Governance and participation in health

"As supporters of women's rights worldwide, we are deeply disturbed by the statement made by a US delegate at the recent Preparatory Meeting for the forthcoming Fifth Asian and Pacific Population Conference that will take place 11-17 December 2002 in Bangkok. The US has threatened to withdraw from the Cairo Programme of Action of 1994 unless the words reproductive health services and reproductive rights are taken out or changed. This is a shocking development which is a threat to women's rights and women's health world wide. We demand that the Cairo Program of Action that has been endorsed by 179 nations be upheld. Reproductive health services and reproductive rights are essential human rights. Reproductive rights and reproductive health services are integral to the Cairo Program of Action. If the US breaks their commitment to the United Nations and to the world community, there will be disastrous consequences for women in all parts of the world who are in need of safe and effective contraceptive and abortion information and services. The position that the Bush administration has taken sets back the efforts of women's organisations by several decades and needs to be resisted. We urge you to make your own statement of protest and send it to the US administration, to the UN and to sign our petition on line at: http://www.PetitionOnline.com/USantiWO/petition.html."

Urban services specialists are coming to realise that sustainability of infrastructure interventions depends on community engagement in operation and maintenance (O&M). But what progress has been made in getting urban communities involved in the planning, construction, repair and maintenance of water supply and sewerage systems? Are projects demand-driven and are communities willing to pay to look after them?

We representatives of diverse civil society groups gathered in Johannesburg, affirm the value of the process of the Earth Summit, but we disassociate ourselves with deep concern from the outcomes of the world summit on Sustainable Development. We are alarmed that the governments of the world continue to show a tragic unwillingness to translate the RIO principles into concrete action and to display an appalling lack of determination to commit themselves to the objectives of Agenda 21. Instead they have shown an irresponsible subservience to corporate led globalisations and have made attempts to role back the commitments they reached in Rio.

I Rusike, R Loewenson, CWGH, TARSC.
Equity in health is a long stated policy goal in Southern Africa, and some significant advances were made often through joint and complimentary action between the public health sector and communities. However, the health and health care gap between communities is still wide or widening, with differences based on gender, geographical area, income, access to public or private services, education and other factors. More recently,the combined impact of AIDS, structural adjustment, and real reductions in the health budget and in household incomes, has reversed many health gains. The quality of health care has declined and health workers and their clients have become demoralised. While these issues demand technical responses, reversing inequities depends in the main on social and political factors. This goes beyond the fact that social networking is important for service outreach and health seeking behaviour, and that social exclusion as a dimension of deprivation or poverty affects health outcomes. What we argue is that unless people affected by ill health have greater control over the resources needed for health care or to be healthy, equity goals will remain a dream. Equity without this socio-political dimension is not equity.