PHM-Exch> [PHM NEWS] COPASAH Symposium report

[Claudio Schuftan]

Community Centered Health Systems for improved governance and
accountability in Health: An Analysis of the COPASAH Symposium.
By Denis Bukenya(People’s Health Movement Uganda/HURIC) on 30th November,
2019
The title to the COPASAH Symposium alone set the pace to this Analysis,
“Leaving no one behind: Strengthening Community Centred Health Systems for
Achieving Sustainable Development Goals”. This title in my mind alludes to
a commitment to serve a people and humanity through a more democratic
approach that allows them to be involved in their own health challenge
solving and development. It is important to note that many marginalized
people’s lives in the community are in jeopardy the world over hence the
need for community ethos and creation of a conversation between grassroots
practitioners, policy advocates, research and academia, policy makers and
the implementer. The symposium encased a motley of approaches from the
grassroots, practitioners, researchers and academia, policy makers and
implementers from all over world, uniquely modeled to gainfully engage
members of community and their leaders to improve governance and encourage
community accountability.
While COPASAH has been run since 2011, this was my fast time to attend the
event. The practitioners use social accountability approaches to strengthen
the linkage between communities and the health systems to provide quality
and accountable care. The symposium revolved around five themes emanating
from a specific theme anchor of Leaving No One Behind: Strengthening
Community Centered Health Systems for Achieving Sustainable Development
Goals. This year, the symposium was organized at the India Habitat Center,
New Delhi-India. Approximately 500 people were in attendance from diverse
political, social and cultural contexts including COPASAH members from
Latin America, Southern Central Europe, Sub Saharan Africa, Eastern and
Southern Asia along with researchers, donors and policy makers in the field
of public health governance.
The five major areas considered included: Community Action; Indigenous and
Marginalized Peoples; Sexual & Reproductive Health and Rights; the Private
Sector in Health and Health Workers. Alongside plenaries and parallel
sessions, the Symposium comprised workshops, dramas, cultural events and
film screenings, and a poster exhibition. Dedicated sessions for regional
consultations allowed time for in-depth consideration of the draft COPASAH
Charter and Call to Action, as well as other geographic-based discussions.
Most importantly, the vast
majority of participants hailed from the Global South. I should say that
the Arab region, North Africa, and the Pakistan perspectives were greatly
missed.
Although in this case the outcomes were fairly benign, the structure and
content of the Symposium and the discussions were fascinating. Owing from
my point of view, combined with my experiences at such Global Health fora,
below I outline what I have learned about citizenship, governance and
accountability in health considering strengthened community centered health
systems.
The need to continuously empower Civil society as a feat for citizens’
voices
The narrative showed that Development cooperation has been highly
characterized and the Civil society organizations (CSO) are being steered
towards certain actions over others depending on the funding curve of the
donor. Multinational corporations have tuned development corporation into a
weapon to disguise profit in the health sector. So many examples were
sited, notably was the issue of medical tourism in India where the doctors
will treat all cost regardless of the survival rate of the patients.
Evidence interrogated at the symposium showed that due to these deliberate
efforts through aid and other Civil Society Organization partnerships, the
focus has turned to treatment rather than prevention. Simply because the
multinational corporations will then line their pockets for trade and
profits. Truly so, development corporation focusing on prevention is
steadily dwindling. The broader challenge that I hailed the symposium for
exposing in the SDG error were the numerous partnerships that have widely
opened the floodgates to the private sector which stands for profits at the
expense of ill health.
Clearly the practitioners in a bid to fast track strategy shared how they
have countered this challenge in their various jurisdictions. The most
memorable approach was to form coalitions and muster collective
responsibility embanked with numerous community voices to their leaders in
demand for sanity. I also got to learn that visual art is a tool of
advocacy that appeals most to the youth and the young.
The conflation between treatment and prevention is problematic.
Within the Global Health agenda, Universal Health Coverage (UHC) issues are
being framed in terms of treatment solutions. Solutions that, for example,
propose public private partnerships to accelerate access to pharmaceutical
products. Jane Nalunga, the Country Director of SEATINI/Uganda described
how reallocation of power in decision-making, funding and provision of
health services from the state to private sector actors and donors
continues the exclusion of communities from information, decisions and
feedback regarding their health care. More evidently so, the UN General
Assembly high level meeting, 2019, prevention was hardly
mentioned but the justification of the need for private partners. Chris
Owalla the Executive Director of Community Initiative Action Group Kenya
(CIAGK) based in Kisumu, Kenya at one of the sessions questioned the
narrative as to whether we are still in focus of the debate to help a
people at the grass-root when we keep discussing how to make a UHC funded
by private public partnerships. We ought to have taken more time
questioning this assumption. However, the discussions soon turned to
circular debates over engaging with “health harming” industries such as
food and alcohol. This illustrates the situation at COPASAH, where civil
society (the People’s Health Movement and a few other NGOs) felt they had
to interrupt the plenary to have their voices heard, to help support the
brilliant panelists points. My analysis is that civil society are in “an
abusive relationship with industry”, Global Health is an uncomfortable
third wheel in this long-term relationship between Public Health and
trans-national corporations.
The commercial determinants of health are at the top of everyone’s
intellectual agenda – but action is not being funded
The most energized and well attended session at COPASAH was the excellent
People’s Health Movement-led session on the commercial determinants of
health and political economy of health. Although the atmosphere was one of
activism the audience contained a range of delegates, including those from
the global governance of health list like the WHO. The discussions did not
progress and likely only served to re-enforce pre-existing assumptions on
both sides. While the importance of tackling the commercial determinants of
health at the community level is widely agreed, as mentioned above this is
not reflected in funding flows. This highlights the challenges for Global
Health actors to implement research and projects that may displease their
donors; donors who are beholden to private capital flows that may well be
invested in the products that public health evidence now shows to be so
harmful. In other words, the political economy of Global Health in action.
To my disappointment, the debate turned political and I really felt like my
fellow community activists were denied the opportunity to process the
information to make it actionable. It is at that point that I made the
suggestion as a way forward that there is a need for PHM to continue
simplifying the messages in their policy briefs and share the information
widely on the pros and cons of the financial determinants of health and the
political economy of health making it more actionable for grass-root
consumption.
Global Health and the Neoliberal Global Political Economy
The governance and accountability in health is dominated by the ideology of
neoliberalism, which places the individual and free-market at the centre.
It is important to view global health as part of a system that has
increased inequality and inequity and strangely so it seems a fantasy to
expect the opposite. The appropriation by many actors in the global health
economy has distracted the understanding of the political economy within
Global Health. There is a fear that by holding a symposium on governance
and accountability in health, and self-congratulate ourselves on seeking to
address the issues of governance and accountability hence the inequality,
a box is ticked and it is business as usual. We need more governance and
accountability analysis of Health systems and the community institutions.
But who will fund it? Who will publish it?
The aim of COPASAH was to: “identify major bottlenecks, root causes and
propose solutions from the grass-roots to the national and global level to
accelerate implementation of proper health systems governance and
accountability in health. Whilst the foreseeable objectives were fulfilled,
it begs the question as why solutions to the root causes were not
forthcoming. Further questions coming to mind were: should the symposium
have further considered an elite UN dominated Global Health symposium to
better interrogate the governance and accountability in health? I am not so
sure.
Moving Forward
To conclude, here is my observation and personal analysis to those who
attended the symposium and would love to see change in the current status
quo in Global Health.
1) The demand for access to information at the grass-roots needs to be
demanded even at Global level. We need to interrupt proceeding to refrain
from using words like business as usual. We need to demand that Aid through
our global leaders is relaxed to serve at the grass-roots. The negotiations
should be made public notice for communities to have meaning-full
participation: It is important that communities demand collectively for
protection from pandemics by the global health leaders, to fight infectious
diseases, to find the cure for cancer if possible, an support nations as
they work out a formula towards a Universal Health Coverage dully financed
by national taxes and also be open to sharing the data generated.
2) There is an ardent need to continuously critique and work with the UN
systems at all levels so that its engagement with the member states can
periodically get reviewed on their safe-guarding norms and aspiring to
global goals with evidence from the communities.
3) In the meantime, let’s use the data Global Health generates more smartly
– to show what is not happening as well as what is. And to use more
political economy analysis to help show why.
4) Let’s dumb down the messages around strengthening community centered
health systems, so that members of the public all over the world can
understand the issues and causes of injustice. Let’s tell the stories
behind numbers in ways that people can understand, communicated in forms
they can utilize (clue: not case studies!).
5) Finally, and most importantly, let’s be inspired by people like the
volunteers at the COPASAH secretariat in India to be champions, to not give
up on what we believe in (for me, social equality, equity and social
justice). But let’s also be realistic: Global Health is great for measuring
things and improving health security; it is not necessarily the right place
for people who want to tackle injustice, and change the world in the many
ways it so urgently needs changing.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20191130/782095ef/attachment.html>