contact
A publication of the World Council of Churches PEOPLES HEALTH MOVEMENT
2 Editorial 16 Struggle for tomorrow 3 Introduction 19 Promoting and endorsing No 176 Health for all now! the Italian experience January-March 2002 22 Lessons learned a case study Experiences (Printed on 25 Update December 30, 2002) 5 Time to act Trade for people, not people for 8 Poverty and WHO trade 10 At the forefront of the struggle 26 Bible study 12 Towards a healthy The courage to change world Africa 27 Networking 14 Moving ahead Announcements, letter EDITORIAL
In communities around Recognizing this, peoples organizations the world, groups from around the world have begun a of people have new mobilization process to ensure that been working comprehensive primary health care together to becomes a reality% Beginning in the late find creative 1990s, in Latin America, Africa, Europe, solutions to and throughout Asia, peoples organiza- their health tions began a process of analysis and care pro- mobilization to pull together ideas for a blems% To Peoples Charter for Health% mobilize In December 2000, nearly 1450 people local and from 92 countries met in Savar, often scar- Bangladesh to review the Charter as a ce resour- strong call for action% Since then, the ces, to put Charter has been translated into more into prac- than 35 languages, and the Peoples tice effec- Health Movement (PHM) has grown% tive, com- munity- This special issue of Contact traces the based and development of the Peoples Health community- Movement, looks at the key points of run health the Charter, and highlights some of the care ser- initiatives in wide range of regions vices% and countries involved in the PHM%
D Taylor These include Africa, Latin America, A child receipient of Basic Bangladesh, Italy and India% These are Minimum Needs (BMN) They have been doing this for more than 50 years, or at least from the time that just a few examples% the international health community, The Peoples Health Movement (May particularly under the leadership of the 2002) was the largest delegation at the World Health Organization has been last World Health Assembly in Geneva% striving to identify practices and policies A short report on this event is included that can make a difference% along with some reflections on Poverty and health (Poverty and WHO)% The Countries such as Guatemala, Cuba, get-together of activists in Geneva from Bangladesh, India, Mozambique, all over the world was also an opportunity Tanzania, the Philippines, China and to share visions of the future% many more provided real life experiences and evidences that Finally, this special issue calls for others underpinned the Primary Health Care to join in the movement and to work (PHC) strategy approved at the 1978 together to help put the control of international meeting held at Alma peoples health in peoples hands% Ata% The Health for All by 2000 AD Andrew Chetley & Ravi Narayan evolved at this meeting%
In September 2003, nine months from now, the world will reach a milestone the 25th anniversary of the Alma Ata Declaration on Primary Health Care% It is disappointing to see that the international health community has failed miserably to deliver that promise% That
Cover failure is being felt most dramatically in Health activists demand health the poorest and most marginalized as a right communities around the world% Credit: Community Health Cell
2 contact n°176 - January-March 2002 INTRODUCTION
A PEOPLES CAMPAIGN FOR HEALTH FOR ALL NOW!
Introduction The PHA meet at Bangladesh was intended to challenge In 1978, an International Health Assembly at Alma Ata in USSR, (co- health policy makers around the world Ravi Narayan sponsored by the World Health reports on this exciting exercise which was intended to Organization; United Nations Childrens remind international bodies and governments of the Emergency Organization; and others) promises they have failed to keep gave the world a slogan Health for All by 2000 AD and endorsed the famous Alma Ata Declaration that brought people and communities to the centre of health planning and health care strategies% It emphasized the role of community participation, appropriate technology and intersectoral coordination% The declaration was endorsed by all the governments of the world and symbolized a significant paradigm shift in the global understanding of health and health care% A receding dream Twenty-two years later and after much policy rhetoric; some concerted but mostly ad hoc action and a lot of governmental and international health agency amnesia; this declaration WCC remains unfulfilled, as the world comes to terms with the new economic forces of globalization, liberalization and small and big groups, using formal and privatization% informal opportunities% The PHA meet Finally, at the end, a Peoples Health Charter emerged, which was endorsed In December 2000, a Global Peoples by all the participants% This charter has Health Assembly, brought together 1453 now become an expression of common people from 92 countries% It included a concerns; a vision of a better and march for health; meetings at which healthier world and a call for radical people shared their testimonies on the action% health situation from many parts of the world% Parallel workshops to discuss a range of health and health related challenges% Cultural programmes to The Peoples Health Campaign for Health for All - Now! was a symbolize the multiregional, multicultural platform to share the unfulfilled Health for All challenge and multiethnic diversity of the peoples of the world; and group discussion in
contact n°176 - January-March 2002 3 INTRODUCTION
Thirdly, it underlines the imperative that Health for All means challenging powerful economic interests; opposing globalization in its existing inequitous model; and drastically changing political and economic priorities% Fourthly, it tries to bring in perspectives and voices of the poor and marginalized encouraging people to develop their own local solutions% Finally it encourages people to hold accountable their own local authorities, national governments, international organizations and corporations% The vision and the principles, more than ever before, extricates health from the D Sawyer/TDR/WHO Ravi Narayan
Significance of the Peoples Health myopic biomedical-techno manageria- Charter lism of the last two decades and centers it squarely in the context of todays The Peoples Health Charter endorses global socio-economic-political-cultural- health as a socio-economic and political environmental realities% However, the issue and a fundamental human right% most significant gain of the Peoples Secondly, it identifies inequality, poverty, Health Assembly and the Charter is exploitation, violence and injustice as that, for the first time since the Alma Ata the roots of ill-health% Declaration (1978), a Health For All action plan endorses a call for action that tackles the broader determinants of Health for All action plan in the Peoples Health Charter health% v Health as human right% This comprehensive view of health v Economic challenges for health% action, as we enter the new millennium, is probably the most significant gain of v Social and political challenges of health% the Peoples Health Assembly% v Environmental challenges for health% Other gains v Tackling war, violence, conflict and natural disasters% For the first time in decades, health and v Evolving a people-centred health sector% non-health networks came together to v Encouraging peoples participation for a healthy world% evolve global solidarity and collectivity in health%
4 contact n°176 - January-March 2002 FEATURE
Another significant development was Health Research (GFHR) and the World the evolving solidarity which found sym- Health Assembly have become the bolic expression in various documents norm% at the global level% These indicated that In addition, public meetings/campaigns people mattered, and these when taken about taking health to the streets as a together represent an unprecedented, Rights issue is gaining popularity% emerging, global consensus% Conclusion It was not just event oriented, but was preceded by a range of grassroot, local The Peoples Health Assembly process and regional initiatives from the different was a rather unusual multiregional, parts of the world% multicultural, and multidisciplinary The most significant development mobilization effort% Bringing together the however, is not what took place before largest collection of activists and pro- the Assembly, but, what seems to be fessionals, civil society representatives going on after the December 2000 and the peoples representatives Assembly% For example, the Peoples themselves, to evolve a global instru- Health Charter has been translated into ment of concern and action, and to several languages which include Dutch, express solidarity with the health French, Greek, Russian, Ukrainian, struggles of people, especially the German, Nepali, Spanish, Urdu, marginalized in todays inequitous and Japanese, Chinese, Arabic, Finnish, unhealthy global economic order% A long Swedish, Tamil, Sinhala, Kannada, road lies ahead in the campaign for Malayalam, Portugese etc% Health for All% Evolving the charter at the assembly in Bangladesh in December Videos have been made for public 2000, was only the end of the beginning% education on the events and issues
Ravi Narayan is the Joint Convenor of the National Coordination Committee for Jana Swasthya Abhiyan (PHM-India), Convenor of the WHO-WHA Circle, and the new co-ordinator designate of the Global Peoples Health Movement from 2003. Peoples Health Movement, Community Health Cell, 367, Srinivasa Nilayam, Jakkasandra 1st Main, Koramangala 1st Block, Bangalore 560 034, Karnataka, India. Email: [email protected]. Richard Hanson Richard For those deprived of basic nutrition, including the BBC Life Series video health is a luxury on The Health Protestors% Presentations of the Peoples Health This charter has now become an expression of common Charter, in national, regional and inter- national forum, including the World concerns; a vision of a better and healthier world Health Organization, Global Forum for
contact n°176 - January-March 2002 5 EXPERIENCE
The Peoples Health Charter TIME TO VISION ACT þ A world with equity, ecologically sustained development and peace þ A world in which a healthy life for all is a reality þ A world that respects, appreciates and celebrates all life and diversity þ A world which enables flowering of peoples talents and abilities to enrich each other þ A world in which peoples voices guide the decision that shapes our lives RECOGNISING HEALTH CRISIS þ Economic changes affecting peoples health and access to health/social services þ Poverty and hunger increasing þ Gaps between rich and poor nations widened; inequalities
within countries increasing J & P Hubley þ Large proportion of the population lack access to basic needs (food, water, sanitation, land, shelter and education) The concept of primary health care and þ Planetary resources being rapidly depleted Health for All grew out of many grassroot þ Upsurge of conflicts/violence experiences in community-based þ The worlds resources increasingly concentrated in hands of few who integral health programmes around the strive to maximise their profit world, as Dr Halfdan Mahler has often reminded us% In Latin America there are þ New economic/political policies affecting lives, livelihoods, health excellent examples of these health and wellbeing of people in south and north programmes that began in the mid 60s þ Public services deteriorating, unevenly distributed and inappropriate and continue to be relevant, especially þ Privatization undermining access and equity principles today% The community-based health pro- grammes and the health promoters PRINCIPLES associated with them have been þ Health is a fundamental human right particularly important in terms of health þ Primary health care (1978 Alma Ata Declaration) the basis for policy of the many and varied indigenous communities of the Americas% þ Governments fundamental responsibility to ensure access and quality We want to celebrate the involvement of þ People and peoples organisations essential to formulation, community health workers and grassroot implementation, evaluation of health programmes movements in the advancement of þ Political/economic/social/environmental factors are primary health% For example, the campaigns for determinants of health and must get top priority in policy making the eradication of smallpox, polio and þ Action at all levels to tackle crisis individual, community, national, measles would not have been successful regional and global without the active involvement and collaboration of these groups% After the Peoples Health Assembly in Bangladesh, throughout Latin America we have been very active in promoting an awareness of the causes of poverty among grassroot communities% It is in knowing and understanding the causes of poverty that we are better able to organize forces to confront and eliminate
6 contact n°176 - January-March 2002 EXPERIENCE
organizations in the PHM are dedicated Maria Hamlin Zuniga and to popular education in health% It is E-GROUP ON Ani Whibey, describe the working with the people that we really HEALTH Latin American process of enter into partnership for action% The Spanish-speak- collective action beyond PHA With the Peoples Charter for Health in ing participants of PHA, mostly from 2000 stressing dialogue and hand we spread the Call to Action working with the people, incorporating Latin America, set up partnership their wisdom to bring about a an electronic list serve transformation for a better world, to continue to share promoting life and health with dignity% with one another% It is called Red Latin We believe that the centenary of the American Asalud or them% The PHM is active in Mexico, Pan American Health Organization and Latin American Heal- Central America, parts of the Caribbean, the twenty-fifth anniversary of the Alma th Network% and in South America, especially in Ata Declaration provides us with an Argentina, Brazil, Ecuador and Peru% In opportunity% Together we, the health each of these countries and regions, the sector workers, universities, civil society similarity of causes of poverty and illness organizations and other sectors along are quite identifiable% with PAHO and our country health ministries, must revisit the holistic Government had created systems that concept of comprehensive primary they believed were to the advantage of health care and its role in the dramatic the people on one hand% On the other, situations we are facing in the region funding for programmes became and throughout the world% In line with extremely limited as governments the Alma Ata Declaration and the sought huge loans from the World Bank Peoples Health Charter we can work and the IMF for other national projects, together toward a renewed commitment for military upbuilding, and even for to truly sustainable healthy human tourism% They allowed multinational development% and transnational corporations the use Maria is the Coordinator of the International Peoples of vast territorial areas for the building of Health Council and one of the key leaders of the big industries thus dislocating hundreds Peoples Health Movement in Latin America. Sr. Ani is of communities, stripping forests and a popular health educator from Brazil. increasing pollution, toxic wastes etc%
National debts reached overwhelming FTAA CIRCLE limits% The WB and IMF created Structural Adjustments in each country, Health activists have decided to work on building awareness of the resulting in a large percentage of effects of the Free Trade Agreement for the Americas (FTAA) on financial cuts for health and education the health of the people% The FTAA goes beyond the WTO! programmes% WSF - BRAZIL In Peru, the Casas de Salud, community Two people represented the PHA at the Social Forum in Puerto health houses, work together with people Alegre, Brazil% They were able to distribute the Charter at the on health and education programmes% Forum and make many contacts at different workshops and In Brazil, Christian communities and events% Julio Monsalvo from Argentina has written an inspiring indigenous movements are working report that has been translated into English and posted on the toward peoples health% In Mexico and PHA Exchange% Central America and the Caribbean, there are community-based health programmes working together in the Regional Committee for the Promotion of Community Health, particularly on Together we must revisit the holistic concept of comprehensive the analysis of health care reform primary health care processes and Free Trade Agreements% The NGOs and the grassroot
contact n°176 - January-March 2002 7 EXPERIENCE POVERTY AND WHO
Poverty is the biggest epidemic for WHO to tackle a message that was oft repeated Mike Rowson at the last WHA According to Mike Rowson, WHO will have to move beyond the disease-specific approach and advocate comprehensive health strategies Community Health Cell
Participants at the most recent World Development, the department in WHO Health Assembly were beaten over the which previously dealt with poverty% But head with numbers% Information booths how can poverty be mainstreamed when in the corridors of the conference building there are no staff and budgets to do and speeches by WHO staff all analytical work, to support the highlighted shocking data: X children mainstreaming process at WHOs dying of malaria each year, Y people in headquarters, regional and country developing countries suffering from offices, and to support governments in cardiovascular illness and Z women per integrating health in development minute dying in childbirth% WHO is very policies? much a disease-oriented institution, and Poverty reduction strategy papers the diseases compete with each other for money and attention% Poverty, even An example of the need for WHO to put though is the most important cause of ill- poverty higher on its agenda, is provided health, does not receive the same by the recent evaluation of the Poverty attention in WHOs work% While poverty Reduction Strategy Papers (PRSPs) that and health are among the pillars were introduced in 1999 by World Bank mentioned in WHOs corporate strategy, and IMF% In a PRSP, countries should the Poverty and Health team has recently outline their plans to reduce poverty% been downsized to just two people% PRSPs could potentially become important instruments for health% Firstly, Poverty cannot be wished away poverty reduction strategies need to be Poverty is being mainstreamed, is the developed with civil society participation% answer given by WHOs senior This could provide space to push for management when they were asked national health policies that are equitable about the consequences of the recent and comprehensive% The needs of the disestablishment of Health in grassroots and experiences of
8 contact n°176 - January-March 2002 EXPERIENCE community-based health initiatives could and health-oriented sections in the World be heard by national policy-makers% Bank, but also with the sections that Secondly, these strategies provide an believe that neo-liberal policies are the opportunity to address health only way to economic growth and that determinants outside the health sector% the poor will somehow automatically Economic policies, for example, need to profit from growth% WHO should start be screened for their effects on peoples looking at the linkages between health, before being implemented% economic policies and health outcomes Thirdly, donors and multilateral and how they impact on health and institutions promised to support the equity, still a largely untouched area% implementation of PRSPs and ensure Conclusion sufficient financing% Instead of supporting separate programmes for malaria, HIV/ To discuss possible roles and strategies, AIDS and other diseases, which risk to WHOs Poverty and Health team and compete for resources and attention, several NGOs organized a seminar on donor initiatives should be bundled and health and PRSPs at the last WHA% integrated through national strategies Reina Buijs from the Dutch government to help ensure they strengthen instead provided a detailed agenda for WHO of fragmenting the health system% country offices, urging them to provide not only technical support but also be an Bring health to the Centre health advocate and fulfil a broker role% This potential still needs to materialise% This call was supported by civil society A WHO review shows that health representatives arguing that WHO continues to be marginalised and under- should guide Ministries of Health to resourced in PRSPs, while proposed ensure that health is integrated in health sector interventions are in most national development plans% Since cases not explicitly pro-poor, and the WHOs work is guided by its member links between health and other sectors states, the countries should voice their are neglected% Important opportunities expectations clearly% This year at the for health are therefore missed% One of World Health Assembly many nations the reasons is the lack of involvement of mentioned poverty as a crucial health ministries of health in the PRSP problem, though without elaborating on formulation process, which in most it% It is a challenge for the Peoples countries is dominated by ministries of Health Movement to build on this growing finance and planning% Economic targets awareness and to push governments therefore prevail in the PRSP% Health is and WHO to treated as a sector costing money, rather adopt a poverty than a fundamental human right and a agenda that will necessary condition for development% A really make a much stronger voice of ministries of difference% health and civil society organisations, is Mike Rowson, therefore needed to integrate health in Medact, 601 Holloway Road, the PRSP% London N19 4DJ, United Kingdom Fax: WHO support 254-2-440306 E-mail: mikerowson@ WHO support is indispensable, to help medact.org governments in developing health Web:www.Medact.org. systems and negotiate over the health
budget, and to analyze the health Ineke Droogers-Zoutewelle consequences of other policies% At the international level, WHO should play a leading role and become a health Poverty reduction strategies need to be developed with civil advocate in relation to World Bank and society participation+ World Trade Organization policies% WHO should work not only with the poverty contact n°176 - January-March 2002 9 EXPERIENCE AT THE FOREFRONT OF THE STRUGGLE
Twenty-four months The analysis made in the after the historical Peoples Charter for Peoples Health Health (PCH) ap- Assembly in Savar, plies to todays world every bit as Bangladesh, much, as it did December 2000, 24 months ago the PHM with only that the affiliates in five sense of urgency has been heigh- continents, is tened% The PCH commited to lobby vision strives for with its document, peace, equity, the Peoples and an eco- logically-sustain- Charter for Health able develop- (PCH) Claudio ment% The health Schuftan crisis described summarises the for most coun- tries in the world issue in the year 2000 has deepened% AKCHP/AKU In Dhaka, Bangladesh, a community health worker teaches a mother how to The charter is use a road-to-health growth chart committed to the points listed out in the Call for Action as powers of transnational corporations, they relate to actively influencing the especially pharmaceutical houses, many direct and indirect determinants greater and a more equitable household of health% food security and some type of a tax that taxes runaway international financial The PCH is committed to combating the transfers% negative impacts of globalization as a worldwide economic and political It unconditionally supports the ideology and process% Listed high on its emancipation of women and the respect agenda, is the reformation of the of their full rights and insists that health International Financial Institutions (IFIs) should be high on the development and the WTO to make them more agenda of governments% responsive to poverty alleviation and The PCH stresses on: the Health for All -Now movement% l The health (and other) rights of In addition, the Charter places high on displaced people% its agenda , forgiveness of the foreign l Halting the process of privatization of debt of least developed countries and public health facilities and for greater use of its equivalent for poverty controls of the already installed reduction, health and education activities private health sector% is another priority area% l More equitable, just and empowered The PCH is committed to greater checks peoples participation in health and and restraints of the freewheeling development matters%
10 contact n°176 - January-March 2002 EXPERIENCE l A greater focus on poverty alleviation defense of effective patients rights% in national and international l Changes in the training of health development plans% personnel to assure it covers the l Greater and unconditional access great issues of our time as depicted for the poor to health services and in our PCH% treatment regardless of their ability l Public health-oriented and not-for- to pay% profit health research worldwide% l Strengthening public institutions, Strong peoples organizations and a political parties and trade unions global movement working on health involved% issues% l Opposing restricted and dogmatic l More proactive countering of the fundamentalist views of the media that are at the service of the development process% globalization process% l Greater vigilance and activism in l Peoples empowerment leading to matters of water and air pollution, the their greater control of the health dumping of toxics, waste disposal, services they need and get% climate changes and other attacks l Fostering a global solidarity network on the environment% that can support and reach our fellow l Militant opposition to the members when facing disasters, unsustainable exploitation of natural emergencies or acute repressive resources and the destruction of situations% forests% The specific actions proposed in the l Protecting biodiversity and opposing PCH under each of these headings are biopiracy and the indiscriminate use not to be seen as the content for a of genetically modified seeds% collection of fitting slogans or as a wish- l Opposing war and the current USA- list% Eventually, the PHM will have one led, blind anti-terrorist campaigns% or more Action circles addressing each l Categorically opposing the Israeli of these clusters of demands% These invasion of Palestinian towns% circles will interact through email and l The democratization of the UN bodies will network with other groups already and especially of the Security Council% working on each of these issues before releasing their conclusions to our list l Getting more actively involved in server and the PHM website% actions addressing violence against women% Twenty-four months after PHA 2000, l More prompt responses and our challenge remains the same, though preventive/rehabilitative measures in more urgent% It still calls for the same cases of natural disasters% actions and makes the same demands l Vehemently opposing the commo- made in our Peoples Charter for Health% ditization and privatization of health But for this challenge to materialize in care% concrete, concerted actions, each of you needs to get involved more% l Independent national drug policies Claudio Schuftan, MD is a pediatrician originally from focused around essential, generic Chile now living in Vietnam. He was one of the members drugs% preparing the PHA2000 and now moderates the PHM listserver E-mail: [email protected] l The transformation of WHO, supporting and actively working with its new Civil Society Initiative (CSI) making sure it remains accountable to civil society% l Assuring WHO stays staunchly Greater and unconditional access for the poor to health services independent from corporate interests% and treatment regardless of their ability to pay+ l Sustaining and promoting the
contact n°176 - January-March 2002 11 EXPERIENCE
Africa with its many health TOWARDS A HEALTHY WORLD problems finds the Charter to be a useful instrument to break the AFRICA silence about the health issues An update by Mwajuma Saiddy The three major aims of PHM in Masaiganah Africa are: l Reflect on the PHA and see how the Peoples Charter for Health could be used to strengthen activities and systems in Africa and start a campaign for greater support for comprehensive Primary Health Care% l Identify key health issues that are important and affect the people in Africa% l Strengthen the Peoples Health Movement in Africa% A range of diseases HIV/AIDS is a serious problem for health William Bertand William in Africa, but not the only problem% It is In Kinshasa, Zaire, a trained important to look at the context and health worker enters field data on a solar-powered lap ensure that sufficient resources are top microcomputer at the available to prevent and treat other School of Public Health leading diseases like: TB, ebola fever, malaria, typhoid fever, cholera, and measles% Introduction Apart from these, some hospitals retain We believe that the key link in this mothers after delivery due to their failure process is the need to develop shared to pay% They wait for relatives to come partnerships with local and national and bail them out% Sometimes this takes governments, to complement their work from one week to even more than a and strengthen their ability to provide months period% services that the people need% Already in many African countries the vast The social, political and economic majority of care for patients suffering determinants that are impacting our from HIV/AIDS is being done in poor health negatively need to be considered households mainly by women who and were identified as: receive little or no assistance from the l Structural Adjustment Programmes health and welfare services% (SAPs)% Governments should give peoples organizations, including the PHM, l Trade Related Intellectual Rights recognition and representation at (TRIPs)% decision-making fora where issues l Gender insensitivity increased affecting health are discussed, and to disparity in access to health with facilitate their recognition and support health systems tending to be gender from national and international donors blind% as channels for resources to facilitate the process of grassroot involvement% l Conflicts and wars%
12 contact n°176 - January-March 2002 EXPERIENCE l Gender violence% and in this case, grassroot funding is of vital importance% Primary Health Care l Lack of basic infrastructure was and still is, the Support of Global PHM transport, deterioration in health correct pathway for us systems including lack of quality PHM needs global recognition by all% Holding this meeting in East Africa is bringing services% international institutions and the agenda home% Lets governments in order to operate and listen to these com- Environmental issues including l access funding, and thus Africa calls for munities% How many water and sanitation, deforestation immediate global recognition of PHM% times do we allow them and natural disasters% Our situation in Africa does not to be part of their guarantee a Right to Health% Thus we development? Genuine l Corruption% people-centred initia- should work towards a change of attitude tives must be strength- l Cultural beliefs and practices that of our governments to respond to ened to increase pres- contribute to poor health and increase peoples health needs and create space sure on decision- the risk of diseases and those that where people can play an active role by makers, governments strengthen healthy behaviours% activating local actions% The people of and the private sector the developing world deserve and have to ensure that the vision Breaking the silence a right to share the resources that the of Alma-Ata becomes a rich countries lavishly enjoy% It is time reality% We have found out that communicating now to demand, and we demand it% It is Dr Upunda, Chief the issues expressed in the Charter is a no more time for rhetoric; we need Medical Officer Ministry way of breaking the silence around many actions% of Health, Tanzania, of these health concerns% Strengthen April 29, 2002 peoples ability to be involved in the Mwajuma is the Convenor of the East and Central process of both contributing to and Africa Circle for PHM activities in Kenya, Tanzania and Uganda and shared the above message at the briefing demanding the development and session on the Peoples Health Charter at the World strengthening of relevant and effective Health Assembly in Geneva in May 2002. health services% E-mail: [email protected] The role of PHM in Africa It must become a strong unifying force, helping to bring together many people and organizations involved in effective initiatives to improve health% The issue of re-use of female condoms is unacceptable by Africa and suggests that other means be sought% After all, rural women cannot afford to buy a condom that costs almost a dollar% We outrightly condemn this with vigour and dignity% The Peoples Charter for Health should take into consideration the issues that concern the youth and the aged% Every government should provide obstetric services that ensure that no woman can get HIV transmission at Crump/TDR/WHO A childbirth - (there should be universal precautions in deliveries, as well as all aspects of health care)% HIV/AIDS is Communicating the issues expressed in the Charter is a way of only one of the many diseases that affect Africa% Therefore, there should be breaking the silence around many of the health concerns a re-orientation where funding goes,
contact n°176 - January-March 2002 13 EXPERIENCE MOVING IN EUROPE
Milestones Director General% Now WHO organized Ellen Verheul, highlights a technical briefing on the Peoples The first meeting on the Peoples Health the challenges for PHM Health Movement and the Charter% In Assembly, during the WHA was two that sense, a lot has been achieved: we in Europe including years ago, in the NGO lounge in the have the possibility to share our views reviewing economic basement of the Palais% And because with delegates and the WHO Secretariat, nobody knew where that room was, we policies on health so that and I think that is very important to start had to put up papers with arrows showing they can respond to with% people the way% We were busy for two peoples need days to get official permission to have In a way we in Europe are somewhat our meeting announced in the Journal% backward, compared to what has been Last year it was much better% There was done in other regions% In most countries, an official room, an announcement in we have not yet come far in terms of the Journal and even a meeting with the mobilising our constituencies, or health professionals% But things are starting, like in Italy where the PHM has fallen on fertile ground% Many organizations and networks also outside the health sector have endorsed the chapter and it was published in medical journals% In St Petersburg, in the Russian Federation, the PHM has brought civil society together for the first time% The Charter has been translated and discussed on the website in Ukraine% We know we share a vision and a common goal and it is easier to find each other and look beyond the single issues% And we know we have something to defend in Europe: our relatively accessible health systems that are increasingly made subject to market forces, for instance under the General Agreement on Trade in Services (GATS) of the World Trade Organization% We are asking for a full assessment of the potential risks for access to health services and the ability to regulate national health sectors% It is important that health ministries make sure that access to health services is not traded Radhika Chalasani/UNDP Radhika away%
14 contact n°176 - January-March 2002 EXPERIENCE AHEAD
Community Health Cell
A need for change interests are not undermined by other policies made in other departments% We We have a special position in Europe, want WHO for example, to start looking since our governments and the EU are at the evidence on the sometimes the biggest donors in health% We want disastrous impact of economic policies our governments to finance and support on health and act upon it% We as civil comprehensive health policies, and society organizations, want to work with avoid putting up vertical programmes WHO on these issues, for we realise it is that end up competing with each other a huge task% And we want WHO to take in terms of money and human resources% the lead% We, therefore expect our We want our governments to support governments and WHO members to and respect national decision-making make sure that WHO at all levels will processes in developing countries% We move full speed ahead% Such a health want WHO to do much more to support alliance can be very powerful (as we developing countries in strengthening saw in the last WTO Ministerial meeting health systems as a part of national in Doha), where governments stated poverty reduction strategies% These that patent rights of pharmaceutical strategies should respond to peoples industry should not limit access to life needs% The proliferating Global Health saving drugs% But this has to be Initiatives should be aligned to these implemented and there is much more to national strategies, instead of the other be done, with a lot of way round% urgency% Finally we want our governments to be Ellen Verheul, Project coherent in their policies% We cannot Leader, Wemos Foun- allow our governments to support health dation, P.O. Box 1693, 1000 BR Amsterdam, for all objectives in the World Health The Netherlands. She Assembly and at the same time promote works on health policies liberalisation of the trade in health in relation to debt, structural adjustment services in negotiations under the World and PRSPs. Trade Organization% We do not want our Tel: +31-20-4.688.388 governments saying they promote E-mail: ellen.verheul@ universal access to health services on wemos.nl. the one hand and at the same time Web: www.wemos.nl. support World Bank strategies that promote commercialisation of health care and full cost charging to the patients%
WHOs task
We call upon our ministries of health We want our governments to be coherent in their policies and development to look beyond the health sector, and make sure that health
contact n°176 - January-March 2002 15 EXPERIENCE
PHM in STRUGGLE FOR TOMORROW Bangladesh gained momentum because of the Beyond 2000 the Global Secretariat, after the International Conference% A shorter but adverse situation of After the international conference in popular Bangla version was also globalization, December 2000, national level health prepared by PHM Bangladesh chapter% accentuated activists, civil societies, professional groups of different social strata, NGOs, National convention through trade unions, womens organizations, As a follow-up, the PHM Bangladesh privatizations, different community representatives of Circle conducted its Second National the country joined together in the health commercialization Convention where more than 500 campaign programmes from grassroot of health care representatives from civil societies, level to policy-making level% services in the policy makers, social forums, NGOs, midst of free The PHM Bangladesh Chapter, womens organizations, human rights conducted 15 committee meetings on institutes, health activists, trade unions, market economy different health agendas% journalists and campaigners partici- A#H#M# Nouman pated% The meeting held at Dhaka in In addition, the PHM Bangladesh May this year was attended by the Health elaborates Chapter, gained momentum to tackle Minister Dr Khandoker Mosharraf the determinants of the health ruins left Hossain along with other representatives by SAP and the globalization process, from the Ministry of Health% by responding vigorously to the most challenging national, political and social The Convention focused on two issues: spillovers% Globalization and Health (presented by Dr Dipak Kumar of Proshika) and The bottom-up approach; lessons from PRSP and Health (presented by B%K% unheard people based on their Adhikary of Development Organization understanding on health care of the Rural Poor (DORP))% The systems; and realization of convention concluded on the note that a the community in national committee with representatives designing the pro- from different communities and grammes of the professionals would be formed% movement were prior- itized through their Structurally, Bangladesh circles have a participation% Aware- different format% These include; ness building, people 1% Geographical circle: Division, to people contact at District, SubDistrict, Union, Village% community level, net- working of small social 2% Working Circle: PRSP & Health, forums at the grassroot Globalization & Health, Human level are some of the Rights, Womens Rights, Mental work done during last Health, Environment, ageing etc% few months% 3% Issue-based Circle: Issues like acid Further, the Peoples violence, pollution, child trafficking, Health Charter has river erosion, torture, road safety etc% been translated and Strategy printed in Bangla by It was decided that a two-way strategy would be adopted%
u The bottom-up at the community A mother and her sick level which included the health village child waiting for help at the community health and stakeholders, through their centre. involvement and participation%
16 contact n°176 - January-March 2002 FEATURE uStrong network- ing, advocacy and l Health is not a lob-bying at the top commodity to be level to bridge the dealt commer- gap in between the cially in the top-down and bot- hands of private tom up approach% sector PHM Bangladesh l Health Rights is advocates that human rights to primary health care be addressed by services should be governments as cheap, available, a constitutional and affordable% obligation They also insist that l Denial of health all activities should rights is denial to be transparent and development to be accountable to achieve this social goal% Action Plan u To disseminate message of health issues to the root level as much as possible Stephenie Hollyman/UNDP Stephenie
HEALTH CRISIS In Bangladesh the health and nutrition scenario is grim% Twenty-six percentage of the population have no access to basic health care facilities, 56% of children under 5 years are underweight and suffer from malnutrition% More than 94% of the children are victims of different grades of Protein-Energy-Malnutrition (PEM), about 70% of the children and women suffer from iron deficiency anemia, and 25% of the maternal death are associated with anemia and hemorrhage% About 30 to 40 thousand children go blind every year due to Vitamin-A deficiency% Bangladesh dietary average is 2000 calories as against FAO recommended intake of 2310 calories per day% About 57% of the population has no access to proper sanitation% Thirty-five million people are drinking tube well water with arsenic contents in 59 districts out of 64 districts in the country% Health crisis: governments in dilemma During the last decade, governments budgets for health care have been decreasing gradually% In addition, the available budget is also focused on donor-driven policies% Most of the governments health budgets go to city areas for salary and low quality infrastructure development, while the poor in the rural areas receive little% Very few hospitals and health care services were built during the last decade under government initiatives% Health care services are left in the hands of private sector beyond the capacity of common people% Thereby, commercialization of health services has been viewed according to ability to pay and not according to the peoples needs%
contact n°176 - January-March 2002 17 EXPERIENCE
Jana Swasthya Sabha A Pre Assembly mobilization process in India
The Peoples Health Assembly in Savar, Bangladesh, was preceded by a series of pre-assembly events all over the world% The most significant of these was the Jana Swasthya Sabha (National Health Assembly mobilization)% In India, from April to November 2000 at Kolkata, India, on 30th November and 1st December%
v Eighteen national networks came India These included: peoples health v At the Kolkata assembly, delegates together after 50 years of enquiries and audits; Kalajathas-health endorsed an Indian Peoples Health Independence as a significant symbol songs and popular theatre; policy Charter, apart from spending two days of national collectivity and solidarity dialogue; block-level seminars; together collectively sharing their These included all the key health translation of the consensus national commitment to the Health for All networks, the peoples science booklets into all the regional languages; campaign They participated in parallel movements, the womens campaigns to challenge medical workshops; sub conferences; movements, the environmental professionals to become more Health exhibitions; a march for Health; a movements and others for All oriented public rally; and cultural programmes celebrating national diversity and v These networks published five v This led up to 250 district cultural plurality booklets collectively on all the key conventions that covered represen- concerns in health These included: tatives from over 1000 community v Lastly, the Jana Swasthya Sabha What Globalization does to Peoples development blocks in the country and has now become the Jana Swasthya Health; Whatever happened to Health was followed by 17 state conventions Abhiyan (Peoples Health Movement For All by 2000 AD : Making Life in India) which is continuing its work at Worth Living (basic needs and v Then 2500 health activists and national and state levels mobilizing intersectoral issues); A World Where professionals boarded five peoples people for health campaigns on a We Matter (health care issues of trains to reach Kolkata for the National variety of issues including Health as a women, children and marginalized Assembly The trains did not just Right, Right to Food, Campaign sections of society); Confronting transport health activists but also against female foeticide, Violence Commercialization of Health Care became travelling workshops and against Women, Commercialisation opportunities to increase health of Medical Care and Irrational v A range of grassroot, local and awareness during the journey, at many Therapeutics regional initiatives took place all over stations, with slogans and songs
u To integrate more NGOs, civil u To evaluate sustainable process of societies, journalists, social and health care systems presently cultural organizations, trade unions, existing in the country tribal and ingenious populations, fisher folk community and other grass u Find possibilities of alternative health rooted social institutes policies in the rural and urban areas affordable to common population u To hear the experiences of unheard people of different communities and Conclusions professions living at different socio- PHM Bangladesh circle shall continue economic and social conditions% to implement programmes to achieve health rights, justice and social equality u Assess the degree of health care facilities available provided by through awareness programmes, governmental institutions and non- conducting workshops, mass governmental organizations at the mobilization, and campaign and remote area advocacy programmes in the days to come% u Assessing capacities and A.H.M. Nouman, Chairperson of PHMB, Bangladesh understanding of the people on health Chapter, is also Secretary General of Development Organization for the Rural Poor (DORP). Address: 44/ care problems living in severe 10, North Dhamondi West Panthapath, Dhaka 1205, economic hardship and poverty Bangladesh. E-mail: [email protected].
18 contact n°176 - January-March 2002 EXPERIENCE PROMOTING AND ENDORSING THE CHARTER THE ITALIAN EXPERIENCE
in the prison of Bologna% Since then it The PHM movement has grown as a feder- is picking up in ation of more than 60 tempo; small groups spread all over incidents are paving Italy% Each group has a democratic structure the way to bigger and nominates dele- events A report of gates to AIFO general activities from Italy assembly% The groups by Dr Sunil Deepak are organized in provincial and regional coordinations and involve thousands of persons including about 570 officials% AIFO supports health care projects dealing with leprosy, primary health care and disability% At the same time, in Italy the AIFO groups are involved in advocacy, awareness raising, teachers training courses etc%, on issues related to intercultural living, development educa- tion, emigration, etc% Wieteke Beernink Wieteke (For details log on to: Distribution of malaria medicines at a PHC www2aifo2it2) Activities related to PHA In the last twelve months, the whole Translation & printing of the Charter: PHM initiative in Italy has grown and In July 2001, the Charter was translated multiplied in different forms% More than in Italian and 1500 copies were printed% 6000 persons have signed the Charter An edited version of the Charter was and more signatures are pouring in% printed in AIFOs monthly magazine in Many new ideas about promotion of the Italian in September 2001% In December Charter are being developed% Part of 2001, AIFO used the Charter as the this success depends upon the way theme for its calendar for 2002% Since AIFO is organized through grassroot then, the Charter has been in many groups and local coordinations% About AIFO: AIFO (Amici di Raoul Follereau), inspired by the words of a French journalist Raoul Follereau started The whole initiative has grown and multiplied in different forms% in 1961, by three enthusiastic persons contact n°176 - January-March 2002 19 EXPERIENCE
other forums like as annex to the seen as part of the struggle in which magazine of Italian workers union, as a many other organizations and supplement with a monthly magazine movements are involved like, Cancel Vita in the Italian Journal of Paedia- the Debt campaign Anti-mine tricians etc% The Charter was also put on campaign, healthy cities campaign, the AIFO web page in both Italian and Anti-globalization forums, Essential English versions% Drugs campaign etc% Thus different organiza-tions like Doctors for People supporting the Charter in Italy: Environment & Italian Health Watch have Till the beginning of May 2002, there decided to include the Charter in their were already more than 6600 signatures activities% for support of the Charter including from some Parliamentarians, some well Organization of specific events: In known Italian personalities, many October 2001, AIFO organized an university professors, many organiza- international workshop on Poverty & tions including NGOs as well as many Development, during which the Charter Catholic congregations and institutes% was also presented% A large number of signatures were In November 2001, the biannual AIFO collected in January 2002, when AIFO National Conference was organized in carried out a massive information Assisi, which focused on PHA Charter% Dr Halfdan Mahler and Dr Mira Shiva were invited to speak% Future plans: It has been de- cided to create some thematic email discussion groups, which should come out with a final document ex- pressing their position about each theme% The themes include nutrition and health; military
Richard Hanson Richard budgets, wars and health; Backing the campaign: campaign in 250 city squares all over women and health; children and health; thousands lobby world leaders to the country, during which AIFO group cancel Third World Debt at the health and equity% For each thematic volunteers sold honey produced at a G8 summit group, a promoter will contact and cooperative of disabled persons and involve persons interested in joining the asked people to sign the Charter% thematic group% About 700 signatures have been On the World Health Day 7 April 2003, collected through individuals who saw it may be possible to launch a post card the Charter and wrote back to AIFO campaign about Give a day of war to saying that they wanted to support it% A peace and health, asking people to detailed analysis of different persons send post cards to government to ask signing the Charter is being carried out% that one days defence budget be Networking: The Charter has been committed to health needs of homeless
20 contact n°176 - January-March 2002 EXPERIENCE
people% It remains to be seen if similar campaign can also be carried out in other European countries or other coun- tries where PHA activities are present% AIFO has also presented a Development Education project related to PHA charter
to European Commission for funding% If WCC the idea of this project is approved, this would provide more funds for doing awareness-raising work with the Charter in Europe some of the ideas include printing the Charter in comic book form for school children, preparing an interactive CD-ROM on the Charter, organizing an international meeting on Charter in October 2003 etc% Finally a newsletter called Condivisione (Sharing) is being planned, to provide an instrument to different persons involved in this initiative in Italy to share their experiences and ideas% It is true that such initiatives are un- Other activities: A doctor in Sardinia coordinated but hopefully, these will island recently informed that she had lead to strengthening of the PHA already organized different meetings movement in Italy% with the local medical council on the Dr Sunil Deepak, Medical Advisor, AIFO, Italy. Address: AIFO, Via Borselli 4 640135 Bologna, Italy Email: Charter% [email protected] Another group in Naples involved in the thematic group on Health and Nutrition, have invented a boardgame called A world where health is a non-negotiable human right Nutritionometer, which should introduce which is in the hands of people% And the needs of the the concepts of healthy eating in school least in the community must form the priority% The children% The city council of Naples has movement sees the strength and health of the agreed to cover the costs for distribution community as that of the poorest and weakest member% of this teaching game to 350 classes of Community can only be strong and healthy when the school children% With each game, each poorest and weakest is strong and health% This is for class will also receive a copy of the me, the aim of PHM% Charter% Eva Ombaka, EPN
Dr Mira Shiva addressing the conference Community Health Cell
contact n°176 - January-March 2002 21 EXPERIENCE LESSONS LEARNED - A CASE STUDY THE AROGYA IYAKKAM INITIATIVE
local health activists% These voluntary This is the synospsis of a community initiative to improve health activists were trained together, child health and nutrition in Tamil Nadu, India which was and more intensively in the field, in one of the case studies at the Peoples Health Assembly talking to mothers about nutrition and diseases, and to pregnant women about in India Balaji and Kalpana outline the key aspects nutrition, delivery, breast-feeding and other health matters% The VHCs also met to read and discuss health books, and helped the health activist to promote Background nutrition and health education% This programme was started in May The main strategies used to address 1999, and is being implemented in child health are: roughly 500 villages in 10 blocks in At the family level Tamil Nadu, India% Supported by l Identify children at risk by weighing UNICEF, the each child programme is l Constantly follow up each child executed by at risk and assist families to the NGO prevent malnutrition or reverse it - Tamil by appropriate health education Nadu and better use of existing health Science services Forum% At the community level The pro- l Strengthen Primary Health gramme Care and Tamil Nadu has three Integrated Nutrition Pro- main aims: gramme (TINP) services through advocacy l Improve the use of l Make child mal- primary nutrition the most health care important index of services; health for local plan- ning, and sen- Improve l sitize pan- childrens chayat mem- health and bers about its nutritional significance% status; and The activists Organise l were given and em- intensive train- power ing in child women Jean-Luc Ray health and around their nutrition to: health needs% analyse the combination of factors that The programme organised village health led to particular cases of malnutrition; committees (VHCs), which selected identify those factors that can be
22 contact n°176 - January-March 2002 EXPERIENCE addressed individually and socially; mother will invariably say she has fed discuss with the family about the childs the baby with colostrum and the baby is risk factors and the importance of healthy; this can be used as proof of addressing those factors; and reinforce concept to convince others% This kind the initial message by repeated visits at of negotiation with a larger group also the family level as well as through cultural requires skill, and often the block-level programmes and village-level meetings% trainers help the activist to conduct such discussions% Programme principles Preliminary results on child malnutrition: The interaction between the health As part of programme activities, children activist and the mother is central to the aged under five were weighed at the programme, and is based on principles beginning of the programme and again derived from experience: roughly 1%5 years later (in October- Respect: The mother and pregnant December 2000)% Of 7133 children woman are seen as intelligent people weighed during both periods, the coping with difficult conditions, and not percentage of children with a normal as ignorant people who will not listen to weight increased from 34%5% to 45%8%% sensible advice% The percentage of grade 1 children Understanding: The focus is therefore, increased by 1%3 percentage points, on understanding why a mother does while the percentage of children in not follow advice, rather than blaming grades 2-4 decreased by 12%6 points% her for not doing so% She already has a If one compares each childs status at world-view, formed by her own both times of measurement, one finds experiences and what she has learned that 34%9% of children improved their from her community% That world-view category, while 13%5% deteriorated; the guides her health practices for herself remainder stayed in the same category% and her child% The advice she is given by That is, there was a net categorical the programme often differs from her improvement among 21%4% of the own information; to succeed, one must children% integrate this advice with her world- These results understate the view, by discussing in detail why it makes programmes impact, in that the sense and how it can be adopted within nutritional status of a under-fives is not the limits of her resources% static in the absence of positive Skilled and patient negotiation: This kind interventions in their favour% Rather, one of dialogue is difficult, time-consuming expects their nutritional status to worsen% and requires considerable skill and In areas of the State where the confidence on the part of the person programme is not being implemented, giving the advice% Training the activist in one finds that the overall nutritional status dialogue takes time; she must learn not of children aged under five deteriorates only to advise, but to counter arguments over a 1%5- year-time period; indeed this and elaborate ways in which advice can pattern is commonly found throughout be adopted in a resource-poor setting% India% The activist needs support from a group Organisational insights of trainers who visit her regularly, provide her work with legitimacy and constantly Explanations for these positive results encourage and provide her with further can be found in the actions of the health training% Peer discussion and reinforcement: One-to-one sessions between the activist and mother are complemented Interaction between the health activist and the mother is central by group meetings called by the activist to the programme to discuss specific issues (e%g% feeding the colostrum)% In such a meeting, a contact n°176 - January-March 2002 23 EXPERIENCE
activist, the programmes design and is primarily responsible for operations place great emphasis on administrative tasks; the activist is motivating her and making her effective: asked to maintain only one page When measuring the activists work, from which all relevant data are she is not blamed for children who are gathered% malnourished or in poor health% The While the preliminary results will need to emphasis is rather on measuring her be independently verified, they suggest work, i%e% talking to mothers and pregnant that this programme might provide a women% If health condition of children viable model to reduce child malnutrition% have worsened, the reasons are sought More time will be required to determine in her training or in programme design% how long it takes to raise a communitys Sometimes there are underlying factors capacity sufficiently to address beyond her control, such as diarrhoea malnutrition without ongoing support epidemics% from an NGO; and to determine the cost Some tips of this model% There are three further considerations l The activist is always praised in front of the mothers% To boost her respect relating to sustainability and replicability% in the village and her self-confidence, First, the model requires supportive village meetings are organised in primary health care and nutritional which she is honoured and called to services, which have traditionally been talk to the village community% These provided by the State% These services mea-sures gain her respect need to be reinforced% Second, this local-ly and moti-vate her model is predicated upon intensive to work harder% outreach counselling and personal relations% l An egali- tarian and While resource constraints play a role in intensive re- malnutrition, much of child malnutrition lationship can be explained by behaviours% Poor between the feeding practices are common, and the trainers, and in-home management of illness can be the activists much improved% is important% These problems can only be addressed Thethrough a dialogue that intensively and motivation of repeatedly seeks to ensure that the these trainers, and right behaviour has been understood their willingness to meet with mothers, and is being practised% There does not often over a period of days, are crucial appear to be a shortcut or substitute for to providing the activist with a good this approach% example as well as the skills she Third, the communitys involvement is needs% important: it provides support to the l The activists voluntary status is activist and examples of positive important to their motivation% The behaviour for others% activists and the village understand Balaji and Kalpana are Health Activists involved with that the work is done for the sake of the Tamilnadu Science Forum and the Peoples Health improving childrens nutrition% Movement in Tamilnadu and India. E-mail:[email protected]
l To ensure that the focus of the activist is on actually meeting mothers and pregnant women, administrative tasks such as report writing and maintaining records are kept to a minimum% The trainer is responsible for monitoring the programme, and
24 contact n°176 - January-March 2002 UPDATE TRADE FOR PEOPLE, NOT PEOPLE FOR TRADE
The right to food, health, education, injustice, spearheaded work and an adequate standard of by trade rules that are living are part of the internationally not fair and dont put recognized framework of human people first, are rights standards% That makes them brutally ripping the a legal obligation rather than just a global community policy option% A global campaign apart% launched in December by the Why churches? Geneva-basedEcumenical Advocacy Alliance (EAA) argues In answer to the that the universality of these question Why are the obligations fundamentally challen- churches taking up the ges notions of competition and issue of trade? Prof% efficiency, which accept that in the Dr Christoph Stückel- global marketplace, some people berger of the EAAs recognize the right to food, ensure and communities may lose these trade strategy group told journalists sustainable agriculture, promote basic entitlements% that it is because the biblical standards for economics, including greater self-reliance in developing Launched in Geneva, Switzerland the trade of goods and services, countries, guarantee access for all on World Human Rights Day, the are justice and taking the side of the to essential services, and allow for three-year campaign wants to poor% regulation of transnational cor- ensure that international human porations% Its action plan covers: rights, social and environmental This vision, said Stückelberger, mass mobilization, including use of agreements take precedence over should not be reduced to mere a global petition; local advocacy trade agreements and policies% Or, equality of opportunity for all to initiatives; and lobbying with as its slogan says that trade is for compete without hindrance% That international institutions by experts people, not people for trade% has only helped those who already from North and South% have access to political and The EAA is a global network of economic power to gain more power Each participating church and more than 85 churches, develop- and a greater share of the worlds organization will take up the ment agencies, and related resources, and to create power common campaign agenda in its organizations on all continents, elites that suppress others% own context with its own including the World YWCA, the government, as well as working The campaign acknowledges that World Council of Churches, Bread together to impact international trade is a basic social activity, and for the World, and many others% It institutions% that it can contribute to the common represents a constituency of good% But it argues that trade on This plan has been shared with hundreds of millions of people% As unequal terms is damaging, creates both World Trade Organization institutions, and as members of civil and maintains inequities, and can (WTO) director general Supachai society, we believe we have both lead to violence, conflict and Panitchpakdi and UN high the obligation and the power to environmental destruction% It holds commissioner for Human Rights speak for justice and change the that trade should be a means to Sergio Vieira de Mello, and both rules of global trade, considers share the bounty of the earth and have agreed to meet with the EAA% EAA board member Dr Musimbi the fruits of human labour, yet too It has also been sent to all Kanyoro% often is a force that causes poverty, governmental representatives and Speaking at a press briefing on the despair, injustice and death% observers to the WTO, and to all campaign, Kanyoro, secretary ambassadors to Switzerland% Campaign plan general of the World Young The plan of action and the petition Womens Christian Association The campaign will advocate for are available on the EAA website at (YWCA), argued that economic trade rules and policies that http://www%e-alliance%ch/trade%html%
contact n°176 - January-March 2002 25 BIBLE STUDY
THE COURAGE TO CHANGE
Christ calls us to walk a new path, and we cant always see where it leads Yes, its risky, and it can be frightening Living openly calls for both courage and discernment, to risk mistakes and misunderstandings
It scares me, Lord, where would I be? the thought of so much change% My only hope is in the change At times, Im petrified, youve worked in me% a hunted creature, Are working% crouched mute in long grass, Renewing me each day, the only sound the pulse beat in my head% and, hopefully, And when I get the chance moulding that quiet transformation I run for cover, which makes me, slowly, hoping I wont be noticed% more like you% Praying that change may pass by I welcome that% silently on hawks wings, At least, I do in my best moments% its shadow sliding softly out of I see the need, vision% and though I sometimes feel the pain, And leaving me to breathe the outcomes sure% again% Lord, help me find the courage to Life just as it was% adventure, Uninterrupted, undisturbed% the willingness to take the risks It doesnt work that way% that living for you brings% Your world, my world, And let me know the joy so solid to the touch, of walking close to you, is constant change% my ever-changing, Growth, and renewal% yet unchanging Lord% And if it werent, by Eddie Askew
26 contact n°176 - January-March 2002 NETWORKING
PEOPLES HEALTH MOVEMENT: PUBLICATIONS
Health in the Era of Globalization from and covers the political economy of the PHA Secretariat, Victims to Protagonists by PHA Drafting assault on health; equity and inequity today; Gonoshasthaya Group 2000# medicalization of health, the environmental Kendra, Savar, This booklet has an overview of the PHA and crisis; communication as if people mattered# Dhaka 1344 its view on world health# It specifically focuses Bangladesh# on factors affecting health and challenges Voices Of the Unheard Testimonies the inequitable and unhealthy global model from Peoples Health Assembly by PHM of development# 2000# This booklet shares peoples testimonies Peoples Health Assembly - Discussion from Tanzania, Ecuador, UK, Bangladesh, Papers: prepared by PHA drafting group# New Zealand, India, Palay, Australia, Brazil, This booklet includes five key discussion Zimbabwe and Guatemala that were papers by PHA Activists for the PHA 2000 presented at the Peoples Health Assembly, GK Savar, December 2000#
What Globalization does to Peoples This third booklet in the series focuses on For PHM Booklets - India Health A peoples health assembly booklet meeting the basic needs for all and the inter- (1) by PHA National Coordination Committee sectoral issues in health care including civic Tamil Nadu Science Forum Jan Swasthya Sabha, India, 2000# basic amenities like water, sanitation and Chennai, Tamil Nadu, India (kb@eth*net) and This booklet is part of a 5 booklet series has housing, basic education and livelihoods and securing peoples livelihoods# Community Health Cell, been brought out by the PHM India Movement Bangalore, India for guiding district and state seminars# It (sochara@vsnl*com)* focuses briefly on understanding what A World Where We Matter A peoples Globalization is all about and how it affects Health Assembly booklet (4) by PHA National the health of the poor# Coordination Committee, Jan Swasthya Sabha, India, 2000# Whatever Happened to Health for All by This fourth booklet of the series looks at 2000 AD? A peoples health assembly health issues of women, children and the booklet (2) by PHA National Coordination marginalised sections of society including Committee Jan Swasthya Sabha, India, street children, differently abled and the 2000# uncared aged# For more information, contact: This booklet briefly dwells on an understanding of primary health care and Confronting Commercialization of Health Dr Qasem Chowdhury the making and the unmaking of the Alma Care! A Peoples Health Assembly booklet Coordinator, (out going) Ata Declaration# It focuses on the war against (5) by PHA National Coordination Committee, PHM Secretariat malaria and tuberculosis as case studies of Jan Swasthya Sabha, India, 2000# Gonoshasthya Kendra P O Mirzanagar distortions from the primary health care This booklet contains a brief introduction to module# Via Savar Cantonment the ethical and professional dimensions and Dhaka 1344 quality of care implications of the growing Bangladesh Making Life Worth Living! A peoples health thrust to privatize all health care services# It assembly booklet (3) by PHA National has special focus on rational medical care Email: Coordination Committee, Jan Swasthya and medical ethics# gksavar@citechco*net Sabha, India, 2000# Dr Ravi Narayan Coordinator (incoming) PHM Community Health Cell, 367, Srinivasa Nilaya Websites: www#phamovement#org# Also Peoples Health Watch section of Jakkasandra 1st Main www#sochara#com Koramangala 1st Block contact: pha-exchange@kabissa#org OR aviva@netnam#vn Bangalore 560 034 Karnataka, India Email: sochara@vsnl*com contact n°176 - January-March 2002 27 NETWORKING ANNOUNCEMENTS Want to stay in contact with the Peoples Health Movement? We certainly would be very glad you did% Do two things: Sponsors 1% Periodically visit PHMs website and see whats new www2phmovement2org This edition is 22 Join our active listserver and receive informative emails 3-4 times a week and sponsored by the post your OWN news and comments to share with 600 others in the list2 Lutheran World Relief, America, Health Link, Write directly to pha-exchange@kabissa%org and ask to join, OR write to the lists Medical Mission moderator at aviva@netnam%vn asking for the same% If you do both things, we still Sisters and Hesperian ask you to share hard copies of the materials you find of interest with those Foundation* organizations and individuals who do not have access to the internet and email services% JOIN THE NETWORK% STAY ABREAST% MAKE A DIFFERENCE% DIVIDED WE BEG; UNITED WE DEMAND! Claudio
New version of Peoples Announcing the relaunch of the Peoples Health Movement website% Please visit Health Movement website the site at www%phmovement%org and encourage others to also visit the site% launched Among the new features are: * the full text of Voices of the Unheard - the testimonies of the people from the PHA *copies of the Charter in several languages (and more are being added) *access to all of the background papers and issue papers from the PHA We would also like to ask any people on the PHA-Exchange list who are interested in and have experience of working on communication, media and website activities to join the PHM Communications Working Circle% Again, simply send us an e-mail to: communications@phmovement%org LETTERS Dear Editor, We have read Contact 175 with great interest, especially the article of Breakfast to Break Barriers from Mr Leonardeo Villegas Zamorano, who describes his therapeutic community for drug addicts* We are involved in rehabilitating alcoholics and home brewers at community level, by prayer, counselling and organization of self-help groups who develop small scale income generating projects* M*W* Tarus, Secretary, Kenya Anti Alcohol Programme
Contact deals with various aspects of the churches and communitys involvement in health, and seeks to report topical, innovative and courageous approaches to the promotion of health and healing
Contact, magazine of the World Articles may be freely reproduced, Manoj Kurian, Miriam Reidy-Prost, Christian Medical Association Council of Churches is published providing that acknowledgement is Jenny Roske* Editor: Reena of India, 2, A-3 Local Shopping quarterly in English, French, made to: Contact, the publication of Mathai-Luke; Design: Indira Mark; Centre, Janakpuri, New Delhi Spanish and Portuguese by a the World Council of Churches* A Mailing List: Indira Mark* Printed 110 058, India* Tel: 91 11 2559 partnership of the World Council complete list of back issues is by Impulsive Creations* 9991/2/3, 2552 1502* Fax: 91 of Churches (WCC); Christian published in the first annual issue of 11 2559 8150* E-mail: The average cost of producing Medical Association of India each language version* subscribe@ cmai*org and mailing each copy of Contact (CMAI); German Institute for is US $2*50, which totals US $10 Medical Mission in Tübingen Editorial Committee: Christoph Contact is also available on the for four issues* Readers who can (DIFÄM), and Medical Benn, Christina de Vries, Elizabeth World Council of Churches afford it are strongly encouraged Coordination Secretariat of the Moran, Patricia Nickson, Sonia website: http://www*wcc-coe* to subscribe to Contact to cover Netherlands (MCS)* Present Covarrubias and Reena Mathai- org/wcc/news*contact*html these costs* circulation is approximately Luke* For this issue, we 15,000* acknowledge the contribution of
28 contact n°176 - January-March 2002 contact n°176 - January-March 2002 29