While the official Rio+20 outcome from June 2012 was a disappointment, a smaller side event saw the initiation of a host of Peoples’ Sustainability Treaties, dealing with a range of issues and actions, starting from the very local, going all the way up to the global level. Peoples’ Sustainability Treaties are aimed at coalescing the thinking of civil society organisations in the direction of a strong social movement towards an alternative and desirable future. A network of Treaties is being created, with each Treaty being driven by a collaboration of partners, and with all the Treaty circles being linked together through a loose coalition structure. By the time Rio+20 commenced, 14 Treaties were already established and from these a common Manifesto emerged, which contained an action plan identifying the issues of equity and sustainability for all as the foundation of any collective global response. Localising our economic systems, decentralising governance, and advancing sustainable lifestyles and livelihoods are promoted in the Manifesto. Localism was a major theme emerging from stakeholders, linked to the principles of devolution and decentralisation, and they argued in favour of turning localism into a world-wide movement.
Governance and participation in health
This brief provides a summary of the events from mid June until mid July at the Peoples Health Assembly in Cape Town.
More than one thousand activists, academics and students from over 60 different countries gathered at the historic University of Western Cape for the third global assembly (PHA3). Walter Flores Gutaemala provided his insights on the Assembly in this opnion piece. He noted that the best plenary took place on the last day. Prof. Jaime Breilh from Ecuador gave a devastating account of how current public health programs and goals, such as the ones addressing nutrition and food security, are lagging so far behind of the ongoing acceleration of accumulation of capital that is destroying and contaminating water and food sources around the world. Large-scale land grabbing in the southern continents by large corporations is making the goal of food sovereignty implausible. The assembly concluded with a call for action that did not satisfy all participants. Clearly, some people wanted more concrete actions and less rhetoric. He comments that although a “call for action” is important, it does not mobilize people on its own, and notes that a clear goal and a path for action, combined with collective indignity and solidarity makes us move.
With evolving South African legislation supporting community involvement in the health system, early policy developments focused on Community Health Committees (HCs) as the principal institutions of community participation. Formally recognized in the National Health Act, the Act deferred to provincial governments in establishing the specific roles and functions of HCs. As a result, stakeholders developed a Draft Policy Framework for Community Participation in Health (Draft Policy) to formalize participatory institutions in the Western Cape province. With the Draft Policy as a frame of analysis, the researchers conducted documentary policy analysis and semi-structured interviews on the evolution of community participation policy. Moving beyond the specific and unique circumstances of the Western Cape, this study analyzes generalizable themes for community participation in the health system. Framing institutions for the establishment, appointment, and functioning of community participation, the Draft Policy proposed a formal network of communication – from local HCs to the health system. However, this participation structure has struggled to establish itself and function effectively as a result of limitations in community representation, administrative support, capacity building, and policy commitment. Without legislative support for community participation, the enactment of superseding legislation is likely to bring an end to HC structures in the Western Cape. The authors conclude that attempts to realize community participation have not adequately addressed the underlying factors crucial to promoting effective participation, with policy reforms necessary: to codify clearly defined roles and functions of community representation, to outline how communities engage with government through effective and accountable channels for participation, and to ensure extensive training and capacity building of community representatives. Given the public health importance of structured and effective policies for community participation, and the normative importance of participation in realizing a rights-based approach to health, this analysis informs researchers on the challenges to institutionalizing participation in health systems policy and provides practitioners with a research base to frame future policy reforms.
After two years of participatory engagement and planning, the People’s Health Movement gathered 800 people from 90 countries for the 3rd People’s Health Assembly. The Assembly strengthened and deepened solidarity; expressed outrage at the continuing global health crises that are embedded in myriad structural and socio-political inequities; developed principles for alternative economic, political and social orders; and re-committed delegates to work towards the world envisioned by the movement. The Assembly reaffirmed commitment to the People’s Charter for Health and the Cuenca Declaration which are the foundational documents to the Call to Action drafted at the Assembly reported here. The Call to Action guides the movements work until the fourth People’s Health Assembly is held.
PlusNews reports that at least a hundred protesters arrived at South Africa's parliament on 11 July 2012 to demonstrate their disapproval of the ongoing court case by Swiss pharmaceutical company Novartis against the Indian government over its patent laws. As the case draws to a close, health organizations say a win for the pharmaceutical company will be a loss to the developing world, which sources the bulk of its generic medicines from India. Novartis approached the Indian government six years ago, seeking to register a cancer drug already commonly marketed under the name Gleevec. The patent was denied and a long-running court battle ensued, but at each step Indian courts have ruled against Novartis and the company has appealed. India has laws against “evergreening”, a term used to describe instances where drug companies maintain artificially high prices on medicines for longer by continually extending patent protection for minor modifications to existing drugs. India's Supreme Court is expected to hand down the judgment that will draw the legal saga to a close on 22 August. This could not only limit the country's ability to produce generics, but also set a precedent in other countries - like South Africa - looking to revamp patent laws.
Studies in rural and urban development since the 1970s have found high correlations between project performance and levels of community participation in many Third world countries. Relevant examples of such
correlation include the agricultural extension services in Kenya, the control of infectious diseases in Israel and the rural water supply and irrigation projects in Asia Region. This paper examines the major
limitations in participatory health development in Nigeria. The author finds that even though most of the assertions in literature about the health behaviour of the rural dwellers in community-based health programmes are upheld, there are exceptions. For example the
health behaviour of people in traditional societies is found to always be an economic rational one. This is in contradistinction to the view in most literature that posits that the health behaviour of the traditional people is almost always determined by socio-cultural and magico-religious considerations.
Brief nine of the National Reconciliation and Transitional Justice Audit reveals perspectives on issues of conflict, peace and justice by the community in Nakapiripirit in Karamoja, in the north-east of Uganda. The major concern of the participants in Nakapiripirit was the strained relationship between themselves as citizens in Karamoja and the state. According to them, the relationship has been characterized by mutual distrust right from colonial times up to now, coupled with deliberate marginalization and an attempt to take away the Karimojong's way of life. They lamented that the rest of Uganda looks at Karamoja as a region apart and says that 'we shall not wait for Karamoja to develop'. In their view, conflicts in Uganda are a reflection of bad governance practices, such as corruption, unfree and unfair elections, lack of term limits, and an absence of border security. This inspires anger towards the Government and provokes rebellion. Impacts of conflicts include more strained relationships between citizens and the state, and delayed development. In that sense, causes and impacts of conflict constitute a vicious cycle.
In Tanzania, the policy of decentralisation and the health sector reform have placed an emphasis on community participation in making decisions in health care. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. study was carried out in the Mbarali District of Tanzania. A qualitative study design was used, with in-depth interviews and focus group discussions conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate differences in influence on health care decision-making processes in terms of gender, wealth, ethnicity and education, as men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. The authors conclude that these inequalities in decision making in health care need to be addressed if greater participation is desired. There must be an emphasis on the right of all individuals to participate in decision-making processes, and role players should ensure that information, training and education is fairly distributed so individuals can participate fully in informed decision making.
In this statement, issued before the United Nations Conference on Sustainable Development (Rio+20), held in Brazil from 20-22 June 2012, CIVICUS affirms that the Zero Draft outcome document for Rio+20 must advance a rights-based approach to sustainable development that reaffirms past political commitments, and in particular, the need to protect civil society space, ensure maximum public participation and advance democratic freedoms, by establishing legally binding commitments which support the three dimensions of sustainable development: social justice, environmental sustainability and economic development. CIVICUS argues that the reason why global governance is failing so badly is partly because we have multinationals whose operations are now global beyond the national jurisdiction of any one government to regulate, police or manage. States have reneged on the democratic values they committed themselves to uphold, and governments have become less accountable to the people. Universal norms and standards are being ignored or sidestepped by new rules that favour markets. To achieve and maintain sustainable development, CIVICUS urges UN member states to commit to improve continuously the implementation and enforcement of environmental policies and legislation, with no regression on environmental protection. Commitments to the principle of non-regression at all levels should be a major objective of Rio+20.