Networks seem to be key for the survival of health activism experiences. Across PHM’s experience there are many examples of how networks work and what keeps them going. The PHM itself can be seen as a network of networks, with distinctive features at the global-local “juncture” that can be explored.
Networks lend strength to any health activism and movement. Across PHM, they highlight partnerships formed between different types of people, communities, organizations and networks; from community, civil society and public institutions or government.
These networks, though varied, seem to follow certain common principles and show certain similar characteristics, presenting a set of strengths and also challenges in their functioning.
Networks are formed when people or organizations come together for a common cause, idea or goal. It can be for promotion of local food produce and medicinal plants and against corporatization as with the Jarilla network in Argentina; to improve the health and sanitation and protect natural resources as in the experience of Morro da Policia (Porto Alegre, Brazil); against healthcare privatization and tax evasion as the National Health Forum in El Salvador (FNS); for improved population health and against government’s regressive policies (PHM Scotland); against climate change and free trade agreements (Save the climate, stop free trade campaign in Belgium), and so on.
Sometimes networks are initiated through an event. For the popular health movement Laicrimpo Salud in Argentina, it was an annual event that led to the coming together of people and formation of the network. For PHM Scotland, the first People’s Health Assembly in July 2012 was instrumental in its formation. Belgian network Action Platform Health and Solidarity (PASS) was created in 2008 after a conference. Similarly, the first global People’s Health Assembly in Dhaka (Bangladesh) in 2000 galvanized mobilization of organisations, networks and individuals to participate in PHM, including in India, as evident from the Indian PHM experience.
Often networks are formed in response to an urgent issue or campaign. In some instances, networks are formed due to the urgent need of the hour, and there seems to be a spontaneous and organic emergence of the network in order to deal with the situation. For example, the National Health Forum (FNS) in El Salvador emerged out of a larger struggle and broader alliances against the government policy of privatization of health services and other reforms in the 2000s. In the Rancho Grande movement in Nicaragua, the community, the church and local and national NGOs came together against the mining operations in their area.
Network formation may be initiated by any one of the partner organizations. For instance in the experience of PHM Brazil project in Morro da Policia (Porto Alegre), it was the health surveillance department that reached out to members of the women’s association (AMUE, an NGO called Women’s Association United for Hope) to work together. The Jarilla network in Argentina was initiated by women health workers/traditional healers.
In this process, we find that there may also be “networking networks” or organizations/networks that facilitate the formation of a larger network. This was seen for example in the pre-first People’s Health Assembly (PHA) mobilization in India where, in each state, organizations and networks took the responsibility of mobilizing others to join the PHA.
Networks have constituents and, depending on the level at which they operate, the constituents may be organizations/persons within a province, country, region etc. For example, the Jarilla network in Argentina is made up of organizations from various provinces and PHM Brazil has several regional units. PHM Latin America brings together networks from the different countries that constitute the region. Networks like PHM have both local and global spread.
The network members may be formally inducted or may be informal participants. For instance, PHM Australia has been debating on whether to have a membership model through which they can formally induct members. Though they feel that having such a model will help them in recruiting new members and also lead to some degree of financial sustainability, however, they are also apprehensive that it might make the network less open and the membership fees may be prohibitive for some.
Often partnerships are forged between people and organizations from various disciplines and most networks seem to draw their strength from such diverse composition. The network may have a mix of practitioners, technical people, academics and ordinary citizens. The Jarilla network was formed through participation of traditional healers, community members and scientists (botanists). A community network in Argentina working on “plants for health” (plantas saludables) includes people working in education, health, students and community members. They are also members of the Jarilla network. The PHM Latin America considers that its strength is diversity in action. The Action Platform Health and Solidarity (PASS) in Belgium includes NGOs, mutuelles (social health insurances), maisons medicales (health centres), and trade unions. The formation of PHM Scotland saw the coming together of organizations working on health, health activists, environmentalists, carers, trade union health and safety representatives, academic institutions and various representatives from across the National Health Service. The participation of such diverse groups helped in discussion and debate from various perspectives and helped in ensuring that the issues relevant to all involved in the process, were included. Moreover, as they write:
“the strongest feedback was undoubtedly around building networks, breaking down barriers and building really constructive links and working relations across these (previous) divides”.
Partnerships may be formed between groups that may be even opposed to each other in some way, but which find common ground to work on. The network in the community of Morro da Policia in Brazil shows that that it may be important to include people who can oppose your network’s work. In this experience a network was formed of environmental practitioners, women leaders of an NGO called Women’s Association United for Hope (AMUE), policy makers, managers and additionally, the drug dealers who could have posed a challenge to them were also included. As a woman from the community said:
“The only way to deal with the leading dealers, so that they wouldn’t repress the process, was to include them”.
The “Save the climate, stop free trade” campaign in Belgium shows that networking may be done across constituencies and at different levels (local, national, international). The campaign worked with various other networks like the Belgian Climate Coalition platform, unions, environmental organizations and movements, North-South movements and/or South-North movements, and the Climate Justice Platform (PJC). It also built alliances with organizations from the Philippines, and other civil society organizations from Latin America, North America, Europe and Asia within the international coalition “Global People Surge”.
Across PHM’s experience there are many examples of how networks work and what keeps them going. Not surprisingly, they are very similar for most networks and therefore it is important to understand this for our own movement building.
Drawing up common network principles
Having a commonly agreed set of principles is essential for any functioning network. This may be done in a formal, written manner or may be just an understanding between the partners. Either way, it is absolutely essential that these principles are articulated and commonly agreed to by all the participating entities.
The Jarilla network drew up their principles according to which they wanted their network to function. In PHM Scotland, the People’s Health Manifesto was a much debated document, but one that clearly stated the issues and concerns of all those involved. In India, in the run up to the first PHA, local charters were prepared outlining local issues through consultative processes at the block level. In the Belgian example, the common demands of the campaign were agreed through a consultative process that involved arriving at a consensus, and not through a vote; not as a unanimous or compromise decision, but through discussions and negotiations within the members.
Mutual sharing and co-production
The common principles develop into and shape the relationships between the groups that are part of the network; relationships of mutual give & take and collective thought and action. This also includes mutual trust, respect and freedom.
As the reflections from PHM Bolivia state:
“the network growth led to systematizing and coordinating further actions, seeking greater social cohesion, solidarity, impact, to establish contact and alliances with other international institutions and networks, being nurtured from their experience…”.
Constituent organizations/groups therefore bring in their respective strengths, complement each other, and build synergy in knowledge building, collective action and co-production.
Continuous engagement & activities
The most common and therefore critical strand among the networks in the PHM experience is that they provided opportunities for continuous engagement, in the form of periodic meetings, regular communication, collective activities and other strategies. Such engagements keep the network alive and ensure its continuity. They also become forums or ways in which the network participants interact, build relationships and strengthen solidarity.
Meetings and seminars – In the Morro da Policia community network, they hold regular seminars and the women and practitioners organize weekly meetings. The annual meeting of the Jarilla network is an opportunity to share and induct new members. The delegates of the network also meet every three months at their local level. In Laicrimpo Salud, regular interactions are designed at the local, provincial and national levels. The PHM in Porto Alegre has monthly meetings while the National Health Forum (FNS) representatives meet every Monday in San Salvador in addition to their local level meetings. The Kenya PHM experience shows that regular meetings, through use of skype for those not able to attend, have been useful in inclusion of people who may otherwise may have been excluded due to remoteness and distance. PHM Australia too organizes monthly meetings.
Courses like the International People’s Health Univeristy (IPHU) have helped to foster network building in various countries and regions, like in East Africa. Folk media was used in India in the preparations for the People’s Health Assembly (PHA), along with meetings, policy dialogues and conventions at the block, district and state levels to mobilize people and organizations.
Collective action – Sometimes the engagement also takes the form of some collective action, including sit-ins, rallies, strikes etc. Such a process is described in the Rancho Grande experience:
“after the intensity of conflict grew between 2013-2015, with the Guardianes holding numerous meetings and protests locally and nationally, and being met by more and more state repression, a major protest occurred with the cooperation of many local and national NGOs and the full support of the Catholic bishop of Matagalpa”.
A different kind of collective action can also be seen in the Morro da Policia experience where the groups came together to clean the square and subsequently started to grow a garden there.
Publications and regular communication – Regular publications and communication are also critical for network functioning.
“the five books developed for the campaign represented a shared understanding of the critique of existing policies as also our recommendations for change and the possibilities for peoples’ initiatives. It was published not in the names of individual authors or organizations but collectively by the entire group and thus became a binding force in themselves”.
Having regular communication with the constituents is essential for the functioning of the network. PHM Latin America keeps in touch with its constituents through regular internal communication, mailing lists. Other ways to connect have been through websites, facebook, twitter and other social media (PHM, PHM Kenya etc). These forms of communication are actively used by the Africa Outreach Coordinator.
Registered or un-registered
Networks may become a legal entity, as in Bolivia where the network had to register with the government due to the law of the country. Sometimes registration may serve some functionality as we see that PHM Kenya registered itself as a civil society organization in order to be able to own assets that were purchased through a project grant.
However, frequently in the PHM experience networks are not registered, but nevertheless often have a formal structure and a system of leadership. For instance, the National Health Forum (FNS) is a formal institution which is quite structured; it is organised thematically and territorially, but it is not a legally registered organisation. Similarly, PHM global is not a legally registered organisation, while some PHM circles are (e.g. South Africa) in order to allow them to fundraise.
Funded or non-funded
Funding of networks is a much debated issue, with people at either poles of the debate.
We find networks that are formed and fully funded by funding agencies, which often push their own agenda. This is not the case for PHM, but you may find them in your own country.
There are networks that are able to self finance through contributions from members. Contributions can be both financial and non-financial. In the National Health Forum (FNS), “funds are raised through consortium funding and coordination between organisations part of the FNS” which also contribute meeting space and other infrastructure support. In Rancho Grande, NGOs in local and national networks and research organizations provided information and resources. Resource sharing within the network was also seen in the pre-PHA preparations in India. All the organizations shared their financial and infrastructure resources generously.
Sometimes networks are funded partly through some activities or projects. PHM Kenya received some short-term project funding for drought relief and health rights training which allowed them to purchase assets. However, this subsequently led to conflict and disagreements among constituent organizations.
In the absence of any kind of funding or similar support, networks can also become quite fragile as we find in PHM Brazil, where the participating NGOs are also devoid of funds.
Depending on how structured the network is, there may be levels of systems of governance and leadership.
In PHM Brazil, there was a group of 8 people elected representing all regions of the country but it is not active currently. The importance of induction of new leadership is highlighted in the reflections from Bolivia, where the highest decision-making body is the assembly. In South Africa it is the Annual General Meeting, which is also when the leadership (Steering Committee) is elected.
The experience of the Action Platform Health and Solidarity (PASS) in Belgium shows certain challenges that they faced in terms of leadership in networking. In their network, they found that a few members who were strong leaders of the network, were not actually the main leaders of the individual organizations that they *represented* and neither did they have significant influence on the organizations. They had therefore adopted a “network identity” which was stronger than their identity as representatives of their respective organizations.
A similar caution is reflected in the Bolivia experience where the leaders of the network, who initially had strong grassroots connections, later became removed from these disadvantaged and vulnerable communities that they represented. They become bureaucratic and involved with law and policy making, while neglecting to empower these communities.
In PHM experience we find numerous lessons in how networks have been strengthened. These relate to various dimensions of functioning of the network. Some of the lessons have been enumerated below.
Intersectoral collaboration & participation in larger people’s struggles
In most of the network experiences, one finds that the networks follow a broader understanding of health, inclusive of an understanding of the larger socio-political and economic environment and need for action on the social determinants of health. This seems to have strengthened the health networks themselves as they participate in struggles of other networks and organisations, who in turn lend their weight to the health network. Often these are struggles by the vulnerable and marginalized groups and communities.
PHM in Latin America provides numerous such instances, both within specific countries & in the region, that includes participating in action on various social determinants of health; for instance, struggles for food sovereignty, people’s resistance & struggles against exploitative and destructive mining, and so on. In Paraguay, the PHM activists participated in social struggles for human rights, and against Monsanto and the harmful use of pesticides. In Meso America region, PHM joined struggles against pollution, and mining (Guatemala). The Morro da Policia network in Brazil initiated action on “various public services (i.e. water, waste, sewage, housing, environment, culture)” with an understanding that all these converge into ill-health. The core concept for Laicrimpo has been “holistic health” that has helped them to engage with organizations and public agencies from a variety of sectors like agriculture and education in addition to the health sector. The National Health Forum (FNS) in El Salvador is a participant in the Social Alliance for Governance and Justice (Alianza Social para la Gobernabilidad y la Justicia) that is a broader social alliance, linking health with other social issues and with broader economic and political structures. The ‘Save the climate, stop free trade’ network in Belgium collaborated with social movements in Europe and in the developing countries.
The Australian experience on Aboriginal health emphasises the need for broad-based alliances to address social, economic, and political causes of health and ill-health (not just work within the health sector).
Linking with larger (country level/global) networks
Often local networks find it worthwhile to link themselves to larger, global networks. Smaller organisations align with larger networks in order to build solidarity and strength. We can see this in the Argentinian community network working with “plants for health” (plantas saludables), Jarilla network, and the PHM itself. The Laicrimpo network has participated in other networks in the country and Latin America like PHM and Agroecological Movement of Latin America‐MAELA. In South Africa, the relatively small PHM network has formed a coalition with other progressive civil society organisations and social movements to influence the proposed policy of a National Health Insurance to be publicly owned and driven and more aligned to funding comprehensive Primary Health Care that also addresses social determinants.
But reflections on activism and advocacy from Bolivia add a word of caution:
“the partnerships with other networks can be beneficial to combine efforts and achieve greater effectiveness, but also can be used in some circumstances, perversely, to give greater visibility to international networks that use the work of local networks to justify their bloated budgets and their lifestyles”.
Sometimes, networks find value in linking with similar networks from other regions. For instance for PHM Scotland
“crucial links were made with international PHM chapters (India, Nicaragua/ Argentina, Australia, South Africa) at the assembly to learn from experiences of campaigns and action strategies utilised in these diverse contexts”.
Dynamism and staying relevant
It is important to recognise that networks are dynamic entities. The successful networks across PHM experience have continuously incorporated emerging issues. For instance, the National Health Forum (FNS) that emerged out of a campaign against privatization of health services is currently campaigning for tax justice. PHM experiences from Latin America too have shown that the network has to respond to immediate and urgent issue. In South Africa, under the umbrella of the ‘For a Peoples National Health Insurance’ campaign the coalition has incorporated action to address the situation of and policies on Community Health Workers (CHW) in alliance with CHWs themselves. These campaign issues have been selected because: they represent a great need and are fundamental to the right to health, because the policies have excited support from a broad range of public health service users and workers (including the labour movement), and because this campaign issue has allowed PHM to build a coalition with other progressive NGOs and begin the long overdue process of bridging divisions amongst health civil society organisations by undertaking common action, thus creating a broader and more multi-faceted movement for health.