA3). Further discussions on how to actively
involve women and marginalized groups in leadership is needed.

The current three Global Secretariats (Cape Town, Cairo and Delhi) are well
coordinated and many within PHM appreciate the new structure. Latin America
has raised they would like to see the Global Secretariat being hosted in
their region.

Financial controls and transparency have greatly improved in recent years



*4. How effective are the current PHM strategies for managing the
sustainability of human and financial resources? *

PHM is very effective in piggybacking on other events and in its use of
limited resources. The number of paid staff is kept to a minimum. However,
the lack of regional administrative coordinators is making management less
than optimal. Most programmes, as well as the PHM-Exchange depend heavily
on one or two people, which is a risk factor and a lost opportunity to get
more PHM members involved.

The IPHU has been one of PHM´s most important activities in the last years,
but the lack of follow-up of alumni, as well as more concrete opportunities
for them to get involved in limit its potential in recruiting active
members. A notable exception is the African region which has employed a
part time person to coordinate follow-up activities. Similar results are
expected in other regions if resources were available.

There is a need for more clarity in terms of who raises funds for what. At
both regional and national levels there are expectations, as well as
uncertainties, over the role of fundraising from global. Although there is
strong appreciation for volunteer work and it is considered normal that
members of the movement contribute, the lack of funding is considered a
challenge across the board. Changes in donor priorities and economic crises
which decrease the availability of development funds pose real threats to
the longer term financial sustainability of PHM.



*5. Is the current geographical spread pertinent to carrying out the PHM
mission? *

PHM has a presence in all regions of the world. Many of those active in PHM
work at the grassroots and PHM is therefore able to represent grassroots
community health movements. There is, however, still potential to develop
more global links with these grassroots health movements. PHM’s ‘presence’
in countries is not always at grassroots, but can also be concentrated on
academics. Regional coordination is lacking in most regions resulting in a
lack of planning. Language forms an obstacle for communications between
regions, between countries and within countries. The digital divide is an
important consideration when aiming to bring out the voices of the poor and
marginalized, especially since much of PHM’s work relies heavily on online
communications.

India and Latin America seem to be the strongest regions, although a
decline in activities has been reported from India. Latin America has
functioned more independently from PHM in other regions and from PHM
global. The movement in Africa is young and less established, but growing.

In other regions, the Movement is patchy and is often represented by a few
dedicated individuals who have direct contact with the global level.



*6. To which extent is the PHM recognized as a global actor for change? *

PHM has a genuinely good reputation globally where it is active. PHM
messages ‘resonate’. PHM is known for its influence on the WHO Commission
on Social Determinants of Health and has a visible presence at the World
Health Assemblies. The Global Health Watch is well recognized by WHO, NGOs
and some governments. Various other PHM publications, as well as articles
in publications like the Lancet, contribute to the visibility of PHM and to
the promotion of the message of ‘Health for All’. PHM’s analysis and health
activism is increasingly incorporated into medical and health education and
taken up by lecturers and students. However, global activities are not
always grounded at the local level and the balance between ‘global’ and
‘local’ (or grassroots) needs to be better managed.


Suggestions and recommendations

The following are suggestions and recommendations from the evaluation team
with the aim of strengthening PHM´s impact as a global actor for change and
from within the movement.



 *To increase the breadth and depth of PHM as a movement and to strengthen
its internal diversity. *To embrace diversity is essential for ensuring
credibility and sustainability. Globally, PHM should identify and apply
better ways to represent the diversity of the movement in its governance
structures, priorities, campaigns and working groups. In the regions, this
will involve increasing outreach to other movements, activists and
academics who share PHM’s core values and vision --and who can develop
activities which are not current priorities of PHM. Concrete activities
that bring together different countries and regions will naturally bring
different strands of PHM together. It is important to consciously guard
against sectarianism and exclusivism. IPHUs have a great potential to
support movement building by running courses focusing on collective
activism and advocacy.



 *The governance structures --from the Steering Council (SC) to the
national and sub-national coordination committees should be reviewed. *It
is essential to keep the current global secretariat functions and to ensure
its capacity for strategic fundraising. However, the governance processes
and representation should be made more inclusive and transparent. A system
of ‘mentoring’ or ‘coaching’ could provide opportunities for newer and
younger PHM members to become more active.



 *The Gender Committee that that was established in 2010 by the SC should
develop an action plan towards strengthening gendered perspectives and the
inclusion of marginalized issues and concerns. *While some of this is
happening, there should be a stock taking of PHM initiatives that provide
spaces for this and alternative new pathways.



 *To strengthen participatory strategic development and planning.
*Prioritizing
strategies and actions (campaigns, programmes, IPHUs, etc) at national and
regional level, along with processes to decide if and what role PHM can
play in campaigns. Interested IPHU alumni and PHM activists need to be
offered concrete projects and/or campaigns to get involved in so as to make
their participation in PHM active, meaningful and enduring. The African
region has positive experiences of such involvement.



 *Regional SC representatives need to be (s)elected and have support
*to* *work
on outreach, networking and communication to support planning and
activities including fundraising. A system is underway to make the
(s)election of Regional SC representatives more participatory, inclusive
and transparent. Organizing Regional PHAs could contribute to Movement
building and solidarity.



 *Environment and health*: PHM is well placed to carry out in-depth,
far-reaching research, awareness-building, campaigning, advocacy and social
mobilising to curb the devastating effects on the health of people, on
communities and climate change, as well as open pit mining and other
transnational ‘mega projects’.



 *Communication strategies for improved transparency. *Regular summarized
meeting minutes from CoCo and from the SC should be made available with the
possibility for anyone to add their ideas and opinions. Information about
the PHM  (Charter, principles, activities, structure, functioning, etc.)
should be disseminated widely and made available both electronically and in
other ways.



 *Communication strategies for improved networking. *In order to improve
PHM communications within the network and with interested ‘outsiders’, a
list serve could be established in which people can select their areas of
interest. Thematic discussions could be initiated through separate email
groups, small skype sessions or internet discussion fora. It is recommended
to create a PHM Global Communications Committee hosted in Latin America
which, in collaboration with the existing web team, could enhance
coordination regionally and in PHM globally through technological and
electronic means.



 *Develop local strategies that can influence WHO and global health
governance. *The WHO Watch initiative is promising. PHM should increase its
emphasis on country circles (in its broadest definition) to better lobby
WHO country representatives, as well as ministries of health.



* A* p*ermanent PHM presence in Geneva would greatly facilitate WHO
lobbying.* PHM is primarily reactive in most policy debates; while Primary
Health Care and ‘Health for All’ were radical and proactive issues. It is
thus recommended that PHM establishes some kind of “think tank” as a
permanent observer of selected priority policy themes. This should be
considered a long term goal given the current financial situation of PHM.
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