EXECUTIVE SUMMARY
More than 1,400 people from over 90 countries met for five days in
December 2000 in Savar, Bangladesh to finalise a People’s Charter for
Health that calls for a radical transformation of local, national and global
systems to enable people to play a greater role in dealing with the
determinants of their health.
This People’s Health Assembly (PHA) - the first of its kind - was a unique
social mobilisation exercise. In country after country, it involved people
in village meetings, in district meetings, in national events, in regional
workshops to prepare for the global gathering in Bangladesh. A series of
international, regional and national materials were produced.
Along the way, the voices of the people were heard:
-
articulating their demands for better health, justice, peace and
equity
-
reaffirming their rights and responsibilities to be involved in the
decisions that affect their lives and their health
-
confirming that the right to health is one of the basic human
rights to which they are entitled.
The five-day meeting in Bangladesh provided an opportunity for people
involved in health, development, human rights, agriculture, trade and
economics, the environment and many other fields to converge, to share ideas
and begin the process of building a coalition to drive change. The Charter
outlines a framework of action that could lead to change.
It includes demands for:
-
increasing people’s involvement in decision making, including
people’s organisations being represented in local, national and
international fora that are relevant to health
-
governments and international organisations to reformulate,
implement and enforce policies and practices which respect the right to
health, and for governments to promote, finance and provide
comprehensive primary health care
-
the radical transformation of the global financial system, the
global trading system including effective regulation of transnational
corporations, the World Health Organisation, and the UN Security Council
-
cancelling Third World debt.
Moving forward from Savar requires:
-
publicising and mobilising support for the Charter
-
developing a PHA process that can continue to grow and flourish as
a force for change and a forum for people’s voices. In due course it
is envisaged that this will evolve into a People’s Health Movement.
-
strengthening people’s involvement in decision-making mechanisms
at local, regional and international levels
Above all, it means rethinking the way we view health - moving from a
concentration on disease control towards a people-centred approach that
focuses on what affects people’s lives and health and looks at how the
totality of the conditions in which they live, work and enjoy their culture
and environment can be improved.
STATED OBJECTIVES
Goal
Re-establish health, with an emphasis on Primary Health Care, and equitable
development as top priorities in local, national and international
policy-making.
Purpose
To develop and begin to implement strategies for achieving the goal of
Health for All based on the knowledge and experiences of different groups
and communities around the world
Objectives/outputs
-
Hearing the unheard. Presentation of people’s concerns and
initiatives for better health, including traditional and indigenous
approaches. Women’s rights, concerns and full participation will be
given high priority. Action plans will be worked out, refined, and
presented to decision-makers locally, nationally, regionally and
internationally.
-
Re-enforcement of the principle of health as a broad crosscutting
issue. There will be emphasis on the inter-sectoral dimensions of
primary health care and focus on health development, rather than health
services.
-
Formulation and endorsement of a People’s Charter for Health (PCH).
To include concrete recommendations for policy and action with clear
commitments to promoting equitable, gender-sensitive and sustainable
health development. To be addressed to governments, international
organisations, the business sector, academia, non-governmental
organisations and people’s movements.
-
Sharing and enhancement of knowledge, skills, motivation and
advocacy for change Throughout the PHA process, opportunities will be
provided for in-depth exchange of experiences and development of both
practical and analytical skills. The People’s Charter for Health will
provide a base for advocacy, policy-formulation and campaigns at the
local, national and international levels.
-
Improvement of the communication between concerned groups and
institutions. Communication and networking among individuals, groups,
organisations (including people’s movements) and institutions will be
developed during the Assembly and sustained and strengthened thereafter.
-
Development and enhanced co-operation between concerned actors in
the health field. The importance of strengthening the links between the
different institutions and actors in the health field will be emphasised.
-
Enhanced media interest in health/equity issues in programmes,
events and articles. Health should be more visible in the media, with
links to policy, not only disease and individual concerns.
REPORT ON ACTIVITIES
INTRODUCTION
Several local workmen were laying bricks in fresh cement at the entrance to
a purpose-built conference facility at Gonoshasthaya Kendra (People’s
Health Centre), in Savar, Bangladesh. It was Sunday morning, 3 December
2000. Around them milled newly arrived people from Africa, Asia, Latin
America, the Pacific, Europe, and North America.
The air was filled with conversation in dozens of languages, as people found
old friends, made new acquaintances, and sought out the location of the
relevant registration desk. This was the day before the start of a unique
five-day event: the People’s Health Assembly (PHA). It brought together a
large number of people, many of them coming from grassroots organisations or
organisations that worked closely with poor and marginalised communities.
However, the meeting in Bangladesh - as impressive as it was to bring
together such a diverse, multinational group of organisations and people -
was not the end point. Nor was it the beginning. It was prefaced by a wide
range of preparatory meetings around the world, by the development of
various background papers and issue papers, and by an extensive consultation
process to flesh out a skeletal People’s Charter for Health.
And it will be followed up by a range of activities designed to carry
forward the momentum generated by the preparation and by the Assembly
itself, and to strengthen networking among the participating individuals and
organisations.
The international organising group that was instrumental in making the PHA
happen drew upon the skills of the following organisations:
-
Asian Community Health Action Network (ACHAN)
-
Consumers International (CI)
-
Dag Hammarskjold Foundation (DHF)
-
Gonoshasthaya Kendra (GK)
-
Health Action International - Asia Pacific (HAIAP)
-
International Peoples Health Council (IPHC)
-
Third World Network (TWN)
-
Women’s Global Network for Reproductive Rights (WGNRR).
The Assembly itself was designed to be as participatory as possible
and to involve a large number of people and stakeholder groups in the
preparations. Assembly activities included keynote addresses, analytical
presentations, sharing of people’s testimonies and stories on health
practices and concerns, workshops, debates, cultural and audio-visual
presentations and exhibitions.
This report highlights some of the initial preparatory work leading to the
PHA, including a brief summary of why such an exercise was needed.
It will then give impressions of the five-day Assembly, providing an
assessment of the positive and negative aspects of the event.
A section is devoted to the People’s Charter for Health - which was a key
output from the process to date.
The next section provides a summary of some of the early post-assembly work.
A final section offers some comments of the income and expenditure and the
budget revisions for the activities from April 2001 onwards.
A set of appendices provides additional background material, including the
text of the People’s Charter for Health, copies of selected press coverage
around the Assembly, a summary of the pre-Assembly activities in India,
details of the Assembly programme, some examples of the newsletter and a
summary of post Assembly activities in Europe.
The tone of the report has tried to reflect the lively and people-centred
nature of this historic event. The breadth of views, ideas and experiences
have been shown as they provide an invaluable window onto the health rights
concerns of millions of people across the world today.
PRE-ASSEMBLY
“In the peaceful surroundings of Chota Badada on the banks of the
still-flowing Narmada, the 3rd convention of the National Alliance of
People's Movements brought together organisations, movements, individuals
and parties from all over India for an intense, thought-provoking, 4-day
deliberation from March 11-14, on struggles and alternatives in agriculture,
labour, politics, globalisation, water, energy, weaponisation, art and
culture. There was a remarkable consensus in a cross-section of people who
have been fighting in various local struggles in different parts of India,
and covering all age groups.”
from an NAPM Press release, 16 March 2000, entitled:
Farmers, dalits, tribals and women resolve to fight against globalisation
“About a hundred people met in a small auditorium at the Institute of
Mathematical Sciences in Chennai during the winter of 1999. Sujatha and
other villagers from across Tamil Nadu had gathered to speak at a discussion
on people’s initiative in primary health care. Sujatha rose and narrated
the moving story of a single mother and her jaundiced child. Nobody stirred.
Dressed in pastel nylon sarees and salwar kameez, the women were all ears
during the first half of the session as Dr. T. Sundararaman of the People's
Initiative in Primary Health Care, explained why hospitals would no longer
suffice. Why in the near future, a door-to-door, village-level initiative
would become essential for a healthy India. This was a preparatory meeting
for participation in the People’s Health Assembly, scheduled to be held in
Bangladesh in the first week for December 2000.”
from an article in the Daily Excelsior newspaper (6 Apr
2000),
by Jyotshna Pandit, entitled The future of your health.
“The heavy downpour on Sunday evening did not deter more than 200
people from attending a rally organised to demand accountability from civic
and health services, and the regulation of services by private doctors and
fair price shops. The rally was organised by two Non-Government
Organisations, Ashish Gram Rachna Trust (AGRT) and Arogya Vikas Samanway
Samiti (AVSS), on Sunday evening. Calling it the 'March for health', the
participants started from two points in the Mundhwa-Ghorpadi slums, and
converged at the Jai Hind Chowk, Ghorpadigoan, where a meeting was held.
Residents of the slums also attended the meeting … which was addressed by
the chief guest of the function and representative of the People’s Health
Assembly, Datta Desai.”
from an article in the Times of India, 8 Nov 2000,
entitled ‘NGOs Demand More Spending on Health’
These reports highlight just three of the many local meetings held in
India and many other countries in preparation for the People’s Health
Assembly.
Background
The World Health Assembly (WHA) is an event that takes place annually
involving health decision-makers from all over the world. The assembly’s
achievements, or lack of them, are easy to see despite the hype that
surrounds it. Over the years, non-governmental organisations (NGOs) have
advocated people-sensitive health policies at the WHA but with little
success. At the WHA held in 1985, a meeting took place between three NGO
leaders who recognised the need to involve poor people in making decisions
affecting their health and their lives. These leaders also recognised the
need to create a forum and process that would make it possible for poor
people to become involved in this way. It was 15 years before this idea was
realised as PHA 2000.
Pre- Assembly activities
Activities leading up the PHA focused on three broad areas:
-
Analytical work
to develop a broad analysis of the major health
issues facing the world, in order to provide a solid basis for policy
formulation, advocacy and development of innovative solutions. This drew
on existing analyses and data as well as some original research by
resource persons with recognised expertise. This background documentation
guided discussions within countries and regions.
Country and regional meetings
to deepen understanding of and
elaborate strategies to address priority health problems. These meetings
aimed to:
-
bring together large numbers of health and development
workers, community members and decision-makers
-
engage critically with the background materials
-
form a basis for future health development action.
-
Case studies, experiences and ‘people’s stories’
from a large number of countries were collected. These described people’s
direct experiences of health and health problems, their own analysis of
causal factors, their initiatives, examples of success stories, failures
and proposals for the future.
Country and regional meetings
The Indian experience, mentioned earlier and further described in Appendix
3, was probably the most ambitious of the national and regional meetings
that led up to the PHA event in Bangladesh. However, similar activities took
place around the world.
Bangladesh
In Bangladesh most of the NGO networks in the country got together to form
different working groups with a central co-ordinating committee called the
Bangladesh Chapter. NGO presence in the country is extensive and through
their networks all levels of people, from those at the grass roots level to
those at the top, responded and volunteered to be involved.
Press conferences and briefings were held with articles appearing in
both printed and electronic media. Several posters were printed and
distributed through NGOs and other development organisations. Many campaign
documents with the goals and objectives, activities, and programs of PHA
were printed and distributed. Special meetings were arranged with
appropriate government organisations and ministries and other relevant
organisations.
Every division and the majority of the 64 districts in the country had
special meetings as part of the campaign to ensure people’s participation.
Divisional meetings were held at each of the five divisional capitals of
Dhaka, Chittagong, Sylhet, Barisal and Khulna. Organised by five different
NGOs, the divisional level assemblies were attended by government ministers.
Small group meetings in the regions with NGOs and local people decided that
experiences of health and development by the people themselves s should be
presented in seminars and workshops before and during the assembly. Hundreds
of case studies were collected. Many grassroots organisations expressed an
interest in organising workshops during the PHA to present their case
studies.
Nepal
In Nepal, more than 500 NGOs from around the country were consulted and took
part in preliminary events. RECPHEC in Kathmandu took the lead in co-ordinating
activities. More than 15 workshops were organised, incorporating topics such
as local self-governance, the ethics involved in health issues, the impact
of mega dams on the health of peoples, and the role of participatory
democracy in policy decisions. More than 70 participants travelled from
Nepal to the PHA in Bangladesh in two buses.
ACHAN was responsible for pre-PHA 2000 activity in Asia. Meetings were held
in Cambodia where Medicam, the main health NGO, was our partner. In the
Philippines, several meetings took place involving a cross-section of NGO
groups involved in activities ranging from health provision to popular
theatre. China, being in a sense the origin of ordinary people’s
involvement in health, was a difficult place to work but fortunately,
through our partners the Amity Foundation in Nanjing, we were able to reach
a large number of semi-governmental organisations there. The same processes
took place in parts of Africa and the Pacific and, by courtesy of the IPHC,
especially in Japan.
Middle East
In the Middle East, despite the outbreak of confrontations, a regional
meeting was held in October in Larnaca, Cyprus. Representatives from nine
countries were present. The meeting clarified the PHA process and identified
the input from the Middle East/North Africa region.
The draft People’s Charter for Health and the main background document -
Health in the Era of Globalisation - were translated into Arabic, while the
other papers were distributed in English. The group’s first task was to
identify their priorities from a regional perspective, and then incorporate
these priorities into the draft agenda. The names of 50 people who could be
participants, resource persons, or reporters were put forward in the
meeting.
Latin America
During many months local and country discussions were held relating to the
proposed People’s Health Charter. In September 2000 a regional forum on
People’s Health was held in Cuenca, Ecuador with representation from other
countries in South America. Case studies and papers were chosen for the PHA.
A similar event took place in the area of México, Central American and the
Caribbean. Local workshops and discussions took place. Theconclusions were
taken to the Regional pre-Assembly meeting in Guatemala in October 2000.
Participants were chosen for the PHA at that time and given the mandate to
represent the region and share the Regional Charter for Health.
The events described above are representative of pre-PHA 2000 activity in
many other countries across the globe.
In Europe the PHA process spread from UK to many countries, including
Germany, Russia, Armenia and the Ukraine.
Regional Co-ordinators
The impetus for the national and regional activities came from a team
of regional co-ordinators who also helped to facilitate participation in the
Assembly and the development of the agenda for the Assembly.
The regional co-ordinators were:
Norman Nyazema, CI ROAF, Zimbabwe
South Africa:
Dona Tversky, Public Health Programme, University of
Western Cape, South Africa; David Sanders, IPHC, University of Western Cape,
South Africa.
Asia:
Prem Chandran John, ACHAN, India
Southeast Asia:
Edelina de la Paz, ACHAN, Manila, Philippines
Europe:
Pam Zinkin, MEDACT/IPHC, London, United Kingdom
Pacific:
Mary Murray, Kambah ACT 2902, Australia; Ken Harvey, School
of Public Health, La Trobe University, Australia
Latin America:
Maria Hamlin Zuniga, IPHC, Managua, Nicaragua; Arturo
Quizphe, Faculty of Medical Science, University of Cuenca, Ecuador
A March for Health
Echoing the pilgrimage undertaken by many of the Indian participants to take
part, a march for health was held in Bangladesh the day before the PHA
opened. The march and the Assembly itself were dedicated to the memory of
the martyrs of the 1971 Bangladesh liberation struggle.
Hundreds of international delegates to the PHA at Savar walked to the nearby
site of the Jyotir Sriti Soud - Bangladesh’s national monument in honour
of the heroes of its Liberation War in 1971.
And in the same spirit as that of the Martyrs the PHA participants
pledged to fight until the agreed goal of providing Health for All was
achieved throughout the world. Arabs, Africans, Europeans, Americans and
Asians joined together to make the People’s Health movement a truly global
one.
Selvi, a health worker from the southern Indian state of Tamil Nadu, who had
travelled by foot, by bus, by train and then by bus again to get to the PHA
said, ‘We are excited about the PHA. We are hopeful that this historic
event will help to strengthen our spirits and solidarity’.
PEOPLE’S HEALTH ASSEMBLY 2000
The Venue
It was decided that PHA 2000 would be held in Asia for several reasons:
these included Asia’s large population, relative lack of infrastructure,
acute health situation, and the plethora of people-based initiatives.
Several options were assessed using criteria such as availability of
physical infrastructure to cater for a large number of delegates, ease of
travel, attitude of local governments, and of course the cost. The most
important criterion was the proximity of people-based programmes that have
worked. Savar, in Bangladesh, was selected because it fulfilled the criteria
above, and is in a poor rural area, which was thus an appropriate location
from which to advocate on behalf of the poor post-PHA.
Savar turned out to be an inspired choice. It is rural but close to Dhaka
and its facilities. GK, our host, is a highly regarded NGO and continues to
have a ‘clean’ record in a country where several big NGOs have
discredited reputations. There is a vibrant field programme around Savar
that is people-based. Adequate infrastructure exists at GK and close by.
There are good relationships with national and local government authorities.
Finally, GK has a large number of dedicated staff willing to help with
organisational tasks. Lack of communication facilities could have been a
problem but they were well provided.
On reflection, much of PHA 2000’s success was due to the choice of venue.
Adequate but not luxurious facilities in keeping with the tenor of the event
as well as that of the participants, the early morning mist and the dew on
the grass, the appetising food served in village-style huts by village folk,
the adequate facilities for group meetings, the newly-built auditorium in
which the participants sat on the floor, the interaction between delegates
and staff willing to help regardless of time or trouble - all these
contributed substantially to the success of the occasion.
The Participants
Participants were carefully selected and had been through a pre-PHA process.
This lies at the root of PHA 2000’s success. Participants had come well
prepared. PHA 2000 was building upon a strong foundation that had already
been laid. Most participants were selected by regional meetings and co-ordinators.
We kept gender parity strongly in mind, and the potential of individuals and
NGOs to further the cause of the PHA in future was a primary criterion for
selection.
We had decided that since this was an event for the people, it should
also be by the people. Therefore, over one third of the participants
were grassroots workers. These were the village-level health workers,
traditional midwives, health activists, community leaders and others who had
shown exemplary leadership qualities and made it possible for communities to
live in reasonable health against the odds. They were ordinary people doing
extraordinary things under difficult circumstances. In a sense PHA 2000 was
a celebration of the vulnerability of the participants.
One third of the participants was made up of practitioners and activists
from People’s Organisations, NGOs and NGO networks, and the remaining
third consisted of health decision-makers, and leaders, and decision-makers
from governments and international bilateral and multilateral agencies.
It was very sad that senior officials from the WHO, the agency most
responsible for global health decision-making, could not to participate in
PHA 2000. With over 1,453 people from 92 countries attending PHA 2000, their
absence was all the more obvious and of concern to all.
The Assembly begins
On the first day of the People’s Health Assembly, as the custom-built hall
began to fill with people, all the minor hiccups and frustrations
participants were having in finding accommodation, locating where to have
breakfast, finding out what to do about missing luggage, working out where
to change money, and trying to discover what was going to happen next began
to fade. In their place came a sense of excitement, of anticipation, of a
desire to take up the challenge of improving people’s health now and in
the future.
Violeta Menjivar
from El Salvador was one of the speakers on the opening
day. She pointed out that globalisation - as practised by companies and
international institutions was taking away people’s right to health.
Instead, she called for the development of a people’s movement to portray
a true meaning of globalisation: the globalisation of solidarity among
marginalised people. ‘Let us globalise our experiences and our vision and
develop a current of human solidarity so that we have equity and justice in
health,’ she said.
Govinda Pillay, a long-standing member of the Legislative Assembly in the
southern Indian State of Kerala, noted that the major improvements in health
in his state had come about ‘through mobilisation of the masses at the
grassroots level’. However, he noted that the gains of the ‘Kerala model’,
which has been praised throughout the world, were under threat from cuts in
subsidies for services such as health care due to pressure from
international financial institutions.
In a special message read out to the Assembly, the Prime Minister of
Mozambique,
Dr Pascoal Mocumbi, said that in his country - where 70 per cent
of the population live below the absolute poverty line - the government had
the responsibility of guaranteeing access to health care. ‘Community must
be a participatory actor in the health system that is designed for it and
directed towards it,’ his statement said. He also noted that peace was a
pre-condition for health.
N. H. Antia from India, who chaired the inaugural session, said the meeting
was taking place at a time when greed had reached its limits and the
pendulum had started to swing. ‘The new process of globalisation,
liberalisation and privatisation, have tolled the death knell of Health for
All, and it will also be the death knell of the planet if we don’t take
adequate corrective measures at this stage,’ he added. He said he hoped
that discussions emerging from the Assembly would give a new dimension to
thinking on the problems of health, so that people were ‘no longer be
cowed down by a few people who have converted sickness into a business and
industry’.
James Orbinski of Medecins Sans Frontieres (Doctors without Borders)
said that poverty and injustice is about people’s lack of liberty. He said
that staff at MSF believed that it was necessary to ‘use our liberty and
use our voice to improve the lives of all’. He pointed out that
institutions such as the World Bank and the International Monetary Fund (IMF)
have co-opted the poor and the language of the poor. ‘We must stop this
co-option and define our own clear vision, sense of action and voice.’
He said, ‘a key challenge for this Assembly is to organise into a global
people’s movement for health. We must be clear in our focus, clear in our
purpose and clear in what we will and will not settle for. It must be a
movement that recognises the political context in which it exists, that
confronts and engages sources of power, that does not simply determine a
shopping or priority list, but that demands not charity, but change.
‘The power of this People’s Health Assembly lies in the clarity of its
purpose or its vision, in the integrity of its actions, and in the
genuineness of its voice - and in its willingness to witness against the
apparent futility of reality. If this People’s Health Assembly is to
become a genuine global people’s health movement, it must be independent,
it must have its own genuine vision, its own genuine action, and it must
speak with a genuine voice. This vision, action and voice must not be
co-opted, and sanitised of its intent and meaning.’
Solidarity
Solidarity of people resisting globalisation was the main theme of the
opening day of the Assembly.
‘I am here to show solidarity with fellow activists. There is a need to
create a critical mass of people for changing the deteriorating health,
social and gender situation,’ said Dr. Mira Shiva, of the All-India Drug
Action Network.
‘It is high time to make joint efforts to place health as a human right.
Humans are equal not just biologically but they should have equal options
and opportunities,’ said Dr. Ghassan Issa from the Health Unit of the Arab
Resources Collective.
‘Indigenous health issues have common root causes around the world and I
felt that I could see how other people are coping with them and strengthen
ties with them,’ said Irene Fisher of the Jawoyn Association, Australia.
‘We are here because we believe in primary health care as a right of the
people, which the governments are not doing anything about. We are
interested in primary health care and want to learn from other groups here
who have experience in this field’, said Mahmoud Masri of Social Progress
in Lebanon.
Structure of the Assembly
The Event itself was structured very simply. Every morning was allocated for
plenary sessions and every afternoon for workshops and round tables.
Substantive issues were discussed at most plenary sessions, and VIPs were
invited to some sessions. Discussion of each issue took place in two or
three sessions in which time was made available for participants to respond
to the speakers. Plenary sessions, though sometimes long and drawn out, were
for the most part orderly. One notable exception was the session involving
the representative of the World Bank. Some delegates were vocal in their
dissent but agreement was reached to enable a very lively and important
exchange of ideas and experiences.
Each day of the Assembly began with a cultural activity or an opportunity
for solidarity announcements. This was followed by a plenary session that
offered opportunities to hear people’s concerns and some of the ways they
were working for better health, including traditional and indigenous
approaches. Their direct experiences of ill health were presented - clearly,
directly and movingly. The causes and possible solutions were then discussed
and analysed. The overall aim was to move towards the development of action
plans on the last day.
Each day had an overall theme:
-
health, life and well-being
-
inequality, poverty and health
-
health care and health services
-
environment and survival
-
ways forward.
Each afternoon, some 15-20 concurrent workshops were held. Through
these a broad range of topics and issues were discussed and explored. From
these workshops, a number of ideas and plans for taking work forward
emerged. They also helped to identify like-minded people who wanted to work
together on key health-related issues.
(Full details of the programme are given in Appendix
4.)
Two workshops on each of the first four days were developed and managed by
the PHA organising group. One dealt with the discussion of the PHA issue
paper that underpinned the day’s theme. The issue papers were part of the
background material developed for the PHA. (Copies of the background papers
are available from the PHA website: http://www.phmovement.org
The second workshop provided an opportunity to discuss the People’s
Charter for Health. (The process of developing the Charter is explored in
more detail in the next section of the report.)
All the other workshops were developed and run by participants.
In the evenings, there was space for spontaneous meetings, for cultural
activities - music, dance and theatre presentations spontaneously emerged
each evening and lifted sprits, energies and solidarity.
Throughout the week, reality was never far away. Each morning, participants
could see the young children making their way to the primary school within
the compound at Gonoshasthaya Kendra, and watch them at play or doing their
exercises. Food during the Assembly was supplied by women’s groups from
neighbouring villages who worked in temporary kitchens quickly constructed
from bamboo to provide a nutritious and varied diet for everyone. The main
eating area was outdoors in a quadrant bordered by the bamboo huts that were
the kitchen space.
Day two
The second day of the Assembly focused on poverty and inequality and heard
testimonies from people representing
Africa, Asia, Europe, Latin America,
the Middle East and the Pacific regions. It opened with calls by the Cuban
and Iraqi delegations for the immediate lifting of sanctions against their
countries. Spontaneous approval was evident and the participants praised the
Cuban experience of providing health care to its citizens despite all the
hardships of facing a hostile United States embargo.
Ramon Collado, one of the Cuban participants, said that over the past three
decades the blockade had cost his country over 67 billion dollars and the
cost was increasing every year. This was imposed, he said, because of
opposition to the Cuban people’s right to determine their own destiny. ‘We
have achieved much despite the pressure. Imagine what we would have achieved
if this blockade had been removed.’
‘No other country has been as consistent in taking measures towards
achieving the goal of Health for All as Cuba,’ said
Halfdan Mahler, the
former director-general of the World Health Organisation. ‘It is a country
which has virtually all the requirements for primary health care,’ he
said.
Salma Jabu, a delegate from the northern territories of Iraq also called for
an end to US sanctions imposed on Iraq after the Gulf War in 1991. She said
the sanctions had resulted in massive destruction of infrastructure and
seriously affected health care. Between 1988 and 1999 she said the infant
mortality rate in Iraq had gone up by a massive 660 per cent. ‘The lifting
of US sanctions, more democracy and greater participation within the country
are prerequisites for change in the situation of the Iraqi people,’ she
said.
Citing the liberation of Bangladesh in 1971 as an example,
Abdur Razzak,
Bangladesh Minister of Water Resources, said that ‘history has taught us
that whatever changes have taken place is through people’s power’. He
said that millions of people around the world were still deprived of basic
health care. He said that unfortunately the Alma Ata declaration in 1978 of
‘Health for All’ had turned out to be a mirage.
A young village health worker from Nepal enacted for everyone the plight of
a young woman who was typical of many she worked with in villages. She was
in bonded labour, had no food, no money. Her husband had died. Now, in order
to feed her child, she would have to offer her into bonded labour. How could
she put her daughter through the misery that she had faced all her life? Her
final, impassioned cry was ‘God help me or let me die.’
Thelma Narayan
from India responded to this by adding that the story
reflected the situation of millions of women in Asia and highlighted the
gender inequality of poverty and ill health. ‘It is the suffering that
moves us,’ she said. ‘Our anger at the injustice has led us to develop
strategies to cope. What we are recognising is that this is a global
phenomenon and therefore the response needs to be global. We need to address
the issue of power and to look at how power affects the lives of people. It
is our role to influence those who hold power.’
Halfdan Mahler
confirmed the failure of the international system to deal
with the interaction of poverty and health. ‘In my 50 years working as an
“international gypsy” it has been clear to me that within the UN system,
we cannot reach the poor. We hear the excuses that it is too difficult, too
expensive. This is an in-built discrimination against the poor. We have
betrayed the primary health care approach so badly. Who is speaking out
against all the obscenities caused by poverty? We are very badly betrayed by
the health professions who have become so commercialised. Governments cannot
be counted on to make radical change. You, the NGOs, forced my hand to
present to the World Health Assembly a report on primary health care. And
now, thanks to you, you still think it is proper to take a look at what has
been happening.’
He urged the participants to continue the struggle. ‘I am naively
convinced that we have to fight out there with the people. If we cannot find
ways of getting together with the poor, to stand up and find ways to express
our political and social activism, we will then have to live with the
nightmares. There are many miracles of people working together. Go home and
do something!’
PHA organising group member,
Maria Hamlin Zuniga
from Nicaragua, who was
chairing the session reminded participants that ‘the struggle for health
is the struggle for liberation of all our peoples’.
Boshi Mohlala
from South Africa compared the phenomenon of globalisation to
that of slavery. He asked ‘why did it take so long - 300 years - to end
the slave trade? Why did it take so long to stop colonisation? Why is the
world organised the way it is?’ Each ‘why’ was said slowly, softly,
meaningfully, and it seemed to resonate around the hall, encouraging
reflection. The answer he offered was that ‘somewhere, someone decides not
to do something about it. Enough is enough. We cannot allow globalisation to
go on. Let’s stop the multinational corporations and the World Bank
policies now. Let us stop poverty and inequality now!’
Dr Halfdan Mahler
was given the floor to end the session, and he reflected
on a question he was often asked: What was the finest hour of the World
Health Organization? He said that most people expected him to say that it
was the successful global eradication of smallpox. With a rueful smile, and
a shake of his head, he said there were three moments: ‘Compare that with
what you NGOs have achieved in pushing WHO to develop an essential drugs
policy - painful for many of us - but you were steady in your pressure.
‘And the second is the follow up to primary health care. Again, you NGOs
have been challenging WHO to engage in much more dialogue. Some of the
things that we should learn from are what people have been doing over the
past few years, because they have the guts to protest.
‘And the third, you will not believe how complex it is for someone like me
when I was Director-General of WHO to come to terms with the issues around
breast milk substitutes. You mobilised, you talked to delegates, and you
supported an international code. It was a great moment of power of the NGOs,
of the people’s organisations, to get companies like Nestle down on its
knees.’
He said there were no recipes for how to get power, but it was certainly
time that more people’s organisations, more representatives from civil
society organisations were on the national delegations to UN bodies where
decisions were being made that affected the lives and health of the poor.
“Down with the Bank”
The early morning mist had barely lifted on the third day as participants
from India began circulating to have a few words with other participants who
were having their breakfast. They talked to as many people as they could,
and explained that late into the night, the Indian participants had been
discussing what position to take over the planned address to the PHA by a
representative from the World Bank,
Richard Lee Skolnik. The conclusion they
came to was that the World Bank had no right to be at a People’s Health
Assembly. They were informing everybody of their plans to stage a peaceful
protest.
As the appointed time for the session drew near, the hall was full to
bursting and a strong tingle of excitement and anticipation crackled like
electricity through the atmosphere. There was a whisper of surprise when
Dr
B Ekbal, one of the leading Indian participants, took the chair for the
session. He said that the session would not be looking at abstract policies
but was an opportunity to tell some real life stories about the impact of
World Bank policies on people’s health. He said that there was legitimate
protest and concern on the part of some of the participants about the Bank
being present. He then called on the Indian participants to make an initial,
small protest.
It began as a few small, clear voices singing and chanting, ‘World Bank:
no chance’ and ‘World Bank, down, down, down’. Soon, the rhythmic
clapping and chanting was surging throughout the audience, a powerful and
defiant roar.
Richard Lee Skolnik, Regional Director for Health, Nutrition and Population
for South Asia at the World Bank, watched the protest impassively. Then,
Dr
Ekbal
called for order. There were some continued protests stating that ‘we
do not want to hear’. However, others in the audience said, ‘we want to
listen’. Two members of the organising group -
Ravi Narayan
from India,
and
Claudio Shuftan
from Chile - called for the protesters to let the
session continue.
It began with presentations from
Mary Sandasi
from Zimbabwe and
Hugo Icu
from Guatemala.
Mary Sandasi
used a quilt developed by women’s organisations that
illustrated the headlines that reflected the impact of structural adjustment
policies. Issues such as the increase in the price of bread and other
essential foods, disintegration of health services, loss of land, increased
sex work by women, increased sexually transmitted diseases and the spread of
HIV/AIDS were all seen as outcomes.
Hugo Icu
explained that health sector reform in Guatemala meant that 40 per
cent of the population lack access to health care. He said that the
structural reform process had deprived the Guatemalan people of their right
to health.
After each of these interventions, there was a reprise of the ‘World Bank:
no chance’ chant. As the floor was about to be turned over to
Richard
Skolnik, the protests built again, filling the room with singing, chanting
and clapping.
Zafrullah Chowdhury, Director of Programmes at Gonoshasthaya
Kendra, and
Prem John, from India, called on the participants to let the
Bank speak. In the end,
Richard Skolnik
was able to speak.
It was an upbeat speech, highlighting the positive activities of the World
Bank. He admitted that the Bank’s structural adjustment policies in the
past did not pay attention to their impact on the poor. ‘In the last ten
years, however, the World Bank has asked governments to spend more on the
social welfare projects, particularly on health,’ he said. He denied that
the Bank recommended the wholesale privatisation of health care and said
that it asked for cuts in subsidies only in sectors like power and
infrastructure and not health. He added that, globally, the World Bank is
the largest lender for programs to control diseases like TB, malaria, polio
and HIV/AIDS. He called for a partnership between the World Bank and the
People’s Health Assembly.
His speech came in for immediate and cutting rebuttals from people from the
Philippines, Australia, Zimbabwe and Bangladesh.
Antonio Tujan, from the Philippines, described how the Bank’s promotion of
neo-liberal economic policies in his country had only resulted in the
commercialisation of health care and benefited drug multinationals. He said
that less than three per cent of the US$ 1.8 billion dollars given in loans
by the World Bank to the Philippines were being spent on public health.
‘The World Bank apparently cannot or does not learn from its mistakes,’
said Tujan. ‘I wonder if no medicine would be better than bad medicine
from the World Bank.
I believe that the World Bank must be dismantled. It must be replaced with
an international development financing agency that truly recognises the
objective of equity and genuine development for our peoples and countries.
This we can achieve by promoting people’s empowerment and upholding the
people’s sovereignty. Only then will we have genuine governments of the
people, and achieve the people’s health and well-being.’
‘We don’t need charity but justice,’ said
Charles Mutasa
of Zimbabwe.
He said
Skolnik’s
presentation missed the point. ‘He is describing
sending in the ambulances (the social programmes) after the tanks (the
structural adjustment policies) have rolled through the country.’ He
blamed the World Bank for a global economic system in which Africa was now
caught in a debt trap. ‘The money spent by African countries on servicing
debt is now four times the amount they spend on health and education,’ he
said accusing the Bank of helping transfer resources from the poor to the
rich.
Muzaffer Ahmad
of Bangladesh accused institutions like the World Bank of
co-opting politicians, bureaucrats and NGOs. The NGOs, he said, were being
funded and pushed by the World Bank as the main provider of health services
to the public and the role and responsibility of governments was being
undermined.
David Legge
of Australia pointed out that the World Bank was a key player in
the running of the global economic system that kept large portions of the
world in perpetual poverty. ‘The New World Order is structured in ways
that discriminate against poor countries’, he said. ‘The Bank has been
saying “suffer now, for better health later”. Now the Bank is telling us
“We have learned. Trust us. We’ll do it better next time.” What we
need is a global trading regime which discriminates positively in favour of
poor countries.’
Thelma Narayan
from India called the World Bank an ‘undemocratic’
institution which functioned with no transparency and was controlled by
United States which dominated most of its decision-making.
Another woman from India, describing
Skolnik
as ‘Mr World Bank’, said,
‘you came here to weep on our shoulders, but we are not impressed by your
crocodile tears. As far as women of the poor world are concerned, you are
treating us as baby-producing machines and are pushing hormonal
contraception and cutting our food security. Please go away from here. We do
not need structural adjustment policies. We need structural transformation
policies.’
In closing the session,
Dr Ekbal
asked the participants to shout ‘yes’
or ‘no’ to a series of questions he posed:
-
Is the World Bank concerned about poverty and health? - a
resounding No was the response
-
Should the World Bank be a PHA partner? - No!
-
Does the World Bank help to improve health? - No!
-
Does it have a hidden agenda? Are we seeing crocodile tears? - Yes!
-
Do we want the justice that Charles Mutasa called for? - Yes!
-
Do we agree with Thelma Narayan that the Bank is undemocratic? -
Yes!
-
Do we agree with Muzaffer Ahmad that the Bank is interested in
co-option? - Yes!
-
Do we agree with Antonio Tujan that the Bank should be disbanded? -
YES!!
-
Finally, do we think that Richard should resign from the Bank and
come and work with some people’s organisations? - Yes!
The session closed with a series of people’s voices from around the
world, reflecting on their personal experience of what they had heard and
what they knew of the reality of the World Bank’s impact.
‘They come in sheep’s clothes, like a tidal wave to submerge our
countries,’ said a voice from the Pacific.
‘We need to eliminate global poverty. We do not want to become a region of
healthy poor. Such a thing does not exist. Millions and millions of people
are being exploited by globalisation,’ said a voice from El Salvador.
‘I cannot ignore the depth of concern I have heard in the audience,’
said a voice from the United Kingdom.
‘Our people are dying every day. Our children can’t go to school. These
restructuring programmes should go. It hurts as a mother to have a child who
has to service a debt that was there when the child was born,’ said a
voice from Zambia.
‘The Bank can be bankrupt, if we target the biggest shareholder,’ said a
voice from the Middle East.
‘We spoke our hearts, because this is our cause. We are unanimous in
finding the World Bank guilty, but it is not alone. It is backed up by other
partners such as the World Trade Organisation, the International Monetary
Fund and transnational corporations,’ said a voice from India.
‘People are having to die because they have no money. Even it is has no
heart, the World Bank has an ear to listen. We need to eliminate the
legitimacy of the new international order. We need to mobilise people to
take to the streets,’ said a voice from Sri Lanka.
The session ran well over time. But there was no doubt that it was a turning
point. It focused attention on many of the critical issues and on the need
to see the answers to the health of poor people not simply in tending to the
diseases of poverty - such as malaria, TB, HIV/AIDS - but in paying
attention to the broader determinants of health - including the inequitable
global trading and financial systems.
Trade with a human face
On the fourth day, it was the turn of the World Trade Organisation (WTO)
to come under fire as a panel of speakers and participants denounced the
conversion of health into a mere commodity. The fourth day also looked at
the role of the environment in health.
‘Our aim should be not only fair trade, but trade with a human face,’
said Abdul Jalil, Minister of Commerce, Bangladesh who described the
implications of the WTO for health. He said that the Trade Related aspects
of Intellectual Property Rights (TRIPS) agreement, which the WTO
administers, are ‘likely to have an adverse impact on public health
programmes by making medicines costlier and unaffordable by the poor’.
He called for amendments to the TRIPS Agreement relating to patents for
pharmaceutical products and chemicals. ‘In all future rounds of
negotiations under WTO, it should be our overriding endeavour to make the
benefits of modern research available for good of the common man,’ the
Minister said.
Mike Rowson, of Medact in the United Kingdom, criticised the way serious
public health issues were being decided by trade bodies like the WTO. He
said the WTO did not have any defined policy on public health and treated
health as just like any other ‘service industry’. He said, ‘the
dispute settlement body in the WTO operates behind closed doors and is
comprised of trade administrators and lawyers’. Such an undemocratic
approach means that the concerns of a majority of people are ignored.
Dr Zafar Mirza, of the Network for Consumer Protection in Pakistan, said
that the TRIPS agreement, with its provisions for protection of patents for
both products and manufacturing processes, would result in essential drugs
becoming unaffordable for the poor. Already, he said, many important drugs
such as those used for the treatment of HIV/AIDS were way beyond the reach
of most people in the developing world.
‘According to the WHO, in the last 20 years at least 30 new diseases have
emerged for which there is no medication and when the drugs for these emerge
they will be too costly for the people who most need them,’ Dr Zafar said.
He drew attention to the provision within the TRIPS agreement allowing
governments to enforce compulsory licensing of essential drugs but noted
that attempts to take advantage of this clause were being strongly opposed
by Western governments.
Dr Rosalie Bertell, an anti-nuclear campaigner from Canada, highlighted the
role of the military in acting as a protector of overseas investment. She
said, ‘the military is the real strength behind the multinationals’. The
arms race and nuclear testing in particular was having an extremely harmful
effect on global ecology, she claimed.
Moving forward
On the morning of the final day of the Assembly, 61 people (34 women and 27
men) from 24 countries took to the floor to offer suggestions of how the
momentum generated by the pre-Assembly activities and by the Assembly itself
could be taken forward in a global movement.
The ideas included:
-
disseminating the Charter widely
-
organising a solid network and sub-networks on specific issues
-
using the website, mailing lists and email list-servers
-
translating PHA documents to many languages including simple
language versions
-
challenging local health decision-makers to a dialogue on people’s
health issues
-
setting up local level people’s health watches and, when needed,
people’s health tribunals
-
embarking one people’s health campaign every year on the most
burning issue
-
co-ordinating international protest campaigns and mass actions on
the same day worldwide
-
continuing a publications activity starting with the proceedings of
the Assembly and the posting of a monthly newsletter on the web
-
undertaking active solidarity work for member organisations facing
hardship
-
developing strategic alliances with unions and progressive
political groups
-
participating in international meetings to promote PHA positions
-
holding annual PHA meetings at national level - participants from
Nepal promised to host a national assembly and develop a national
network of groups working on health issues
-
monitoring the implementation of pro-people and anti-people health
initiatives worldwide and reporting on them, and meeting annually in a
parallel session to the World Health Assembly in Geneva to present the
PHA position in relation to WHO’s annual agenda.
Pulling all this together depends on the goodwill, the resources -
both human and financial - and the continued commitment of the many
organisations that have been involved in developing the process so far. It
will also need to draw in even more organisations and resources.
An initial step will occur once the organising group and the PHA secretariat
are able to put together the report of the Assembly and prepare a
consolidated plan of action.
And, of course, another significant event on the final day was the adoption
of the People’s Charter for Health. This is covered in more detail in the
next section of the report.
The workshops
The workshops were, in a sense, the heart of PHA 2000. They provided an
opportunity to discuss a wide variety of topics, and those who had not had
an opportunity to speak at the plenary sessions could participate. The
workshops also provided an opportunity for different language groupings to
make inputs. On average, there were 20 workshops every day covering topics such
as:
-
Traditional Health Practices
-
Mental Health
-
Women and HIV AIDS
-
Maternity Protection
-
Urban Inequalities and health
-
Social Capital building
-
Migration and Health
-
Consumer Rights and Health
-
Environment and Survival
-
Ethics, Justice and Health
-
Food Security and Health
-
Agriculture and Health
-
Breast Feeding Codes
-
Essential Drugs
-
Health Sector reform
-
Privatisation of Health
-
Poverty Reduction
-
Human Rights
-
Women and Violence
-
Community Health Action
A complete list of workshops in the programme booklet is attached as part
of Appendix 4. The entire process was documented, and the consolidated set
of documents is being compiled.
A success?
‘It was a really wonderful process,’ said Sri Rahayu
of Indonesia.
‘I never thought very seriously about the connection between inequality
and health issues, but I have learned a lot in the past five days.’
‘As far as the objective of “hearing the unheard”, the PHA was very
successful. It was centred on people, people were doing most of the talking,
the trial was held by them and it was their verdict,’ said Andrew Chapfika
of Zimbabwe.
‘It was very important to have a meeting like this,’ said Hani Serag
of
Egypt. ‘The People’s Charter for Health is an important tool and should
be followed carefully to evolve plans for action.’
‘I thought PHA 2000 was fantastic,’ said Fran Baum
of Australia. ‘We
could do a lot of networking and establish contacts across sectors.
Sometimes when you are on our own, you think there are only a few people who
don’t agree with the direction the world is going in. It is good to know
that there are so many people who think like you.’
Some of the drawbacks mentioned by people include:
-
too little time for too many workshops
-
the need for a more detailed plan of action and possibly an
international structure to follow it all up
-
the need for a list of names and contact details of participants to be
able to maintain contact
-
more analysis of what the people’s stories mean in terms of
strategies to combat globalisation.
The People’s Charter for Health
The aim of the People’s Charter for Health is to present a set of
concerns and vision for the future that can be used as a rallying point in
the struggle for better health, social justice and equity.
When
Nadine Gasman
from Mexico - who was the member of the Organising Group
responsible for overseeing the Charter process - introduced the concept to
the Assembly on the first day, she described the Charter as both a ‘vision
of hope for the future’ and as a political document.
The Charter was developed over nearly 18 months and involved a first
consultation to identify the key guiding principles, concerns and possible
areas for action. This led to an outline draft that was circulated to a wide
range of organisations around the world for suggestions and input.
The basic principles were:
-
health is a fundamental and basic human right and, therefore, so is
universal access to health care
-
respect for human, cultural and environmental diversity
-
respect for the right of indigenous people to their traditional
lifeways in the context of public health
-
support for initiatives that empower people to fight for their own
health rights
-
opposition to conscious and unconscious violence
-
opposition to inequalities in wealth distribution and health
-
support for participatory democracy.
An overarching concern was the continual deterioration of the health
situation of the poor and of the environment in which they live. Other
concerns included:
-
the overwhelming focus on economic growth rather than human
development as the main objective of development
-
the increasing hardship faced by people as a result of lack of access
to basic social services
-
the lack of participation of people in decisions that affect their
lives at all levels
-
the prevailing dominant world economic order which is creating greater
inequalities and poverty
-
the lack of commitment of individuals, governments and international
organisations to put the health and well-being of the majority of people
and the protection of the environment at the heart of their agendas and
making them priority development objectives.
The first draft of the Charter was widely discussed. It focused attention
at regional and national meetings in all parts of the world. It also led to
the development of local versions: an Indian National Charter was approved
in December 2000; Nepal developed a National version; a Central America
charter was developed.
Through this process, a number of suggestions were incorporated into the
basic draft Charter. Over the first four days of the Assembly, participants
had the opportunity to take part in a daily workshop to review the Charter
and to offer improvements. A large number of boxes were also distributed
around the Assembly site to enable people to contribute written suggestions.
Out of the discussions, several hundred suggestions were collected. A
drafting team, headed by Nadine Gasman, met each day to consider and discuss
the issues being raised. Where any issue emerged that the drafting group
felt needed additional input, it was brought to the attention of the daily
meeting of the Organising Group. Included on the team were: Mohan Rao,
Niclas Hallstrom, Mike Rowson, Olle Nordberg, Sarah Sexton and Andrew
Chetley.
Sarah Sexton and Andrew Chetley acted as the primary compilers and
editors of the final document.
Final drafting took place through the third and fourth day and well into the
fourth night of the Assembly. The Assembly Secretariat
laid out the final
version and staff at the printing press at Gonoshasthaya Kendra worked
through the night to have printed copies available early on the final day
for people to have in their hands. Shortly before lunch, an international
group - representing Latin America, Europe, Asia, and Africa read out the
Charter for the Assembly. At its conclusion, there was spontaneous approval
and participants signed banners and printed lists confirming either their
personal or institutional endorsement for the Charter.
Key points
The full Charter is contained in Appendix
1. It builds on five basic
principles - one for each of the five fingers in the hand holding the globe
in the PHA logo. These are:
-
The attainment of the highest possible level of health and well-being
is a fundamental human right, regardless of a person’s colour, ethnic
background, religion, gender, age, abilities, sexual orientation or
class.
-
The principles of universal, comprehensive Primary Health Care (PHC),
envisioned in the 1978 Alma Ata Declaration, should be the basis for
formulating policies related to health. Now more than ever an equitable,
participatory and intersectoral approach to health and health care is
needed.
-
Governments have a fundamental responsibility to ensure universal
access to quality health care, education and other social services
according to people’s needs, not according to their ability to pay.
-
The participation of people and people’s organisations is essential
to the formulation, implementation and evaluation of all health and
social policies and programmes.
-
Health is primarily determined by the political, economic, social and
physical environment and should, along with equity and sustainable
development, be a top priority in local, national and international
policy-making.
Following on from these principles, the Charter sets out key demands on
the issues of:
-
health as a human right
-
tackling the broader determinants of health
-
a people-centred health sector
-
people’s participation for a health world.
Examples of those demands include:
-
press governments and international organisations to reformulate,
implement and enforce policies and practices which respect the right to
health
-
transform the global trading system including effective regulation of
transnational corporations
-
cancel Third World debt
-
transform the global financial system
-
place education and health at the top of the political agenda
-
ensure universal human rights
-
ensure health and environment impact assessments are incorporated into
development activities
-
increase the speed at which reductions of greenhouse gases take place
-
end the use of occupation and sanctions, and support campaigns and
movements for peace and disarmament
-
oppose policies that privatise health care and turn it into a
commodity
-
demand that governments promote, finance and provide comprehensive
primary health care
-
democratise the UN Security Council
-
transform the WHO
-
promote, support and engage in activities that encourage people’s
involvement in decision making
-
ensure people’s organisations are represented in local, national and
international fora that are relevant to health.
David Werner, author of Where there is no doctor, and one of the
leading advocates of the PHA, described the Charter as ‘a really valuable
tool for looking at issues and identifying areas so that they can take
action for change’. He said it is different from the Alma Ata declaration
because it looks at areas affecting health outside of the health sector and
at the power relations of international agencies and transnational
corporations.
Since the PHA, the Charter has already been translated into over twenty
languages - French, Spanish, Russian, Dutch, Greek, Bengali, Hindi, Tamil,
Arabic, Ukrainian are just some of the versions - by local organisations.
POST-ASSEMBLY ACTIVITIES
A clear agreement reached during the Assembly was the Charter. The areas
contained within the Charter were agreed to be areas where action was needed
if we were to achieve a world where equity, social justice, peace and health
for all was to become a greater reality.
Key areas for follow up are:
-
publicising, adapting, implementing the Charter
-
developing a co-ordinating and communication mechanism to enable the
PHA process to continue to grow, to flourish, to act as a force for
change, and to be a powerful and effective forum for people’s voices
-
strengthening people’s involvement in decision-making mechanisms at
local and regional levels
-
exploring creative and effective use of existing rights legislation
and agreements to strengthen the argument for a rights-based approach to
health
Mobilising around the Charter
Publicising the Charter - its existence and contents - would be a useful
awareness raising activity. People need to know it exists and need to
understand its key meanings and content.
A useful tool to encourage the implementation of the Charter and the
improvement of understanding about how to take it forward would be the
development of a simple guide that helps to unpack the Charter, section by
section, and provides access to the key international documents or resource
materials that underpin particular demands.
One way to publicise the Charter will be to hold a series of practical
workshops with different audiences and sectors to explore the role they
could play in endorsing the Charter and working towards its implementation.
This might include:
-
other European civil society organisations
-
trade unions
-
health professional bodies
-
the media
-
partner organisations in the South
-
donor agencies
-
researchers and academics.
With each of these groups, it is planned to develop tailored guides to
roles and responsibilities under the Charter - what the Charter means to
each group and what they can do to put it into practice. A clear objective
of each workshop is to achieve institutional endorsement of the Charter, and
a commitment to work towards its implementation.
Significant activity has already taken place around the WHA in Geneva in May
2001. Workshops were held, the Charter widely distributed and a meeting was
held with the WHO Director, Gro Harland Bruntland, to discuss the PHA
process. The PHA was a part of her opening speech and a new Civil Society
Consultation mechanism has been established.
PHA Secretariat Report
Initially, the PHA Secretariat was set up in
Penang, Malaysia
to
co-ordinate pre-PHA activities and communicate with the selected members of
the Co-ordinating Group for preparation to hold the grand PHA 2000 event.
Later, when it was decided that
PHA 2000
would be held at
GK, Savar, Bangladesh, the PHA Secretariat was transferred there. The activities
performed by the Secretariat in Penang and at Savar are stated below:
Report from PHA Secretariat Penang (1st June 1998 to 31st July 2000)
The PHA Secretariat was set up in the Consumers International
regional Office for Asia and the Pacific (CIROAP), Penang, Malaysia, on 1st
June 1998.
Dr K Balasubramaniam with secretariat support from Ms Lin Min Min carried
out the activities, volunteering their services. Ms Kiran Sagoo joined the
team on 1 July 1998 also volunteering her services. Ms Elaine Wong, the
finance officer of CIROAP took voluntary responsibility for the book keeping
of the financial transaction. Mr Kalimuthu also of CIROAP volunteered as the
office assistant.
The first task was to develop the first briefing paper on the proposed
PHA in collaboration with the Dag Hammarskjold Foundation (DHF) and submit a
project proposal to obtain funds and convene the First Planning Meeting for
the PHA. Other activities carried out included:
-
DHF and the International People’s Health Council (IPHC)
identified NGOs and individuals to form the Co-ordinating Group (CG) of
the PHA.
-
They communicated with the selected members of the CG to organise
the First Planning Meeting.
The first Planning Meeting for the PHA was held on November 5th-9th 1998
in Penang with 14 participating members.
Ms Janet Maychin joined as a paid member of staff to co-ordinate the
Secretariat. The First Planning Meeting agreed on the goal of the PHA and
its objectives.
To achieve the goal and objectives, the CG identified a number of
structures and processes that needed to be set up and put into action. The
Penang Secretariat was mandated to implement the various activities related
to the structures and processes involved. Dr Ken Harvey volunteered to
assist the Secretariat in developing the PHA web page.
The major tasks assigned to the Penang Secretariat by the First Planning
Meeting were to:
-
develop a draft project proposal for the Funding Committee;
-
serve as a clearing house enabling the members of the Co-ordinating
Group to provide inputs, share experiences;
-
in consultation with NGOs and network partners, identify
grassroots organisations around the world and request their active
participation on the PHA event;
-
assist the special groups set up at the First Planning Meeting to
carry out their tasks; these groups were:
-
The Core group
-
The Funding group
-
The Analytical group
-
The Drafting group
-
develop a short list of possible venues with relevant information
for hosts about the Assembly; and
-
in consultation with the CG , develop an agenda and convene the
Second Planning Meeting.
The second Planning Meeting was convened in Penang, on the 2nd-4th of
March, 1999.
The draft project proposal submitted by the Secretariat on behalf of the
Funding Group was discussed and some changes were made.
The Second Planning Meeting requested the Secretariat to carry out the
following tasks:
-
prepare brochure on the PHA in consultation with GG to be printed
in English for wide distribution;
-
finalise the logo for the Assembly;
-
mail the revised draft project proposal to the CG, get feedback
and finalise it;
-
translate the brochure into French and Spanish;
-
send mail invitations to all resource persons identified by the
participants during two planning meetings;
-
develop briefing papers to assist the Funding Group in presenting
the Project Proposal to potential funders;
-
convene the Third Planning Meeting in September 1999. All these
activities were successfully carried out. In addition, regular News
Briefs on the PHA process were widely circulated.
Brochures, newsletters and information packs were widely disseminated by
the Penang Secretariat. Communications were sent to over 400 grassroots
organisations worldwide. Encouraging responses were received. Having
received a positive response, 5,000 more brochures were printed.
The
Third Planning meeting was convened at GK, Savar, Bangladesh, on the
4th-9th of September, 1999.
It was agreed that the Charter would be called “People’s Charter for
Health”.
The Penang Secretariat worked with the drafting group to circulate
successive drafts of the Charter to members of the CG and worked towards a
draft for presentation and discussion at the Assembly.
Criteria for the selection of participants from thousands of applications
were agreed. The main responsibility for selection would be with the
regional Co-ordinator. It was agreed that a total of about 500 participants
would be invited. Allocation of participants from the different regions and
neighbouring countries was also decided.
The Penang Secretariat developed the second brochure. This contained the
following information:
The
Fourth Planning Meeting was held in Penang, on the 10th-13th of March
2000. The four days were filled with intense discussions, constructive
suggestions, interesting debates, small group interaction and clarification
of roles and tasks ahead. Dr Ken Harvey and Dr Prem Chandran John joined the
Penang Se
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