PHM-Exch> [PHM] a bit of history (6)

[Claudio Schuftan]

*A bit of history:*

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


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. *

   - Efforts have been made in East Africa; Latin America, the Middle East,
   and Asia.
   - 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. *

*-------------------------------*
PART 2:



*b)  ** 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.





[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].
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