This article, based upon seven years of research and some 70 interviews with Cuban medical personnel, both in Cuba and abroad, seeks to provide a broad overview of the importance of Cuban medical internationalism. The article reviews several, different, programmes of medical cooperation in terms of basic data on their evolution and impact, and analysis of the rationale for their development. As of April 2012 there were 38,868 Cuban medical professionals working in 66 countries–of whom 15,407 were doctors (approximately 20% of Cuba’s 75,000 physicians). In Africa some 3,000 Cuban medical personnel are currently working in 35 of the continent’s 54 countries, while in Venezuela alone there are approximately 30,000. But that is only part of the story, since there are many other significant facets to Cuban medical internationalism. In all cases the author suggests that 'human capital' is the most important common denominator. For over fifty years Cuban medical personnel have served the poorest and most neglected areas of the world, going where other doctors refused to go.
Governance and participation in health
This collection of essays looks at the post-2015 development agenda. In it, researchers and activists argue that the process undertaken to shape the new development agenda must be organised around seven priorities. 1. Integrating community experiences, expectations and insights at the heart of the process. 2. Widespread dialogue to capture and consolidate expectations of civil society organisations (CSOs) with regard to the second round of development goals. 3. Supporting and including evidence from research and analysis by institutions and experts located in the global south 4. consultations held with community groups, CSOs and academicians and engagement with the relevant policy makers. 5. Meaningful engagement by regional blocs like the African Union and trade forums such as BRICS and the G20. 6. Reaching out to young people and urban populations, and 7. Monitoring and enforcing corporate accountability.
This book captures the experiences and voices of over 6,000 people who have received international assistance, observed the effects of aid efforts or been involved in providing aid. More than 125 international and local aid organisations in 20 aid-recipient countries were interviewed about their experiences with, and judgments of, international assistance. The researchers also spoke with people who represented broad cross-sections of their societies, ranging from fishermen on the beach to government ministers with experience in bilateral aid negotiations. The voices reported here convey four basic messages: first, international aid is a good thing that is appreciated; second, assistance as it is now provided is not achieving its intent; third, fundamental changes must be made in how aid is provided if it is to become an effective tool in support of positive economic, social, and political change; and fourth, these fundamental changes are both possible and doable. What people want is an international assistance system that integrates the resources and experiences of outsiders with the assets and capacities of insiders to develop contextually appropriate strategies for pursuing positive change. The idea of international assistance needs to be redefined away from a system for delivering things and reinvented to support collaborative planning.
Social movements have been successful in beating back the tide of water privatisation that swept the world in the 1990s, forcing the retreat of water multinational companies in the poorest countries of the global South. With global temperatures rising, unions in the energy sector can learn from these struggles – many of which were worker-led – to give rise to a strong counter-movement for energy democracy. While the political economy of the energy and water sectors are different, the author argues that we can build on water justice victories and draw lessons on how to frame demands for local control over the commons. Further lessons learned include the importance of building broad coalitions with unlikely allies; and practising internal democracy in social movements. While there have been significant victories in the water sector, the author argues that community-based struggles on energy have a long way to go. The struggle for energy democracy is argued to require movements to “resist, reclaim and restructure” communities to draw on locally sourced, decentralised, alternative energy resources.
This blog reports on the Third People’s Health Assembly (PHA) held in Cape Town, South Africa, in July 2012. Participants reported on the extraordinary gains in human development occurring in Thailand and Brazil, where millions of people are moving out of poverty and for the first time accessing health care and social support, as well as the impotence of global leadership to effectively deal with climate change, and massive land grabs. Key strategies agreed on at the PHA were supporting countries to act on the PHM’s Right to Health Campaign; a global campaign on the adverse health and environmental effects of extractive industries; a food security campaign focusing on the health consequences of the growth of transnational food corporations, and a campaign against the privatisation of health services, which will document the ways in which public ownership and control of health services is being undermined by various forms of public private partnerships and by the outsourcing of previously publicly provided services.
In this article, the author evaluates developments in the field of community participation in health, arguing that in many national experiences, the distinction between the different forms of participation remains blurry. In particular, there is little distinction between community participation as a way to devolve services to community members and community participation as the community (co-)management of health centres. This confusion in part reflects two decades of debate on participation as either an end in itself or as a means for other purposes. Although free care and performance-based financing are two of the most popular health policies currently being developed in Africa, they have implications for participation. Performance-based financing strategies raise a need to ensure that the voice of the people continues to be heard when financial incentives drive the system. Free health care on a large scale also poses new challenges because, with the removal of user fees, the financial interest community members have in the health centre management disappears. Research about community participation has evolved in the last 25 years, with new methods for quantitative approaches mixed with qualitative insights, contrasting with the ethnographic and sociological approaches used in the past.
In this interview with Susan Rifkin of the London School of Economics and London School of Hygiene & Tropical Medicine, she talks about the past and future of community participation and community participation research. Community participation, she argues, cannot be limited to an intervention; the next big challenge of research will be to understand the processes that tie community participation and health outcomes. She points to a growing recognition by policy makers that community participation is critical and necessary but not sufficient for improvement of the health of the populations. As communities become aware of their rights and their obligations, they become in a much better position to negotiate policy and the provision of services with policy-makers, she argues. At this moment most research views community participation as an intervention and therefore uses a natural scientific paradigm to look at it linearly as a causal effect. This approach is inductive and very narrow; direct causes have effects. Instead, Rifkin calls for a closer investigation of processes and how community monitoring leads to better health outcomes. The other question about the research in this area is how we address issues around power and control, key to community ownership of health programmes.
In this Call to Action, the People’s Health Movement (PHM) argues that the underlying cause of health inequities are the neoliberal economic policies that are the hallmark of present day capitalism. PHM says the global health crisis is a consequence of the failure to address the social, political and environmental determinants of health. Ironically, the response of national and international institutions to the current financial crisis has been merely to restore the confidence’ of the same institutions and financial markets that caused the crisis in the first place. Governments have meanwhile enacted an austerity agenda by cutting health and social spending, effectively deepening and reinforcing inequities between rich and poor. PHM puts forward an alternative vision in which a reformed economic system values individuals over capital, with just, fair and democratic political and economic processes and institutions, and better and transformed global heath governance that is free from corporate influence and the influence of unaccountable private actors. It calls for equitable public health systems that are universal, integrated and comprehensive, and also provide a platform for appropriate action on social determination of health.
Since the Global Fund to Fight AIDS, Tuberculosis and Malaria announced its new model for allocating funds in September 2012, African civil society organisations have stated that they were not included in the process, arguing that consultations were held behind closed doors and that most non-governmental organisations (NGOs) on the continent are unaware that a new model exists. The Rights Alliance of Southern Africa (ARASA), the South Africa-based World AIDS Campaign and almost 40 African non-governmental organisations (NGOs) have called for the Fund to develop a more robust and inclusive communication and consultation process around the model's development, which is ongoing.
In this open letter to the World Bank, a group of 110 international civil society organisations (CSOs) call on the Bank to play a truly progressive and transformative role in health by supporting countries to achieve universal health coverage (UHC). The World Bank is well-placed to be a vocal champion of UHC by deploying its knowledge and experience in health system reform, as well as its financial support. However, the Bank must reform the approach of its programmes and policy advice in order to deliver on this potential, and ensure it positively impacts poor and vulnerable populations. The CSOs call on the Bank to actively support countries to offer care that is free at the point-of-use for all people, as well as scale up investment in public health systems in developing countries, by supporting them to expand public financing, and by offering balanced policy advice that does not privilege private sector solutions over publicly financed and delivered health systems. The Bank can take further steps to promote UHC by ensuring all Bank programs benefit the poorest two quintiles in the countries where it works, actively supporting involvement of civil society in national health policy development, in order to improve democratic oversight and accountability for improved health outcomes, and collaborating with the World Health Organization and other global health institutions in the push for UHC.